Archived: Le Chalet

Updated 13 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 8, 12 and 20 June 2018; it was unannounced on all visits. One adult social care inspector carried out the inspection and was accompanied by an expert by experience on the first visit. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information we held about the service. This included safeguarding alerts and statutory notifications. A notification is information about important events which the service is required to send us by law.

We reviewed information about people's care and how the service was managed. These included: two people's care files and medicine records; three staff files which included recruitment records of the last staff to be appointed; staff rotas; staff induction, training and supervision records; quality monitoring systems such as audits, spot checks and competency checks; complaints and compliments; policies and procedures; action plans; incident and accident reporting; minutes of meetings and the most recent quality questionnaire returned.

We spoke and spent time with all 11 people living at the service and spoke with 11 visiting relatives. We spoke to the provider, registered manager and nine members of staff including senior care staff, care staff, the cook, the activities co-ordinator and housekeeper.

We received feedback from the local authority safeguarding team, quality improvement team and the care homes education team (one nurse and one occupational therapist). We sought feedback from five health and social care professionals and received two responses.

Updated 13 July 2018

This announced comprehensive inspection took place on 8, 12 and 20 June 2018 and was unannounced.

Le Chalet is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Le Chalet is a care home registered to provide accommodation with personal care for up to 12 people in one adapted building. 12 people lived at the service when we visited, with one of the people in hospital.

We had previously carried out an unannounced comprehensive inspection of this service in March 2015. At that inspection we rated the service as good overall. The effective, caring, responsive and well led sections were good. The safe section required improvement due to low numbers of staff on duty. We then carried out a further comprehensive inspection in February 2017. Following that inspection the service was rated as requires improvement overall. The caring section was good. The safe, effective, responsive and well led sections required improvement. Five breaches of regulation were found. We found concerns relating to people’s health, care and welfare. There were not sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet people’s needs. The principles of the Mental Capacity Act (2005) had not been followed. The service had not notified the CQC of incidents as required by law. The provider’s quality assurance systems did not effectively assess and monitor the quality of the service.

Following the inspection in February 2017, the provider submitted a service improvement plan (SIP) to CQC. We then met with the provider and newly appointed manager to discuss the SIP and the timescales required to meet their legal requirements. The local authority Quality Assurance Improvement Team (QAIT) supported and worked with the service up to December 2017 to address the breaches of regulation.

The manager was now the registered manager of the service. A registered manager is a person who has registered with the CQC 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.

At this comprehensive inspection, we found the provider and registered manager had made improvements to how the service was run. The breaches of regulation had been met. However, there were still further improvements to be made. This related to:

• The management and leadership of the home and the embedding of quality monitoring systems

• The adaptations, fabric and furnishings of the home to make it an environmentally safe and pleasant place for people to live

People and relatives were happy with the care and support provided at Le Chalet. They spoke positively of the management and staff team. There was a relaxed, homely and happy atmosphere at the home.

There were sufficient and suitable numbers of staff on duty to keep people safe and fully meet their needs. The service had recently had two staff members leave. The registered manager had acted quickly and recruited three new members.

Recruitment checks were safely carried out with updated employment records in place. Staff received regular induction, training and supervision. Some of the staff had been historically reluctant to undertake training in the past but the registered manager had addressed this by introducing new training programmes.

People were protected by staff who had been trained in safeguarding people from abuse. They had undertaken training, knew the right action to take and who to inform if abuse had been suspected.

People’s needs were assessed before they came to live at the service. People had personalised and comprehensive care plans in place. They contained all the information required and detailed people’s preferences, choices and interests. Risk assessments had been carried out in a way to ensure people were restricted as less as possible. People were involved in making decisions about their care. They were referred promptly to health care services when required and received on-going healthcare support.

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. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Staff knew which people had a Power of Attorney (POA) in place to support the person in decision making. Best interest decisions had been made and involved the relevant parties.

People received their medicines in a safe way and effective systems were in place. The registered manager and staff were committed to ensuring people received end of life care at the service in an individualised way. An activities co-ordinator had been employed. People had a choice of activities and interests to take part in.

Staff were polite and respectful when supporting people. They had built up relationships with the people they supported and knew them and their families well. People’s relatives and friends were able to visit at all times and were complimentary of the service. Regular feedback was sought from residents and their relatives.

The majority of staff felt were motivated and proud of their jobs. They felt they were listened to and had confidence in the registered manager. There had been some unsettlement recently in the staff team but this had been addressed by the provider and registered manager.

People were complimentary of the food and enjoyed the choice of home cooked meals. They were given choices and asked about their favourite meals.

There was a complaints procedure in place and people knew how to make a complaint if necessary.

People, relatives and health and social care professionals were complimentary of the registered manager and their approach. They spoke of them having good communication, together with fostering a friendly and open culture at the service. A quality monitoring system had been put into place which monitored and improved various aspects of the service. This was being further developed to cover all areas of the service.

The physical environment was not consistently decorated or adapted to meet people’s needs. A maintenance and improvement programme was not in place. Therefore, areas of the home which required refurbishment and maintenance were not monitored. There were no specific dates and timescales for actions to be completed by. Some aspects of the service were tired, not fit for purpose and would benefit from continued investment in the premises.