Chaseways

Chaseways is a residential care home providing personal and nursing care to up to six people. At the time of the inspection five people were living at Chaseways.

The building consists of three ground floor flats which have two bedrooms and en-suites, two lounges and one kitchen. Each flat has access to their own garden. There is an office on the ground floor and second floor.

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

Staff spoke about how they felt they needed to develop on their communication skills, in particular with British sign language. Staff identified this could contribute to a person’s frustration if they were unable to communicate effectively. The provider had offered training to staff and gave further resources following the inspection.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected most of the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The provider had systems in place to ensure they captured people, staff and family views about the support being provided.

The provider was proactive in investigating concerns and putting actions into place to improve the service.

Staff and the provider had systems in place to ensure that safe infection prevention controls were in place.

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 24 October 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about how the provider ensured that people’s basic human rights were at the centre of their care. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chaseways is a residential care home providing personal and nursing care to up to six people. At the time of the inspection five people were living at Chaseways.

The building consists of three ground floor flats which consist of two bedrooms and en-suites, two lounges and one kitchen. Each flat has access to their own garden. There is an office on the ground floor and second floor.

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

People had risk assessments in place which identified their support needs. There had been significant changes and improvements when supporting people with the less restrictive measures. Although there were still some restrictive measures in place this was something the management team were reviewing.

The services infection prevention control measures were in place and we were assured the provider had implemented systems and processes to provide safe care during the pandemic.

Where safeguarding issues had been identified these were addressed and the management team were open and willing to make changes and share lessons learnt.

There had been changes to the management structure and the staff team. Overall, there was positive feedback regarding this change. Professionals feedback was positive and recognised the changes to people’s support.

People were mostly 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care and setting was starting to develop support that offered choice and control of the person’s life. There was still some restrictive practice and decisions were historic that the service took on which had remained in place. When speaking to the manager they had recognised these practices and were working with health professionals to ensure all potential risks were looked at and a best interest decision made.

The support people received was person-centred and staff understood people’s individual support needs.

There was a dedication from leaders and staff to make sure people were receiving good care. There had been a change in leadership which meant that positive changes had been made towards shaping the service to be person centred. Although the service had made great improvements it was recognised that there was further development to be achieved. The manager had clear action plans with how they were going to continue to improve the service.

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 Inadequate (published July 2020) and there were multiple 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 regulations.

This service has been in Special Measures since July 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced focused inspection of this service on January 2020. 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, The nutritional needs of people was not met due to a lack of food available to sustain good, Good governance and Duty of Candour

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chaseways is a residential care home providing personal and nursing care to 4 people aged 65 and under at the time of the inspection. The service can support up to 6 people who require daily support with their learning disabilities and / or mental health needs. The building has been adapted so people can live within their own self-contained accommodation.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were not supported by sufficient numbers of staff. Risks to people’s safety and wellbeing were identified, but not reviewed when their needs changed. Staff had unnecessarily restricted people’s freedom through use of restraint without following best practices guidance. People were not protected from the risk of harm or abuse as incidents were not investigated.

Staff did not receive training to enable them to fully support people’s needs. Staff did not feel supported by the interim manager. People’s nutritional needs were not consistently well met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people had a lack of choice and control, limited independence and limited inclusion in the community.

Governance and oversight of the service did not identify areas of improvement. Management arrangements in the service were not sufficient to keep people safe from harm. The interim manager and provider did not act in an open and transparent manner when things went wrong. People were not effectively engaged with by the management of the service.

People were safely supported with their medicines. People lived in a clean environment. People were able to see health professionals when needed and staff supported them to attend these appointments. The environment was adapted to meet people’s needs, however some areas required ongoing maintenance or decoration.

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 07 November 2018).

Why we inspected

The inspection was prompted due to concerns received about inappropriate use of restraint along with people at risk of harm from lack of staffing, effective training, lack of management oversight and people’s nutritional needs being unsupported. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the Key Questions of Safe, Effective and Well-led only.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We found evidence during this inspection that people were at risk of harm from this concern. We reported these concerns to the provider who took immediate action to make improvements and promote people’s safety. We also informed the local authority of our concerns. We found the actions taken by the provider had been effective in mitigating the urgent risks, however, also found further improvements were required.

On 15 February 2020 we received further information that suggested staff were not supported to raise their concerns and that staff were not being supported. We found no further evidence at that time to substantiate the concerns received on this occasion. Please see the 'Effective' section of this report.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, safeguarding service users from abuse and improper treatment, meeting nutritional needs, training and support for staff, good governance, and being open when things go wrong at this inspection.

The service is rated as inadequate overall and in the Effective and Well-Led key questions.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. 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.

The overall rating for this service is 'Inadequate' and the service has been placed in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

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.

Chaseways 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. Chaseways accommodates six people living with learning disabilities or mental health needs in one adapted building that has been divided into three flats. At the time of this inspection there were four people living at Chaseways. People were not all able or willing to communicate with us however, it was clear they trusted staff and that they worked in partnership to achieve as much independence as possible.

The care service has been developed and designed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The provider had a manager in post who had applied to register with the Care Quality Commission. 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.

People’s relatives told us they felt that people were safe living at Chaseways. Staff had been trained to safeguard people from avoidable harm and people had access to safeguarding information in an easy read format to help keep themselves safe. Risks to people's health, well-being and safety had been assessed and were reviewed regularly to take account of changing needs and circumstances. Sufficient numbers of safely recruited staff were available to meet people’s needs. There were suitable arrangements for the safe storage, management and disposal of medicines and people were supported to take their medicines by trained staff. The home was clean and fresh throughout. Personal emergency evacuation plan plans had been developed for each person and staff could tell us what support would be provided in the event of an emergency such as a fire.

Staff received training and supervision to enable them to support people safely. The service worked within the principles of The Mental Capacity Act 2005 (MCA). Staff worked closely with individuals and obtained their consent before they provided day to day care and support. Assessments were undertaken to identify if people were at risk from poor nutrition or hydration and people were provided with a choice of food. People’s individual health needs were met in a timely way and they had access to health care and social care professionals as needed. The communal areas of the home were appropriate to meet the needs of people who used the service.

People and their relatives were satisfied with the staff that provided people’s care. People and staff communicated well with each other, staff were sensitive to people’s individual needs and were caring. Staff treated people with dignity and understood people’s support needs well. People were well groomed, staff had listened to how people wanted to look and supported them with that. People were supported to regain their independence and to make achievable goals. People’s personal records were held securely to promote their dignity and confidentiality.

People and their relatives where appropriate had been involved in developing people's support plans. Staff supported people to identify goals for personal achievement in all areas of their lives. Regular meetings were held for people to share their opinions about the service and facilities provided at Chaseways. People were provided with a range of activities and opportunities for engagement. Concerns and complaints raised by people who used the service or their relatives were appropriately investigated and resolved.

People who used the service knew the manager by name and felt that they were approachable. Staff told us that the management team was approachable and that they could talk to them at any time. Management meetings were held regularly to discuss such issues as recruitment, the performance of the service and any matters arising. There were a range of checks undertaken routinely to help ensure that the service was safe. The manager completed a governance dashboard monthly, this gave the provider a clear oversight of the support people needed and how it was provided. Quality questionnaires in an easy read format were distributed to people who used the service to enable them to give the provider feedback about the service they received. The manager had informed the CQC of significant events in a timely way which meant we could check that appropriate action had been taken.