Chelmunds Court

Chelmunds Court is a purpose-built residential care home providing personal and nursing care to up to 73 people. The service provides support to older people, some of whom, may have dementia. Bedrooms are located across two floors. People with nursing needs are based on the first floor with most people with dementia on the ground floor. At the time of our inspection there were 55 people using the service.

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

Since our last inspection there had been changes in the management of the home with many improvements noted. There were some issues found with records not being clearly recorded, but this had not resulted in any negative impact on people. Staff spoke positively about the impact of the new manager and how they were able to effectively carry out their role and responsibilities. People and relatives were positive about the service and had regular opportunities to provide feedback about their care. Any areas identified as needing improvement were shared with staff, so lessons were learnt.

People spoke positively about the home and people’s relatives felt people were safe living there. Staff understood their safeguarding responsibilities and people were observed to be relaxed around staff. Individual risks to people had been assessed and risk management plans were regularly reviewed to help ensure staff supported people safely. Medicines were stored, managed and administered in line with good practice guidelines. Infection prevention control was effectively managed. Arrangements were in place to ensure visitors to the home were made aware of infection control requirements to keep themselves and others safe.

Staff completed regular training to ensure they could meet people’s needs safely and effectively. 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.

Care plans guided staff about people's needs and how to meet them. Staff supported people to be involved in decisions about their care and were responsive to people’s needs.

People were supported to maintain relationships with people that were important to them. Staff were observed to be kind and caring in their approach and ensured people’s privacy, dignity and independence was maintained as appropriate.

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 December 2020) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Some improvements to risk management had been made since the last inspection. Sufficient action had been taken in response to the issues identified in the warning notice we had served. However, further improvement was required to ensure people received safe, person centred, responsive care. Staff were recruited safely but staff told us there was not enough of them. This was despite the home being staffed in accordance with the provider’s dependency tool used to calculate the staff numbers required to care for people.

An ‘infection prevention control’ audit was carried out by CQC during the inspection. We found the provider was not following government guidelines to keep people as safe as possible and minimise infection control risks associated with Covid-19. Staff did not consistently follow PPE guidance and requirements for isolating people were not followed as required. Covid-19 testing for people was not completed in accordance with required timescales. Effective arrangements were in place to ensure visitors to the home were made aware of infection control requirements to keep themselves and others safe.

Arrangements to protect people from potential harm and abuse needed improvement. Staff knew how to recognise abuse but the provider’s arrangements to minimise and manage risks were not always clear or followed.

Governance systems to monitor the quality and safety of the service continued to be ineffective. When areas for improvement had been identified by audits and checks, timely action continued not to be taken to keep people safe and maintain their wellbeing. Staff spoke of the challenges they faced to follow procedures to ensure people received safe, person centred care.

People and their relatives spoke positively about the staff and the care they provided at Chelmunds Court. Relatives had maintained some contact with their family members during the national lockdown which included video and telephone calls.

Management changes had occurred since our last inspection. The new registered manager was supported by a management team. Regular staff meetings took place to inform staff of changes in practice and what was expected of them by the provider.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 27 March 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider remains in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections although there has been evidence of some improvement at each of those inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We needed to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had identified concerns in relation to medicine management and completion of risk assessments related to peoples care. Care plans were not up-to-date and food and fluid charts lacked information to show people had consumed enough to maintain their health. Significant events that had resulted in injuries sustained by people had not been reported as required.

The inspection was also prompted in part due to concerns received about people falling, infection control risks, and the management of people’s care. A decision was made for us to inspect and examine those risks. 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. Ratings from previous comprehensive inspections for those key questions not reviewed were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chelmunds Court 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 two continued breaches and one new breach of the regulations. These breaches are in relation to safe care and treatment, staffing, and good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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

The management of people's medicine was not consistently safe because people did not always receive their medicines as prescribed. Medicines were ordered, received, stored and disposed of safely. Risk management continued to require improvement because the provider could not demonstrate all risks were being well managed. This placed people at risk of potential harm.

People did not always receive personalised and responsive care. People’s care records continued to lack up to date and correct information to help staff provide individualised care.

Management and leadership at the home was not consistent. Management changes had occurred since our last inspection and further changes took place immediately after our visit. Staff provided mixed feedback when we asked them if they felt valued and listened to by their managers.

The management team welcomed our feedback and responded immediately when we shared the concerns we had identified and begun to take reactive action to make improvements. Some areas requiring improvement had been identified prior to our visit but remedial action had not been taken in line with set timescales. Some previously demonstrated standards had not been maintained to ensure compliance with regulations. This showed lessons had not been learnt.

Quality assurance systems continued to be ineffective because the management team did not have sufficient oversight of the service provided. Relatives felt the management team were approachable, but some lacked confidence in their ability to make changes to improve outcomes for people. Overall, people and relatives had confidence in the ability of staff to provide effective care and we observed staff helped people to move safely during our visit.

Staff were recruited safely. They received an induction when they started work and completed ongoing training to help them to be effective in the roles. Enough staff were on duty during our visit to respond to people’s needs in a timely way. However, we received mixed responses when we asked people, their relatives and staff about staffing levels. The nominated individual had begun to explore the feedback we shared with them.

Whilst the mealtime experience in dining rooms was positive for people the provider was unable to demonstrate people had consumed sufficient amounts of food and fluids to maintain their health. Staff knew what people liked to eat and drink and people's dietary preferences were known and catered for.

People felt safe and told us they liked living at the home. Safeguarding procedures were in place to protect people and staff received training to help them understand the different types of abuse people might experience.

People said staff had a caring attitude and they felt involved in planning their care. However, some relatives did not share this view point. Staff enjoyed their jobs and spoke fondly about people. People engaged in meaningful activities and continued to be supported to maintain relationships with those that mattered to them. People had opportunities practice their chosen religions and some people’s suggestions to improve the service had been acted upon.

People were supported to be independent. Whilst staff understood the importance of maintaining people’s dignity, it was not consistently upheld. Some relatives felt people's personal belongings were not treated with respect.

The process used to assess people's mental capacity and to ensure their rights were upheld required improvement. However, people were supported to have 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.

People had access to healthcare professionals when needed and the management team had continued to develop relationships and improve communication with health and social care professionals to benefit people.

The environment continued to meet people's needs and people and relatives remained happy with the cleanliness of the home. The provider's infection prevention and control measures were effective.

People and their relatives knew how to raise a complaint. However, complaints were not always resolved in a timely way which meant opportunities to learn from complaints could have been missed.

Following our inspection, we notified commissioners about the areas of concern we identified.

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 Requires Improvement. (Published 4 March 2019)

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider and request an action plan from them 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.

Chelmunds Court is a 'care home'. 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.

Chelmunds Court accommodates up to 73 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. During our visit 31 people lived at the home and one person was in hospital. The home is located in Solihull, West Midlands.

At our inspection in June 2018 we identified the need for improvement in all the key questions. We found six breaches of the regulations. The service was rated 'Inadequate' overall. Due to the seriousness of our concerns we imposed a condition on the provider's registration. The condition required the provider to complete regular quality and safety checks and provide us with monthly reports to demonstrate improvements were being made.

The service was placed into 'Special Measures'. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

In August 2018 in response to information of further concern we carried out a focused inspection looking at the key questions of Safe and Well Led. Despite some improvements being made the rating remained ‘Inadequate.’

At this inspection improvements have been made in all areas. The service is no longer rated as 'inadequate' overall or in any of the key questions. We have removed the condition we had imposed on the provider’s registration and the service is no longer in Special Measures.

The service is required to have 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. A manager had been in post since August 2018. Their application to apply to register with us is under consideration.

The management team had worked hard in the previous six months to make changes. The quality of care had improved and changes made needed to be sustained over a longer period of time as more people came to live at the home in order to be fully embedded.

People and relatives were happy with the service provided and the way the home was managed. Staff received on-going support and training to be effective in their roles. Staff morale and job satisfaction was now good. Staff respected people’s rights to privacy, maintained their dignity and independence. Staff were described as caring and kind; they knew people well and were responsive to their needs. Care plans supported staff to provide personalised care. Work was on-going to improve care records and compile new care plans. Relatives were encouraged to be involved in their family member's care and there were no restrictions on visiting times.

Quality monitoring within the service had strengthened. Action had been taken in response to the feedback gathered from people. However, further action was needed to ensure all audits and checks were effective. The management team continued to work in partnership with the local authority and the CCG to drive this forward.

People felt safe and staff understood their responsibilities to protect people. Some risk management plans required improvement to ensure people were kept as safe as possible. Accidents and incidents were monitored, and action had been taken to prevent reoccurrence.

People received their medicines when they needed them, and medicines were in stock. Further improvement was needed to ensure medicine protocols were detailed and medicines were always stored safely.

Enough staff were available to meet people’s needs and staff had been safely recruited. The use of agency staff had significantly reduced which meant people received support from staff they knew. The home was clean and regular checks ensured the environment and equipment was safe. Staff followed good infection control practices.

The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff gained people’s consent before they supported people and respected people’s decisions and choices.

People enjoyed the food, and staff had good knowledge of people's dietary needs. People were supported to have sufficient amounts to eat and drink to maintain their health. Further improvement was required to ensure people had timely access to health professionals when needed.

People were occupied with meaningful activity. People had opportunities to maintain positive links with their community.

People’s end of life wishes were documented which assured us people’s wishes would be respected at the end stage of life and following their death.

Complaints were being managed in line with the provider’s procedure.

Chelmunds Court is a 'care home'. 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.

Chelmunds Court accommodates 73 people in one adapted building over two floors. There were 40 people living at the home on the day of our visit, most of whom lived with dementia

At our previous inspection on 26 June 2018 we rated the overall service as 'Inadequate' and it was placed into special measures.

At that inspection we identified six breaches in the legal requirements and regulation associated with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were breaches in Regulations 9, 10, 12, 14, 17 and 18. This was because there were not enough staff available with the knowledge needed to support people in the right way which meant people did not receive personalised care. Risks associated with people’s care were inconsistently managed. Medicines were not managed safely and people were not assisted to external healthcare appointments when required. The provider failed to demonstrate people had received sufficient amounts of food and fluids to keep them healthy. Effective systems were not in place to ensure the service was delivering good quality care to people.

The significant concerns we identified during that inspection resulted in us imposing a condition on the provider’s registration. This meant they had to complete regular checks of the quality and safety of the service and provide us with monthly reports of their findings to demonstrate the required improvements were being made.

The provider sent us an action plan which informed us of the improvements they planned to make to would be completed by 30 September 2018.

Since that inspection no further people had been admitted to the home. We received further information of concern in relation to the service. These concerns related to people not being given their medicines when they needed them, further management changes and the risks associated with people’s care were not managed safely which had placed people at risk. As a result, on 15 August 2018 we undertook this unannounced focused inspection to check whether people were safe and whether the service was well-led. This report only covers our findings in relation to these two key areas.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Chelmunds Court on our website at www.cqc.org.uk.

As a result of this inspection the overall rating for this service remains 'Inadequate' and the service therefore remains in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Further management changes had taken place at the home since our last inspection and the provider had recruited their fourth manager since the home opened in November 2017. Therefore, a registered manager was not 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.

Relatives continued to lack confidence in the leadership of the service and shared concerns about the competencies of staff who worked at the home. The checks completed by the provider and managers to ensure staff had the skills and knowledge they needed to provide safe care were not always effective and did not always take place.

People's medicines were not always managed safely and some people had not received their medicines when they needed which placed them at potential risk of harm.

People were not always protected from abuse by other people living at the home. The provider had failed to mitigate risks to keep people as safe as possible. Accident and incident reporting remained ineffective because the provider and managers were not aware of all incidents that had occurred. Also, staff did not always correctly report incidents in line with the provider’s procedure.

Management audits and checks were not effective to ensure people always received safe care.

The recruitment of staff to work at the service was ongoing. Enough staff were on duty during our visit but the service remained heavily reliant on agency staff to provide people’s care.

Staff felt more supported by their managers than they had done previously. Managers told us they continued to work in partnership with the local authority and the Clinical Commissioning Group to improve the quality of care people received.

The home was clean and tidy during our visit. People remained satisfied with the cleanliness of the home and staff understood their responsibilities to protect people from the risks of infection.

We found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found the service was inadequate overall, and in all of the key questions. The inspection identified six breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service and will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Chelmunds Court is a ‘care home’. 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.

Chelmunds Court accommodates 73 people in one adapted building over two floors. There were 58 people living at the home on the day of our visit, most of whom lived with dementia.

The provider had recruited their third manager into the home since it opened in November 2017. The home manager advised that they would be registering with the CQC so they could be the registered manager. 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.

The management of people’s medicine was unsafe and put people at risk of significant harm. People had missed their medicines due to ineffective stock control. People had been placed at risk of harm and in some cases had sustained harm because of this. There were not enough staff with the knowledge of people’s care needs to keep people safe. Staff felt people were neglected as there was insufficient staff to meet people’s needs. People raised concerns about the safety of people who lived with a dementia related illness and relatives felt their family members were not always safe. Where potential risks to people had been identified the plans to reduce the risk where not consistently followed. Staff understood what abuse was and how to report it. Staff understood the importance of reducing the risk of infection to keep people safe.

People who had a dementia related illness were at risk of not eating and drinking enough to keep them healthy. Staff were unclear about how much people should be drinking and how they were sure people had sufficient to drink. People did not have suitable and timely access to external healthcare professionals. People’s appointments with external healthcare professionals had not been missed. Where some people had been seen by visiting professionals staff had not consistently followed their guidance about how to support people. People who had been living at the home for some time had not had proper assessments or reviews of their care. The management team were re-assessing people’s care needs with the involvement of external healthcare professionals. Where they had identified they could not support people adequately, they were working with the person and their families for alternative placements. The provider had taken steps to improve how people were supported to have maximum choice and control of their lives so staff could support them in the least restrictive way possible; the policies and systems in the service support this practice.

People shared their experiences were their dignity had been compromised and they had not been treated respectfully. Staff did not have time to adequately support people.

People did not always receive personalised care which met their needs in a timely way. People’s individual preferences were not always known or acknowledged by staff. The provider had not invested in their staff so they could spend time with people so they could support them with their interests. People had access to information about how they could complain about the service, while these complaints were responded to, the provider had not ensured sufficient action had been taken and lessons learnt to improve the service delivery.

The provider had ineffective systems and processes in place to review the quality of the care delivered. This had resulted in people receiving poor care. People, relatives and staff told us they had not been involved in the way the service was run. Staff morale was low and they had felt let down and unsupported by the leadership of the service. The provider was not keeping us informed of events, such as allegations of abuse that they are required to inform us about. The new management team were implementing new processes and ways of improving the service, however these had only been in place for two weeks so the provider could not test these to understand if these were effective, working well and sustainable.