Archived: Chesapeake House

Chesapeake House is a residential care home, registered to support 11 adults, in an adapted building over two floors. The property is two houses converted which was registered before the

Registering the Right Principles were adopted. Chesapeake House is registered to provide accommodation for persons who require nursing or personal care, for adults with learning disabilities. Personal care was also provided for up to four people who were supported to live more independently in individual flats in supported living settings, which were located on the same site.

At the time of our inspection, 11 people were receiving residential care which included one person living in the individual flats on the same site. A further three people were living in the flats, not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. One person was in receipt of personal care when we visited.

The service had not fully 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. However, the size of the service having a negative impact on people was not fully mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were was an identifying sign and industrial bin outside to indicate it was a care home.

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

The providers quality monitoring systems were not effective to monitor the quality of care provided and to drive improvement. The provider lacked oversight in reporting all incidents. Risk guidance to keep people safe was not always detailed to ensure staff knew what action to take should a person become unwell. Window restrictors were still not fitted to the windows on the second floor, to prevent accidents. People's safety was not protected by the provider's recruitment practices, as not all pre-employment checks were carried out. Support plans and risk assessments were not always in place to ensure people’s needs could be consistently met.

We recommend the provider assesses the environment both internally and externally to ensure there are no hazards for people with limited mobility.

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.

The outcomes for people using the service reflected 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.

Staff received an induction, ongoing training and support to discuss their work and developmental needs. However, staff had not received training relevant to the needs of the people at the service.

People told us they felt safe at Chesapeake House. Staff understood their responsibility to safeguard people from harm and knew how to report concerns.

People were supported to maintain relationships with people important to them. Staff were caring in their approach and had good relationships with people. Staff treated people with respect and their dignity and privacy was respected. People were supported by staff to maintain their independence.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported to eat and drink enough to maintain a balanced diet.

Refreshments were available to people throughout the day. People and their representatives were involved in their care to enable them to receive support in their preferred way. People were supported to access local community facilities to enhance their well-being.

The provider's complaints policy and procedure was accessible to people who used the service and their representatives. Peoples representatives knew how to make a complaint. Relatives and staff felt they could approach the registered manager if they had any concerns.

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 11 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

During this inspection, we identified one breach of the Health and Social Care (Regulated Activities) 2014. This was in relation to the governance of the service. A breach of the Care Quality Commission (CQC) (Registration) Regulations 2009 was also identified relating to notifying CQC of incidents.

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

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.

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.

Chesapeake House is registered to provide accommodation and personal care for up to 11 adults with learning disabilities, who live at Chesapeake House. Personal care is also provided for up to four people who are supported to live more independently in individual flats, which are located on the same site. At the time of our inspection, 10 people were living at Chesapeake House and three people were living in the flats located on the same site.

A registered manager was in post and was available throughout the inspection. 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.

Staff understood how to keep people safe and were aware of their duty to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe medicines management practices were followed by staff.

Staff felt supported and received induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005.

People had sufficient to eat and drink and nutritional risks were monitored by staff. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. However, advocacy information was not easily available to people. People received care that respected their privacy and dignity and encouraged their independence.

People received personalised care that was responsive to their needs. Care records contained sufficient information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising concerns with the management team and that appropriate action would be taken.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided. However, these systems could be more clearly documented and more structured audit tools could be used to ensure that all areas of the service were being fully monitored.

Staff also told us they had the opportunity to undertaken qualification courses and said they were satisfied with the training they received.

We found that staff training had improved since our previous visit in April 2013 and training in essential health and safety areas was up to date. Staff had the opportunity for supervision on a group basis.

We saw that quality assurance processes had improved and the service had gathered feedback from staff and service users and their families via meetings and surveys. Feedback was all positive and praised the service and staff. One comment said 'An extremely well run establishment'.

However, the service was not recording any checks of care records or medication records, which meant it was unclear if policies and procedures and good practice were being followed.

Water temperatures were being monitored on a monthly basis to ensure they were safe and the provider had purchased new policies that were up to date.

Relatives also told us that they were satisfied with the service provided. One said "They look after people very well".

We saw that people were undertaking a range of activities during the period of our visit such as pursuing their own hobbies and accessing local community facilities.

We found the provider had made some improvements to the service following our last inspection visit in November 2012. Medication procedures had improved, water temperatures in one area were being monitored and safeguarding information had improved. Although the provider had purchased new policies some of the information in them remained out date. There had been no improvement in monitoring the quality of the service as there was no evidence that feedback was obtained from either service users or staff.

We found that people were involved in discussions about their needs and care. One person said that 'I like it here. I like the food and staff look after me well.' Another person told us that 'staff help me to be independent. I can go to bed when I want and get up when I want.'

A visitor said that Chesapeake House is a 'wonderful place, with a friendly and family environment.' They told us that the staff 'really do care about residents by thinking about their individual needs and giving them choices.' They felt that their friend was always respected and treated well by staff.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs. We saw that staff had received relevant training for their job.

We found that the provider did not have up to date safeguarding policies and procedures in place to identify the possibility of abuse and prevent abuse from happening to people who use the service.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines.

We found that the provider did not have formal systems in place to monitor the quality of the care and service that people receive, and to identify and manage risks to the health, safety and welfare of people using the service and others.