The Chace Rest Home

The Chace Rest Home is a residential care home providing personal care and accommodation for up to 41 people, some of whom have dementia. There were 38 people living at the service at the time of our inspection.

People's experience of using the service and what we found

People were supported in a way that was person-centred and achieved good outcomes. However, systems to review the quality of care and ensure the good governance of the service were not always effective in driving improvements. Quality assurance processes were being improved upon by the newly registered manager, and they recognised some areas still required development.

Risks around people’s health and well-being had been identified, but records to demonstrate risk management were not always accurately completed. People had their prescribed medicines available to them, although some improvements were required around the management of ‘patch’ medicines and ‘as required’ medicines. The home was clean and tidy, and staff understood their role in minimising the risks of infections spreading.

There were enough staff to meet the needs of people living at the home and staff were on hand and attentive to support people’s physical and emotional wellbeing. Staff were trained in safeguarding and understood their responsibility to protect people from avoidable harm, abuse and discrimination. 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.

Staff were motivated to provide good standards of care and we received positive feedback from relatives about the staff team. The registered manager was establishing and improving practices to support positive outcomes for people and worked with other healthcare professionals to ensure people’s healthcare needs were met.

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 requires improvement (published 9 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chace Rest Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to Good Governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

People's experience of using this service:

¿ The provider’s systems and procedures in place to manage the risks associated with the storing of items which were of a potential hazard to people and from cross infections needed to be strengthened.

¿ Staff were knowledgeable about safeguarding and able to raise concerns.

¿ Personalised risk assessments for some people needed to be in place so staff had all the guidance required to promote people’s safety and consistency in care.

¿ People told us they felt safe living at the home. They told us the staff team were kind and caring and they treated them in a considerate and respectful way.

¿ People were supported by staff at the times they needed care without unnecessary delay and systems were in place to recruit staff safely.

¿ People were supported to take their medicines to meet their health needs.

¿ Staff were supported through on-going supervision and they accessed training relevant to people's needs, to ensure these could be met.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People’s needs and wishes were assessed before they moved into the home with their preferences forming part of this so people’s needs could be met and they would not be discriminated.

¿ People were encouraged and supported to make choices about what they ate and drank.

¿ The provider had taken some measures to create a dementia-friendly environment, and had plans in place to further adapt the home to people’s needs.

¿ Staff and management worked with a range of health and social care professionals to ensure people’s needs were monitored and met.

¿ Staff recognised the need to promote people’s equality and value their diversity.

¿ People had the opportunity to participate in activities for fun and interest, and the registered manager gave assurances they would continue to develop personalised activities to meet each person’s needs.

¿ People who lived at the home and relatives knew they could speak with the registered manager if they had any complaints and concerns to raise.

¿ The provider and management team had quality assurance systems and processes in place to monitor the quality and safety of people’s care. However, daily quality checks needed to be strengthened to identify staff practice concerns and drive improvements. After the inspection we received actions the management team and provider had taken which included some of the concerns identified during the inspection.

¿ People who lived at the home, relatives and staff found the registered manager was approachable and willing to listen.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection, on 9 November 2017, the service was rated Requires Improvement (report published 22 February 2018). At this inspection the rating has remained Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

The Chase Rest Home 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.

The Chace Rest Home provides accommodation and personal care for a maximum of 41 older people. On the day of our inspection there were 34 people living at the home, some people living at the home were living with a Dementia.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 our last inspection in September 2016 we found the provider was good overall, however we found the provider had not ensured people received consistent quality care.

At this inspection we found areas where improvements had been made, however these had not been fully completed or sustained. We also found other areas where improvement was needed. This is the third time the service has been rated requires improvement.

The management team had improved how staff were allocated, and people told us staff met their needs in a timely way. However, on-going monitoring to identify where staff practice needed improving was not consistently completed. People continued to receive an inconsistent experience of the quality of care they received.

Improvements to bathrooms to reduce the risk of infection had been identified but not completed. The provider had included these in their planned improvements.

We found shortfalls in systems which failed to identify when Deprivation of Liberty Safeguards had expired and best interest decisions had not been completed. The registered manager and the provider had not ensured there was a system in place to monitor this.

Where people needed support with making some decisions, information was not always recorded effectively and staff did not consistently understand what this meant to their practice. Reviews on people’s best interests decisions were not always completed in line with legislation.

The provider had failed to ensure their web site displayed their performance ratings in line with current legislation.

People told us they felt safe because staff knew them well and were available when they needed them. Staff understood how to recognise potential abuse and where they needed to report any concerns to. People had risks to their wellbeing identified and staff knew how manage the risks to people’s safety. People told us there were sufficient numbers of staff to meet their needs.

The provider used safe systems to recruit new staff. People’s medicines were stored securely and administered as prescribed. Staff had been trained and observed to ensure safe practice when administering medicines. Staff followed infection control guidelines, and the provider had plans in place to update bathrooms to ensure they remained free of infection.

People had their needs assessed to ensure the service could support them effectively. People’s rights and preferences were taken into consideration when their care was planned. The service used information technology to support people’s needs and maintain their independence as much as possible. Staff received regular updates to ensure they were able to meet people’s needs.

People told us they enjoyed the food and were offered healthy choices. We saw people were offered visual prompts to support their decisions about their meal choices. Staff adapted how they communicated with people to ensure they understood the choices they were offered. People were asked for their permission before they were supported, and their wishes respected.

People and their relatives were assured that health and social care professionals were involved when they were needed. The district nurse we spoke with said appropriate referrals were made and staff followed their guidance. Staff worked in partnership with other organisations to support people’s well-being.

People were supported in an environment which was adapted to meet their needs. People had access to different communal areas and there were opportunities for people to follow their own interests and social activities. They had access to outdoor areas which were monitored for their safety.

People had caring relationships with staff, and they knew each other well. People enjoyed the company of other people living at the home and staff supported them to do this. People said their dignity was respected and we saw staff maintain people’s rights and independence.

People had their individual needs met, and staff responded to changes in their care needs appropriately. People felt they were listened to and the management team had made improvements. There were systems in place to manage people’s concerns and complaints and we saw these were completed and learning discussed with staff. People’s preferences and choices about their end of life care were recorded and relatives told us staff showed compassion and understanding.

People were regularly asked for their views about how the service could be improved, they told us they were happy at the home and staff met their needs. Relatives were given opportunities to provide feedback about the quality of the service.

The provider used information technology to monitor and improve the safety and quality of care. People benefitted from staff working in partnership with other organisations to improve their well-being.

You can see what action we asked the provider to take at the back of the report.

The inspection took place on the 6 and 7 September 2016 and was unannounced.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

We carried out an unannounced comprehensive inspection of this service on 19 and 22 February 2016 when we found that they were in breach of the law because they were not managing medication safely. The provider wrote to us to say what they would do to make the necessary improvements. At this inspection we saw that the actions required had been completed and the regulations were now met. However we saw that further improvements were needed in the safe storage of medicines to ensure people had their medicines safely. For example, keys for medicine cupboards needed to be accessed by staff responsible for administering medicines. Also temperatures needed to be monitored to ensure medicines were kept within manufacturer’s guidelines.

People said they were happy with the support that staff provided. They told us staff were caring and helped them stay independent. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People we spoke with said there were regular delays in when they received their meals, and we saw one meal time where delays occurred in people getting their meal. Medicines were administered in a safe way; however we found there were improvements needed in how medicines were stored. People told us they had access to health professionals as soon as they were needed.

Three relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. People living at the home were able to see their friends and relatives as they wanted. People and their relatives knew how to raise complaints and felt confident to do so when they needed to. The registered manager had arrangements in place to ensure people were listened to and action would be taken if required.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well and took people’s preferences into account and respected them.

Staff had the knowledge and training to support people. Staff were aware of the need to ensure people agreed to the support they received. They listened to people’s choices and supported them when needed with decisions.

The registered manager and staff had a culture of focussing on people as individuals. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views about the quality of the service.

The provider and registered manager had systems in place to monitor how the service was provided. However further improvements were needed with the monitoring of the safety of the environment, storing medicines and supporting people with consistent quality care. Newly implemented processes needed to be embedded to sustain and continue the progress with delivering quality care.

The provider of The Chace Rest Home is registered to provide accommodation and personal care for up to 41 people. At the time of the inspection there were 40 people lived at the home.

There was a registered manager in post, who was on duty during our 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.

People did not have their medicines administered and stored in a safe way. The staff practice did not follow the procedures written by the provider and these increased the risk of cross infection. This is a breach of the regulations because the registered person had not ensured the safe management of medicines.

There were some arrangements in place to assess, monitor and improve the quality of the care but these were not always effective. This is because the checking systems had not identified some areas that required improvement actions to be taken. We saw staff did not always follow the risk assessments advice when helping people putting them at potential risk.

People were kept safe from potential abuse and harm by staff who understood how to identify the various types of abuse and knew who to report any concerns to. Staff were trained and supported to meet the needs of people who lived at the home. Checks had been completed on new staff to make sure they were suitable to work at the home.

People enjoyed the food they received and but food and drinks were not consistently monitored to ensure they stayed healthy. When people needed it they had access to a range of healthcare professionals to make sure they remained healthy and well.

People were not always treated as individuals, as staff didn’t always know people’s needs and their individual preferences. Most interactions between people and staff were task orientated.

People knew how to complain and felt able to discuss concerns with the registered manager. The registered manager was visible in the home so people felt able to approach them to discuss their concerns.

You can see what action we have asked the provider to take at the back of this report.

Is the service safe?

People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and care staff. There were risk management plans in place and health and safety arrangements for most people. The premises were well maintained and hygienic so they remained safe for people's use. Staff had received training for their respective roles to promote their competency for delivering safe care and support for people who used the service.

Staff did not have the documentary evidence of the moving and handling assessments carried out by a professional but in their absence staff did not carry assessments themselves. Staff had not developed a care plan for a long term health condition because they were unaware the person had the condition. A recent admission with a history of falls did not have a risk assessment in place to protect them from unnecessary accidents and injuries. We found unsafe staff practices to ensure that people received their medicines as prescribed by the doctor. At times staffing numbers were not adequate to deliver people's care safely or when they wanted it and needed it.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to people's safety.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Most people's health and care needs had been assessed and with the exception of the latest admission, care plans were in place. Care plans were regularly reviewed but not necessarily at the time when people's needs had changed. We found that other health needs had been assessed regularly such as, nutrition, skin care and most people's mobility. Health care professionals helped staff by caring for people's specialist needs. It was clear from what we saw and from speaking with staff that they did not fully understand people's care and support needs because they had not been fully informed. The people we spoke with all said they received the standard of care that matched their needs. Care staff encouraged and supported people in leading interesting and enriched lifestyles.

Is the service caring?

People were supported by attentive care staff who encouraged them to be as independent as possible. We saw that care workers showed patience when supporting people. The people we spoke with were positive about the way they were cared for and supported. A person told us: "They (staff) look after me." A relative said: 'It's (care) very good. They are very proactive and take a lot of time and trouble.' We observed people asking staff to do things for them. Staff responded to the requests as soon as possible and carried them out efficiently. We observed staff encouraging people and making arrangements for them to attend the activity that had been arranged for them. We saw that staff respected people's decision if they did not want to take part in the activity. Staff spent one to one time with people stimulating them by reading magazines with them. People were treated with dignity and respect by staff.

Is the service responsive?

The home had a people carrier and the activities organiser took people to places they liked to visit, such as garden centres. We found when staff identified concerns about people's health they contacted the appropriate professional and asked for their help. The service worked well with other agencies and services to make sure people received care in a joined up way. People and their relatives knew how to make a complaint if they were unhappy. We saw from the complaints that had been received the manager dealt with them in a timely way. Letters of response had been sent to the complainants with explanations and where necessary apologises.

Is the service well led?

Records showed us that improvements had been made when they were identified through the maintenance process. Staff told us they were clear about their roles and responsibilities and the ethos of the service. This helped to ensure that people received a good quality service at all times. There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something. Staff told us they were able to actively contribute during staff meetings so that they may lead to improvements in the service.

The manager told us people who used the service, their relatives and visiting professionals had completed annual surveys. The manager told us the surveys had been analysed and a report developed by the provider but it was not available in the home for people and staff to refer to. Therefore, we were unable to evidence it as part of the inspection process. The manager had failed to regularly check that essential documents had been developed. For example, moving and handling assessments and a care plan for a long term health condition. The manager had not checked that staff had made recordings in the kitchen cleaning schedule to confirm the work had been completed. The manager told us they carried out regular checks regarding staff practices for administration of medicines. We found concerns about the way medicines were administered. The home was registered with The Care Quality Commission (CQC) to accommodate 34 people but we there were 36 people living in the home.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to management of the service.

We looked at care records for three people and other supporting documents for the service. Consent had been obtained from people before care and treatment had been provided. Alternative arrangements had been made to support people who were unable to consent to their treatment or support. Staff told us they: 'Always ask people if they want me to give them care before I give it'.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs. People told us staff were: 'Very good here' and that they were: 'Very happy with the staff who worked at the home'.

We saw that staff were kind and caring in their approach to people who lived in the home. Recruitment procedures were in place that made sure suitable staff were provided to care for people.

A complaints procedure had been made available to people and their relatives should they wish to make a complaint. We saw comments from relatives: 'Thank you for the excellent care and support you give to X (person's name)'.