Chegworth Nursing Home

We found the following examples of good practice.

The provider had developed new ways of recording observations about people's health which were shared with healthcare professionals in advance of appointments. This had reduced the need for external visitors to the home and had facilitated smooth virtual consultations with healthcare professionals.

The provider was following best practice guidance in terms of ensuring visitors to the home did not introduce and spread COVID-19. They sent information to visitors about the procedures to follow during a visit.

The provider had made a visitor area on entrance with handwash facilities since the pandemic to perform visitor screening and to wear PPE before entering the service. All visitors had to complete a visiting form on arrival, and had their temperature checked. The provider had a clear screen in the visitor area for visitors to speak to people living in the service. A COVID-19 lateral flow test was undertaken for visitors of people on end of life care as they were allowed inside the service. This was to ensure the safety of staff and people. People were supported to see their visitors in the front car park, or when this was not possible people were supported to speak to their families on the phone or via video call.

To ensure the well-being of people the provider had employed an activities co-ordinator who regularly organised individualised and group activities.

The provider had an admission process in place. People had a COVID-19 swab test within the last 24-48 hours prior to being admitted into the service and they were isolated for 14 days following admission to reduce the risk of transmission of the virus.

The provider had set-up donning and doffing personal protective equipment stations across the care home. Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

Further information is in the detailed findings below.

Chegworth Nursing Home is residential care home that was providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service is registered for up to 43 people to receive care and support.

People’s experience of using this service:

People received a good standard of care in all areas. The service met the characteristics for a rating of “Good” in four of the five key questions and "Outstanding" in the responsive key question. More information is in the full report

The provider was outstanding in its delivery of end of life care to people. The staff delivering care and support were skilled and suitable. They were deployed in sufficient numbers to deliver care effectively and to ensure people were safe. People’s health needs were met, they ate well and were supported to access healthcare services whenever they needed to. Staff were caring and the provider had a track record of supporting people compassionately during end of life care. People were active and were supported around their cultural and spiritual needs.

The registered manager and senior staff provided good leadership and were popular with people, relatives and staff. Effective quality assurance processes were in place to drive improvements at the nursing home.

Rating at last inspection:

At the last inspection the service was rated good [report published on 24 October 2016]. More information is in our full report.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Chegworth Nursing Home provides accommodation and nursing care for up to 43 older people. At the time of our inspection 42 people were using the service, some of whom were living with dementia. The home specialises in supporting people requiring end of life care and wound management.

A registered manager was 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 2008 and associated Regulations about how the service is run.

There were sufficient staff at the service to meet people’s needs. Staff were allocated to support individuals and this enabled them to build caring trusting relationships with people. Staff had the knowledge and skills to meet people’s needs and these were updated through the completion of regular training courses and discussion during supervision sessions.

Staff treated people with respect. They spoke and interacted with them in a caring and friendly manner. Staff knew the people they were supporting and provided care in line with their wishes and preferences. Staff respected people’s privacy and maintained their dignity.

The registered manager assessed people’s needs and developed care plans outlining how those needs were to be met. People and their relatives were involved in discussions about their care needs. The staff had the knowledge to support people with wound care. When people had been admitted to the service with pressure ulcers staff had provided people with the care they required in order for these wounds to heal.

Staff assessed the risks to people’s safety and plans were in place to manage and mitigate those risks. This included providing people with the equipment they required. Risk management plans were reviewed in response to incidents that occurred at the service to prevent recurrence of similar incidents.

Processes were in place to keep people safe. This included ensuring staff were aware of their responsibilities to safeguard people and to report any concerns of possible abuse to their manager and the local authority safeguarding team so appropriate action could be implemented to protect people, where required.

Staff were prompt to identify when people required support with their health. Staff undertook some screening processes to identify possible infections so prompt treatment could be sought. Staff liaised with the GP and undertook weekly ‘ward rounds’ to review people’s health needs. Staff liaised with other healthcare specialists as required and supported people in line with the advice provided. This included seeking advice about people’s nutritional needs.

The service was part of the Vanguard initiative. This initiative was about supporting people with their healthcare needs within the care home by trained and knowledgeable staff in conjunction with other community healthcare professionals and about smoother transitions between the care home and admissions to hospital. The registered manager felt being part of this process had strengthened their processes to support people with their healthcare needs and ensured people received the support they required in a timely manner.

Staff provided people with end of life care and support in line with their wishes and preferences. Advance care plans and ‘co-ordinate my care’ records were available so all professionals involved in the person’s care were aware of their wishes. Staff supported people to be at their preferred place at the end of their lives and staff stayed with the person so they did not die alone. The service had been accredited as part of the Gold Standards Framework (GSF) recognising the ability of the staff to provide quality end of life care.

People received their medicines as prescribed and accurate records were kept of medicines administered. The registered manager had worked with the community pharmacist to further strengthen and streamline medicines management.

Staff were aware of their responsibilities to adhere to the Mental Capacity Act 2005. Staff asked for people’s consent before providing support and respected their decision. The registered manager organised for people to be reviewed under the Deprivation of Liberty Safeguards to help ensure their rights were upheld while their safety was maintained.

Activities were available to provide people with stimulation. This included one to one engagements and some group activities. The provider was supporting the activities coordinator to develop their knowledge and build links with other activities coordinators to further strengthen the activities programme. A minibus had recently been purchased to provide further opportunities for people to engage in the local community.

A complaints process was in place. People and their relatives felt able to speak with the registered manager if they had any concerns or complaints. We saw that these were investigated and addressed as required. People, their relatives and staff were asked for their feedback about the service through regular meetings and completion of satisfaction questionnaires. Feedback received was used to further improve service delivery.

There was clear leadership at the service with strong management in place. Staff felt well supported by their manager and able to approach them for advice and guidance. They were able to express their opinions and that their suggestions were listened to.

There were processes in place to review the quality of the service. This included a programme of audits and review of key performance data. The registered manager worked with the local authority, clinical commissioning group and other healthcare professionals to review and improve service provision.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People who use the services told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs were assessed together with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected four people's care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments. Relatives told us that the care and support that their relatives received was good. One person said about their relative's care, 'it covers all their needs and when the needs change the care plan is updated'.

Is the service caring?

People were treated with respect and dignity by the staff and they were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The eight people we talked to said the staff treated them well and respected their wishes, dignity and privacy. One person said, 'I like living here. The staff are so caring, it's more like a family home'. Other comments included, 'the care is really good and the staff are very kind' and 'my mother is very happy here, the care and support she gets meet her needs'. We observed that staff knocked on people's doors before entering their rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Is the service responsive?

Relatives of people who use the services told us that if a person's needs changed, their care and support would be tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in the most appropriate way to meet their assessed risks and care needs.

The manager carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

We found that the provider was working closely with building regulators and the fire safety officer to ensure that people were safe during this time. The temporary accommodation was warm and well appointed. People told us that they were being kept informed of what was happening all the time.

People told us that they were free to spend their days as they wanted to, joining in with activities or occupying themselves. There were activities arranged for those who wished to participate including trips out of the home. Those people who were mobile were free to walk around the home as they wished and out into the garden.

We saw that care was planned and delivered in line with people's individual care needs. Families were involved in discussions about how people liked to be supported. Regular reviews made sure any changes were identified and addressed.