Archived: Chipstead Lodge Residential Care Home

Updated 11 September 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection site visit took place on 31 July 2018 and was unannounced. The inspection team consisted of two inspectors and a nurse that specialised in the care of people with a mental health diagnosis.

Prior to the inspection we reviewed the information we had about the service. This included information sent to us by the provider, about the staff and the people who used the service. We reviewed notifications sent to us about significant events at the service. A notification is information about important events which the provider is required to tell us about by law.

We reviewed the Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the visit we spoke with the registered manager, a director, nine people, two relatives and seven members of staff. There were people that were unable to verbally communicate with us; instead we observed care from the staff at the service. We looked at a sample of eight care records of people who used the service, medicine administration records and training, supervision and three recruitment records for staff. After the inspection we were sent further evidence that related to safety checks at the service.

Updated 11 September 2018

Chipstead Lodge Residential Care 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. Chipstead Lodge is registered to provide accommodation and personal care for up to 36 people. There were 26 people living at the service at the time of our inspection.

This inspection site visit took place on 31 July 2018 and was unannounced.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspections in July 2017 we asked the provider to make improvements in relation to the safety of care to people, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), activities for people, lack of detailed care plans, staff training and supervisions and quality assurance at the service. At the focused inspection in September 2017 we asked the provider to make improvements in relation to the safety of people. We issued a warning notice to the provider in relation to this. We found that actions from these inspections had not be sufficiently addressed.

The premises and equipment was not maintained to a safe standard. In the event of an emergency there was not up to date information on the support people required to evacuate the building. There were areas around the service that smelled strongly of urine and furniture did not feel clean. Audits were not effective in identifying these shortfalls.

Risks to people were not managed safely. There was a lack of detailed guidance for staff to assist them to manage people and their behaviour due to their mental health or dementia. Monitoring tools were not used effectively where people were at risk of malnutrition and dehydration. After the inspection the provider sent in evidence that they had addressed the most urgent concerns.

The management of medicine was not always safe which put people at risk. Accidents and incidents were not always recorded and appropriate analysis was not undertaken to look for trends to try to prevent future accidents.

Staff were not always working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Information about people’s care was not always being communicated effectively between staff.

The premises adaptation did not meet the needs of people that were living with dementia.

Care plans were difficult to navigate which meant that new staff and agency staff may not easily find the most up to date information on people’s care needs. Staff had received training in relation to their role and had the opportunity to meet with their manager. However, as staff were not always practicing safe care this training and supervision was not always effective.

There were varied responses from people about the caring nature of staff. At times people felt ignored. We found that people were not always involved in the planning of their care and did not have choices in their day to day care. People were not always supported with their independence.

Activities were not always person centred and people did not have appropriate opportunities to go out. Care plans were not always detailed and lacked guidance around people’s diagnosis.

Records of complaints were not kept and people did not always feel that their complaints were responded to. Quality checks that were taking place were not effective and audits did not always identify the shortfalls that we identified. Improvements were not always made as a result of feedback. Records at the service were disorganised and therefore difficult to navigate.

There were aspects to people’s care that was safe including a robust recruitment processes, safe levels of staff that were always maintained, staff protected people from the risk of abuse and there was a business continuity plan in place in the event of an emergency.

There were mixed responses from people about the quality of the food. People were offered choices of meals and drinks. People were supported to maintain their health and had access to health care professionals. Before people moved in to the service a full assessment of their needs took place.

We did see examples of people being treated in a caring and respectful way by staff. People were supported to practice their faith and visitors were always welcome to the service.

Staff told us that they felt supported and listened to by the manager. Where appropriate, notifications regarding significant events were sent to the CQC.

The overall rating for this service is ‘Inadequate’ and has been placed into ‘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. 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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.