Chaxhill Hall

Chaxhill Hall is a residential care home providing accommodation and personal care up to a maximum of 36 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 30 people using the service. People were accommodated in one adapted building.

People’s experience of using this service and what we found

Medicines had not always been administered as prescribed and processes designed to support safe medicines management had not always been followed by the staff. Although no-one had been harmed, the failure to identify shortfalls in safe practice and process, had put people at risk. During the inspection immediate action was taken to prevent further shortfalls and more frequent monitoring of staff practice was put into place to ensure correct procedures were followed.

We found since our last inspection, improvements made to several other aspects of medicines management. People told us they were provided with support to take their medicines.

The provider had made improvements in how they quality monitored the service which the registered manager had found supportive. We also found improvement to how areas of the service were audited, but also found gaps in the completion of the audits. Time was needed for these to be used more effectively so they could robustly support, an already improving system, to maintain compliance and service improvement.

Safeguarding processes had been reviewed to ensure the reporting of safeguarding concerns, to the local authority and other relevant agencies took place in a timely manner. There were now arrangements in place to ensure appropriate investigation and action took place in response to safeguarding concerns. People told us they felt safe and people’s representatives told us their relatives were looked after safely.

Improvements had been made to ensure risks to people were assessed in a timely manner and action taken to reduce these. Staff had been supported to understand their roles and responsibilities regarding risk management. A new care records system had been implemented to ensure risk assessments and associated care plans were detailed and regularly reviewed for staff reference. We observed some arrangements put into place to help people remain safe, which included the use of technology such as alarmed sensor mats and specialised equipment.

Improvement had been made to the cleaning arrangements and to infection, prevention and control practices. Staff were following national guidance regarding the use of face masks and other personal, protective, equipment (PPE) to prevent the spread of infection. People told us their bedrooms were cleaned daily and they had been supported to have Flu and COVID-19 vaccinations. There were no visiting restrictions and visitors were being supported to visit their relatives and friends safely.

Arrangements were in place to keep the environment secure and safe for people who lived with dementia. We observed staff supporting people skilfully, who sometimes became distressed due to dementia, to stay safe and regain a better state of wellbeing.

The registered manager was visible to people who used the service and their visitors. Relatives described them as ‘helpful’ and ‘easy to talk with’. Staff appreciated the support and leadership they provided and felt positive and invested in the service. Feedback was sought from relatives and people to support service improvement. Learning had been taken from past inspections, complaints, concerns raised and errors to help develop staff practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 March 2021). This is the second time the provider has been rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of medicines management.

At this inspection we found the provider had made improvements and was no longer in breach of regulations in respect of safeguarding service users from abuse and improper treatment and good governance.

Why we inspected

We carried out an unannounced inspection of this service on 9 January 2021 which due to the service experiencing a COVID-19 infection outbreak concluded on 11 and 12 February 2021 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they remained in breach of legal requirements in respect of medicines management. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection those key questions were inspected, to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chaxhill Hall on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a repeated breach in relation to safe medicines management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chaxhill Hall is a residential care home, providing personal care for 21 people aged 65 and over at the time of the inspection. The service can support up to 36 people with a variety of needs, some of whom live with dementia and/or disability. Chaxhill Hall accommodates 36 people in one adapted building.

People’s experience of using this service and what we found

People had not always been protected from the risk of spread of infection. The service had implemented recommendations made by an infection prevention and control (IPC) specialist during a Covid-19 outbreak at the service in January 2021. However, we found further improvement was needed to ensure IPC risks were managed safely in line with best practice and national guidance.

People’s risks had been assessed and support plans were in place to guide staff in supporting them safely. However, changes to people’s weight and accident reports had not always been acted upon in a timely way, to ensure new risks to people were managed promptly.

People may not always have been protected from abuse as the service had not always done all expected of them in response to safeguarding concerns.

People did not always receive their medicines safely.

People had enough staff suitable staff to support them.

People were not protected by robust systems to monitor and improve the quality and safety of the service. Accurate and complete records had not always been maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was Good (published 22 May 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to people’s safety, people’s medicines and the staff culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chaxhill Hall on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

The provider and registered manager took immediate action to reduce risks to people. However further action was needed to implement and embed the improvements needed.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chaxhill Hall is a residential care home for 36 older people. People living at the home have a range of needs including dementia. At the time of our inspection visit there were 30 people using the service. At the last inspection on 9 November 2015, the service was rated Good. At this inspection we found the service remained Good.

People benefitted from a service where their needs were put first and their safety maintained. There were enough suitable staff to meet people's needs. Risks to people were managed with the support and guidance of health professionals to ensure people remained safe. Staff worked openly with other agencies to safeguard people from harm. The building and equipment were well maintained and people were protected from risks associated with cross infection. When accidents or incidents occurred, the care people received was reviewed and lessons were learned to prevent a similar incident from occurring in future. We have made a recommendation about reviewing how medicines are managed, in line with best practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. They were supported to access appropriate health care.

People benefitted from a stable and caring staff team who knew them well. Staff took a personalised approach to meeting people's needs. People's preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People received good end of life care.

People's views about the service they received were sought and these were used to improve the service. People were able to raise complaints and these were responded to promptly and thoroughly. The culture at the home was open and transparent. Staff and managers worked together to provide a personalised service where people felt at home. We have made a recommendation about managers networking with other providers.

Further information is in the detailed findings below.

We were given a tour of the home. We spoke with nine people who lived in the home. We spoke with two family members. We spoke with the manager, the assistant manager and six members of staff. We read the care records for four people who lived in the care home. We inspected the polices and procedures, the complaints procedure and we read the report from a quality monitoring visit from the local authority. We spent time observing staff interactions with the people they were supporting.

A single inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report any concerns they had immediately, to a senior member of staff, or to the manager. Policies and procedures were available for staff to follow, and local authority contact details, with telephone numbers were available.

We saw that people were cared for by staff who received appropriate support and training. One member of staff told us, "I think we are well supported and encouraged to do further training. I completed my Level three and four in Health and Social Care".

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager completed mental capacity assessments for all people who lived in the home. There were some people who lived in the home who had best interest decisions made on their behalf, with involvement of family members or health professionals. The reasons for decisions made were clearly documented, and reviewed regularly.

We found the service was effective.

We saw involvement from external health professionals, such as social workers, district nurses and occupational therapists.

We observed that people appeared happy and comfortable in their environment.

We found the service was caring.

We saw that staff had a good rapport with the people who lived in the home. We saw warm, friendly and respectful interactions between staff and the people they were supporting. We saw that people were able to choose how they spent their day. Most people chose to spent time in the communal areas, whilst some people chose to spend the day in the privacy of their own bedrooms.

We found the service was responsive.

People had their needs assessed and reviewed on a regular basis. The care records confirmed people's likes and dislikes, and we found that staff were knowledgeable about the likes, dislikes and preferences of the people they were caring for.

We found people were appropriately referred for assessment and treatment by other health professionals when needed.

We found the service was well-led.

There was a registered manager in post who was supported by the staff team and the registered provider.

Quality assurance processes were in place to ensure the service was monitored and actions were taken to improve the care and treatment provided for people.

Risk assessments were in place and were reviewed monthly. This included risks around eating and drinking, falls and pressure area care. When a risk had been identified appropriate measures had been implemented to protect the person.

The home was generally clean and free from odours. People said, 'It's clean enough' they are forever changing your bed' and 'I do think it's clean, it can't be spotless'.

The people we spoke with thought highly of staff, one said, 'They are all very nice, very helpful. I have no concerns. I am amazed that they can cope with so many people'. Another said, 'I can't fault it a great deal. They're very obliging'.

People were given information and support to make a complaint. Although the provider met this standard the manager identified improvements that would be made in how complaints and comments were addressed by the home.