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Chelston Park Nursing and Residential Home - Chelston Gardens Dementia Nursing Home Outstanding

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Inspection report

Date of Inspection: 17 September 2014
Date of Publication: 17 October 2014
Inspection Report published 17 October 2014 PDF

Overview

Inspection carried out on 17 September 2014

During a routine inspection

Two adult social care inspectors carried out this inspection. 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 safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

This is a summary of what we found:

Is the service safe?

Staff ensured people received safe and effective care which was in accordance with people�s individual needs. However people�s care plans were not always reflective of people�s assessed needs. This could place people at risk of receiving unsafe or inappropriate care if they were cared for by staff who did not know them well.

Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included �I feel very safe here� and �I have no concerns at all. If I did, I would tell someone.� A visitor told us �I have never seen anything but kindness. The staff treat people so well.�

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns.

Visitors were only able to access the home when they were let in by staff and all visitors were required to sign a visitor�s book when they arrived and left the home. This helped to provide a safe environment for people who used the service.

People were cared for in a clean, hygienic environment. The systems in place to reduce the risk and spread of infection were effective. We saw that all areas of the home were clean and there were no offensive odours.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager had followed appropriate procedures where concerns about some people�s safety had been identified and certain restrictions were needed to reduce risks to these people.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people�s care and support needs and that they knew them well.

Staff knew how to ensure that people�s rights were respected. They demonstrated a very good understanding of how to support people to make decisions. They knew the procedures to follow where an individual lacked the capacity to consent to their care and treatment. Procedures were in place which meant that decisions about the care and support people received would be made in their best interests.

People enjoyed a range of activities which included in- house activities, trips out and visiting entertainers. . The people we spoke with told us they enjoyed the activities. Comments included �It�s very good. There is always something or other going on. I especially enjoy the music sessions� and �I do enjoy the trips out. We went to the garden centre recently.�

People said they were provided with a choice of meals and drinks; they liked the food served in the home. People were able to choose where to eat their meals. Some people used adapted cutlery to enable them to eat independently. Where people require help to eat their meal they were well supported by a member of staff.

Is the service caring?

People told us staff were kind and caring. We observed staff interacted and supported people in a gentle and professional manner. People appeared comfortable with the staff who supported them.

The people we spoke with were complimentary about the care they received and of the staff who supported them. Comments included �I am very happy here. The staff are nice and everything I do is my choice.� We met with three visitors. They were positive about the care and support their relatives received. They made the following comments �It�s lovely here. I don�t know how they do it. I visit regularly and my X is certainly well cared for� and �the carers really do care. You can see it in their eyes. I am very pleased with the care.�

Is the service responsive?

People received care that was responsive to their individual needs. People�s health care needs had been monitored and appropriately responded to. Information about people�s health needs and contact with health and social care professionals had been recorded. We were informed that the service received good support from health care professionals and there were no problems obtaining their input for people when required.

Staff had a very good knowledge of people�s healthcare needs and were able to tell us about how they monitored and treated individual needs.

One person told us �I saw the doctor recently because I had a pain. I told the nurse and she arranged for the doctor to see me the same day.� Another person told us �If I needed a doctor; all I have to do is tell the nurse and they will make the arrangements.�

The care records we read showed that staff responded promptly to any concerns about people�s health or well-being. We also saw they implemented recommendations made by health care professionals. For example, one person had been seen by a speech and language therapist (SLT) after they had experienced difficulties in swallowing and had lost weight. We saw the SLT team had recommended a diet which should be �mashed� to a certain consistency. We observed this person being assisted with their lunch and saw they had been provided with a meal in accordance with the recommendations made.

We saw people had access to a call bell so they could summon staff assistance when needed. During our visit we observed staff responded promptly for any requests for assistance. People told us staff did not keep them waiting too long when they used their call bell. Comments included �I sometimes need to use my bell at night. The staff are very good and come quite quickly� and �If I ring my bell, the staff are there.�

Is the service well led?

There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

There were systems in place which monitored and improved the quality of the service provided. Regular internal audits had been carried out which monitored the health and safety of people. Internal audits included checks on the home's fire systems, environment, care planning, reducing the risk of falls and the management of people's medicines.

The provider may find it useful to note that the current systems for auditing people�s care plans did not identify that staff had not always created a care plan to reflect changes in people�s needs or following recommendations by health care professionals. We discussed our findings with the manager and quality manager at the time of our inspection.

Risks to people were assessed and reviewed. If risks could be reduced then appropriate measures were taken. If any incidents or near misses occurred they were reviewed to see if any lessons could be learnt or trends identified.

The home was accredited to the �National Gold Standard Framework.� This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life. Many cards praised the staff for the care their relatives had received at the end of their life. Relatives had also shared their positive experiences through our on line �Share Your Experience� survey.