Background to this inspection
Updated
9 January 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe, and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.
This inspection took place on 2 December 2020 and was announced.
Updated
9 January 2021
Chyvarhas is a ‘care home’ that provides accommodation for a maximum of 36 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 29 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Chyvarhas is situated in the town of Callington. It is a purpose built single storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Callington with links to public transport. There is a main lounge/dining area with three ‘wings’ where peoples bedrooms are located. In the foyer there is a fourth ‘wing’ where peoples bedrooms are also situated. All rooms were single occupancy. There was a large communal lounge/ dining area but smaller lounge areas were situated throughout the home for peoples use. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.
The last inspection took place on the 28 March 2017. The service was rated as Requires Improvement at that time. There were concerns around how risks for people were managed, how staff supported people who may become anxious, medicines were not always recorded safely and records had not been completed satisfactorily.
This unannounced comprehensive inspection took place on 5 June 2018. At the previous inspection (March 2017) the registered manager had been in post for a matter of days. Since that time she has remained in post and has worked with the staff team to implement the necessary changes. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection. The service is now rated as Good.
The service is required to have a registered manager and at the time of the inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
Staff told us with the change of registered manager and also changes at senior management level there had been a number of positive improvements to the service. Staff told us that there “Is now a process for everything we do, we know what is expected of us.” Staff felt that as their roles were clearer this meant that staff knew who was responsible for each task and these were now completed. Staff were also clear about how they needed to record information to evidence how they supported and monitored a person’s health and the process to follow if a person had an incident. We found records were up to date and reflected the person’s individual needs. Accident and incident records were also completed and audited by the management team.
The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation.
People, relatives and staff all told us they found the new management structure more open and approachable. They felt their views on the running of the service were sought and were complimentary about the changes to the service. A person told us “Things have definitely improved, especially recently with the new manager, and the new staff are just as caring as the staff I’ve known for many years.”
Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.
Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.
Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.
The service had implemented a ‘person for the day’ and this meant that their care records, risk assessments and incident records were reviewed to ensure they were in place and were accurate.
The service had implemented a daily ‘Stand up meeting’. The meeting consisted of senior care and nursing staff, activities coordinator, head of housekeeping and head of catering. Information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.
There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR).
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.
People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.
People and their relatives told us they thought there were enough staff on duty and staff always responded promptly to people’s needs. Staffing arrangements met people’s needs in a safe way. The manager reviewed people’s needs regularly. This helped ensure there was sufficient skilled and experienced staff on duty to meet people’s needs.
Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. Staff monitored people’s food and drink intake to ensure everyone received sufficient each day. People told us, “There is plenty of good, wholesome food and we do eat well here. My appetite is still good, and I know what I like and I can tell you I don’t have any complaints at all about the food.”
The care we saw provided throughout the inspection was appropriate to people’s needs and wishes. Staff were patient and discreet when providing care for people. They took the time to speak with people as they supported them and we observed many positive interactions that supported people’s wellbeing.
Staff were proud to work at Chyvarhas and told us “Love it, you help someone [person] and see them smile”, “I find it humbling to look after people here” and “We want to provide the best for them [people] so when they leave here they know they were well cared for. We may be their [person’s] last friends they ever have.”
Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time. People had access to some activities both within the service and outside. An activities co-ordinator was employed and organised a planned programme of events. The activities coordinator was passionate about making sure activities were fun for people.
Staff were supported by a system of induction training, supervision and appraisals. Staff meetings were held regularly.
The premises were well maintained. The service is registered for dementia care. There were people living at the service who were living with dementia and were independently mobile. The service was warm, comfortable and appeared clean with no unpleasant odours.
There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.
There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the registered manager and members of the senior management team.