Archived: Chatham House

Chatham House is registered to provide accommodation and personal care to up to 26 people. The home specialises in the care of older people. At the time of the inspection there were 13 people living at the home.

The registered provider manages the service on a day to day basis. 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 last inspection was carried out on 9 April 2015. At that inspection we found improvements were needed. The recruitment practices needed to be more robust to ensure people were fully protected. We found that although new staff were interviewed, and limited checks were carried out to make sure they were suitable to work with vulnerable adults, there was no information about their previous employment.

At the last inspection we also found that there were no effective quality assurance systems in place to monitor the quality of the service offered and plan ongoing improvements. There were no records of how people had been involved in planning their care or treatment and no evidence that they, or their representative, had been involved in reviewing their care plans.

At this inspection we found that all staff files had been audited and additional information had been sought. This meant the provider now had a full record for each person they employed.

A quality assurance system had been put in place to monitor the quality of care, seek people’s views and plan ongoing improvements to the service offered to people. There was a range of audits in place which helped to ensure people’s safety and welfare.

Action had been taken to address the issues raised at the last inspection but we found further improvements were still needed to make sure the systems in place identified all shortfalls and took timely action to address them. For example audits had not identified issues with care plans identified at the inspection. Whilst it is acknowledged that improvements had been made in the systems in place to monitor quality it was too early to establish the effects of this over a period of time. Although people were receiving the care they required, the lack of accurate records about people’s needs meant staff did not have clear guidelines to enable them to meet people’s needs. This could place them at risk of receiving care that did not meet their up to date needs.

People were cared for by a stable staff team who they were able to build relationships with. Staff were kind and people felt comfortable and relaxed with them. Staff were attentive to people’s needs and treated people with dignity and respect. People’s privacy was respected and they were able to choose where and how they spent their time.

Staff had received training which enabled them to carry out their roles effectively. One person said “The girls are well trained. They know what they are doing.” Another person said “They [staff] know their stuff. We’re well looked after here.” People received their medicines safely from staff who had received specific training to enable them to carry out the task safely. There were sufficient numbers of staff to make sure people were not rushed and were able to maintain their independence.

Staff were well supported and told us they enjoyed their jobs. This created a happy and relaxed atmosphere for people to live in. One person told us “The nice thing is you can have a laugh with them.”

People were complimentary about the food served in the home. Comments included “Definitely plenty to eat” and “Always a good choice of food.” Where people required support or encouragement to eat this was provided.

People told us the management in the home was open and approachable and they would be able to raise any concerns or complaints with them. The provider was very visible in the home and people were very relaxed and comfortable with them.

We found one breach 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 this report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

This is a summary of what we found:

Is the service caring?

All of the people we spoke with said they were happy with the care and support they received. One person said 'Yes, I'm happy with the care. All the staff are very good'.

People told us the staff looked after them and treated them well. One person said 'The staff are kind and considerate'. Another person said 'The staff are very nice people and there are no problems at all'.

People looked happy in each other's company and with the staff. We heard staff talking with people in a friendly and respectful manner and observed them supporting people as needed.

Is the service responsive?

People told us they could talk to the manager or the other staff if they had any issues and they would be responded to. One person said 'We're lucky to be in such a nice home. The food's good and we have nothing to grumble about'. Another person said 'I've got no troubles here at all'.

We observed the manager was very visible around the home. We saw her regularly talking with people and staff throughout the day. In this way the manager was able to gain people's views about the service and discuss any issues or concerns.

A quality assurance questionnaire was circulated to people and their relatives. The returned questionnaires we saw were completed by people's family members and they rated the service as either good or excellent.

We saw care plans contained information about people's individual support needs and personal preferences, such as their preferred personal care routines. This enabled staff to provide a consistent level of care and support which respected the person's individual wishes.

In our conversations with staff they demonstrated a good understanding of each individual's support needs and preferences.

Is the service safe?

Steps were taken to protect people from abuse and avoidable harm. Care staff we spoke with knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns. One member of staff said 'The residents are definitely looked after here, I've never seen anything untoward'.

The manager said they always carried out relevant employment and criminal record checks when new staff were recruited.

We saw care plans included a range of individual risk assessments and control measures, such as equipment and care guidelines for managing these risks.

We found medicines were prescribed and given to people appropriately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager said no one in the home had been deprived of their liberty. However, they knew when a Deprivation of Liberty Safeguards application should be made and who to go to if an application was required.

There were arrangements in place to deal with foreseeable emergencies. We saw each individual had a personal evacuation plan to follow in the event of a fire. Training records showed staff received fire safety and first aid training. We saw records of weekly fire alarm and emergency lighting tests.

Is the service effective?

People told us they received good care and support and their needs were being met. One person said 'The staff treat us very well', another person said 'Everyone is very good, I've got no grumbles'.

One person with a history of falls told us how they had become more confident since moving to the home. They said 'I kept falling even when I was in hospital. But I haven't had a fall since I came here. I have people to assist me and watch out for me here'.

Staff received a range of training to ensure they had the skills and knowledge needed to provide an appropriate standard of care. Records showed additional support was sought from other health professionals when needed.

Is the service well led?

The owner is a registered provider with the Care Quality Commission and was in day to day charge of the home. There was a clear staffing structure in place with clear lines of reporting and accountability. The manager was supported by senior care staff who supervised the work of the other care staff.

A member of care staff said about the manager 'In her heart she puts the residents first. She's pretty good with staff and is fair and approachable, but she does like things to be done her way'. Another member of care staff said 'I'm very happy here. I can always speak to a senior or the manager and they will listen. We are all treated very fairly'.

Staff told us they attended regular staff meetings where they could raise any issues or concerns.

The manager audited different aspects of care to help improve the service. External reviews were also carried out by the local pharmacist and the environmental health department.

The home looked in a reasonable state of repair and decorative order on the day we inspected. The manager said they employed qualified contractors to service and maintain essential equipment such as electrical, gas and fire safety equipment.

The people we spoke with who used the service and two family members all said that they knew what was in their care plans and they had been asked to give consent. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

The three staff we spoke with knew the individual care needs of people who used the service. One relative said “the care provided will be whatever the person wants”. Two people said that staff knew their preferences and that they met their needs “very well”. Everyone said that staff treated them with dignity and respect.

We saw evidence in the training matrix that nearly all staff had up to date mandatory training. The manager used a computerised system which recorded supervisions and appraisals and notified the manager when training was due. We saw five staff files that showed that appropriate pre-employment checks such as CRB clearances and two references were obtained.

We had concerns about people's care and treatment records. These included the assessment of pressure damage to people's skin, the monitoring and management of people's weight and incident reports kept separately from people's daily records. We judged that this had a moderate impact on people who used the service.

We reviewed the systems in the home that identified, assessed and managed the risks to health and safety and assessed and monitored the quality of service that people received. We found that these were not sufficiently robust and that this could have a moderate impact on people who used the service.

We found that the provider had not notified us when people died or were seriously injured whilst living at the home. We judged that this could have a minor impact on people in the home.

We received a provider action plan on 8th October 2012 and visited the service on 16th January 2013 to follow up the compliance actions.

We found that the provider had taken action to ensure that the service was compliant in all areas. They had amended assessments in the care plans and improved their quality assurance systems. They had been sending us the required notifications in the appropriate format.

We were able to talk with some people who lived in the home and also observed the care of some people who could not talk with us.

We received positive feedback from people who lived in the home and their relatives. Some of the comments were; 'I am happy here, staff are kind and respectful, they give me a bath every Thursday' and 'I am really happy with the care she gets and she's happy that's the main thing'.