Archived: Chapel Brook House Nursing & Residential Care Home

During the inspection we spoke with the acting manager and the provider and three other members of staff. We also spoke with four of the people who lived in the home.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked in detail at the care being delivered to five people who lived in the home. We found that actions stated in people's care plans as being required to care for and monitor their health were not being taken. For example one person at high risk of malnutrition was not being weighed at the intervals specified in their care plan. This meant their weight was not being monitored closely which increased the risk to their health and well-being. We had identified this issue at our previous inspection and had been told by the provider that the problems had been rectified but we could see that they had not.

Is the service effective?

Examination of care records showed that care plans had not always been updated to reflect people's current personal and healthcare needs. For example the care plan for one person regarding their mobility had been written in November 2013. The care plan had not been rewritten or updated to reflect significant changes in this person's needs. Without up to date and accurate care plans there was a considerable risk that staff would not have the information they require to deliver effective care, particularly as the home was mainly being staffed by agency nurses providing the nursing cover. These nurses were not employed by the home and would not have known the people who lived in the home as well as staff who were employed by the home.

Is the service caring?

During our inspection we saw care staff engage and interact positively with people who lived in the home. They appeared to know the people well and have good relationships with them. One care staff told us that they were disappointed that the home was closing. They felt that the care they provided was good but they were aware that there were a lot of problems. The nurse on duty during our inspection spent a considerable period of time ringing care agencies to find cover for the night shift for that night which took her time away from supporting the people in the home.

During our inspection we saw people who lived in the home were sitting for long periods with nothing to do. We saw that there was an activities worker present but they were spending the majority of their time in the conservatory writing records. In the afternoon we saw the activities worker play bingo with three of the people who lived in the home but we did not see any interaction or engagement with the nine other people in the home.

Is the service responsive?

The provider had told us that building plans and finances had been agreed in principle to re-build the conservatory. We went into the conservatory and could see that no changes had been made. The conservatory was very cold and there was condensation running down the windows. The day of the inspection was a warm day and as the day progressed the heat in the conservatory was very uncomfortable.

The provider told us that for a number of different reasons work on the conservatory had not been started. Planning permission had not been applied for and no changes had been made to the structure since our last inspection.

At our previous inspection we had raised concerns about the quality of the care plan audits. We had stated that they were not fit for purpose. We asked to see the care plan audits and we saw that none had been carried out following our previous inspection.

Is the service well led?

We spoke with three members of staff during our inspection, two of them were employed by the home and one member of staff came from an agency. All of the staff we spoke with told us that they had not received any formal supervision since they had been working at the home. We asked the acting manager about supervision and they confirmed that the majority of staff had not received any. They showed us a supervision planner which showed that four supervision sessions had taken place since our previous inspection in May 2014. We told the acting manager that this was inadequate and that staff were not being supported appropriately.

At our previous inspection we had raised concerns about the quality of the medication audits. We saw that the acting manager had tried to audit the medication processes. However we had concerns that these processes were inadequate as we were still able to identify a number of problems with the medication records. We were told that due to previous problems with the controlled drugs that these were audited daily. We looked at these records and saw that this audit had been missed five times in the previous 10 days.

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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at medication administration within the home and found a significant number of concerns. We saw that medication was not always administered safely and according to the policies and procedures in place.

We had concerns about the safety of the conservatory in the home. It was not fit for use as living space by the people who lived in the home. This had resulted in cramped, crowded conditions in the available living areas. The conservatory was still being accessed and it does not meet health and safety standards.

Is the service effective?

During our inspection we spoke with five people who lived in the home. They all told us that they were happy living in the home and that they received good care. Comments we received included; "The staff are very kind and they have a gorgeous sense of humour" and "I feel well looked after and they always help me when I want them to."

We also spoke to three relatives who all spoke very highly of the care that their relatives received and of the staff team. One relative told us that their family member had lived in the home for seven years and that they were "happy with the care and the carers." Another relative said "My mum is happy here. We have had our ups and downs but at the end of the day mum is happy. I know that this home has its problems but I would hate to see it closed."

Is the service caring?

During our inspection we observed people using a system called a Short Observational Framework of Inspection (SOFI). This process helps us gather information where people using services cannot verbally communicate with us. People looked clean and well cared for. We saw care staff interacted well with people, were warm, supportive and sat and talked with people, when possible.

During our inspection we did not see any activities taking place. We saw that people who lived in the home were sitting for long periods with nothing to do. We spoke to the provider who assured us that a new activities worker had been employed and was due to commence work as soon as all the pre-employment checks had been received.

Is the service responsive?

We saw that following our previous inspection a number of audits had been introduced and were carried out on a regular basis. We looked at the audits file and saw that cleaning, infection control, fire safety, water temperature and wheelchair safety audits were being carried out on a regular basis, issued had been recorded that were then actioned and recorded.

During this inspection we noted considerable problems with medication administration and with care plans however the audit systems in place had not identified any of these problems.

Is the service well- led?

We raised concerns with the provider regarding the difficulties that we observed during our inspection between the senior staff within the home. The provider informed us that they were aware of these difficulties and that the relationship had broken down and that this was impacting on the home. The registered manager had tendered their resignation due to these difficulties. The provider told us that they were taking steps to resolve the issues.

At the time of the inspection the home was not being well-led. Senior staff had not taken responsibility for the problems in the home. Considerable conflict was taking place and this was having a detrimental effect on the running of the home.

We saw that capacity assessments were carried out and best interests meetings held to uphold people's rights and that there were improvements in the care planning process.

We found that the environment was clean, repairs had been carried out and the security of the home was maintained.

We saw that there were processes in place to ensure that people were recruited effectively, and that the home took appropriate steps to ensure that sufficient staff were available to meet people's needs.

We saw that training and development activities had been carried out, but there were still shortfalls in this area. We found that the home had carried out some audits, but there were still some audits that were planned to be completed.

We noted that there had been improvements within the care documentation at the home, but some records were still not accurate.

We saw that notifications had been submitted to the Care Quality Commission without delay.

Following that inspection we were sent an action plan detailing how the areas of concern would be addressed. During this inspection we found that some areas of the action plan had not been implemented and the concerns remained outstanding. We also identified additional concerns.

We spoke with two family members who said they had no complaints. We spoke with two people who lived at the home, they both told us that they were happy at the home. We spoke with one health professional who told us that they had no concerns with the care people received.

We found that the home still required decoration and maintenance, and that several areas of the home needed cleaning. We also found some equipment required replacement. We saw that a fire door was unsecured throughout the inspection.

We looked at three care records and found that these required updating. We saw that information was difficult to find and that care was not being delivered in accordance with people's needs. We saw that decisions had been made on people's behalf, but there were no records of best interests meetings to ensure that people who did not have capacity had decisions made in their best interests.

We found that staff required training and development in order to enable them to deliver safe and effective care.

We asked the registered manager what audit systems were in place. We were told that no systems were in place at present.

We saw that events that should have been reported to the Care Quality Commission had occurred and had not been reported to us.

We also spoke to four people who lived at the home, they all told us that they enjoyed living at the home and were complimentary of the staff.

We found that in some areas the home required decoration and maintenance. We also found that some areas of the home were cluttered and some equipment required cleaning.

We spoke to one health professional who told us that they had no concerns with the care that people received at the home.

We looked at three care records and found that two of these required updating. We also noted that records were disorganised and information was sometimes difficult to find.

We saw that where appropriate, family members were involved in their relative's planning of care, but that legislation was not being followed to ensure that people who did not have capacity had decisions made in their best interests.

We spoke with four members of staff who all told us that they enjoyed working at the home and that they felt well supported in their roles. They told us that they received some training and development activities to enable them to deliver safe and effective care.

We found that people felt confident to express any concerns. Members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

We noted that all members of staff received the training and support they needed in order to provide safe and effective care for people using the service.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.