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Archived: Le Chalet Requires improvement

Reports


Inspection carried out on 8 June 2018

During a routine inspection

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

Inspection carried out on 3 February 2017

During a routine inspection

Le Chalet provides personal care and accommodation for up to 12 older people. It is one of two homes owned by Vijay Enterprises Limited. The service does not provide nursing care. People’s nursing care needs are met by the local community nursing team. On the dates of inspection, the service had one vacancy. Some of the people at the service had physical and mental health needs.

This comprehensive inspection took place on 3, 22 and 23 February 2017. At our last inspection on 12 March 2015 we found a breach of regulation with regards to staffing levels. We asked the provider to take action to meet the legal requirement. We did not receive an action plan. We found this breach of regulation had not been met.

There was no registered manager in place. The last registered manager had left several months before and successfully deregistered with the Care Quality Commission (CQC) in November 2016. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

The service had a manager in place. They had applied to the CQC to become joint registered manager for both this service and another service owned by the same organisation in Cornwall, approximately 100 miles away. Staff felt supported by the new manager and felt the service had changed for the better. Following the inspection, the nominated individual confirmed the manager would not be continuing in their application to be registered by CQC at Le Chalet. They were actively recruiting for a new full-time manager.

Not all environmental risks to people had been identified and reduced. Hot water from taps was found to be in excess of the temperatures required under the Health and Safety Executive guidance. This put people at unnecessary risk of scalding. Following the inspection, the nominated individual confirmed this had been addressed and resolved.

Whilst there were some audit systems in place to monitor the running of the service, these did not include all of the areas required. The provider visited regularly but had not always checked on the quality of the systems and the running of the service. Following the inspection, the responsible individual confirmed changes in the management of the service.

The CQC had not received the formal notifications from the service. These are for events which affect the running of the service and are required to be sent by law.

There were not always adequate staff available on duty to meet people’s individual needs and choices in a timely way. No dependency tool was used to assess people’s needs and how many care staff were required to be on duty.

Staff did not always initially follow the correct infection control procedures to prevent the unnecessary spread of infection to people. However, these procedures were improved during the inspection.

The manager and staff had some understanding of the Mental Capacity Act 2005 and how it applied to their practice. However, the correct procedure for following the MCA had not always been followed. For those people who required it, applications had been made to the Deprivation of Liberty Safeguards team.

Staff were safely recruited, trained and supervised to do their jobs properly. They worked as a team, some of whom had worked there for several years. They knew how to recognise and report signs of abuse. They knew the correct procedures to report this.

People were very complimentary of the food. There had been recent changes in the kitchen and a new cook employed. They were in the process of developing new menu plans to reflect people’s likes and dislikes. Food was nutritious and home-made as much as possible. Not everyone received the support they needed to eat their food and at the right times.

People felt safe at Le Chalet and were very comp

Inspection carried out on 12 March, 2015

During a routine inspection

The inspection took place on 12 March 2015 and was unannounced. Le Chalet provides care and accommodation for up to 12 older people who require personal care. The home does not provide nursing care. On the day of inspection there were 12 people living in the home.

The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission (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 and associated regulations about how the service is run.

At our last inspection on 13 November 2013 we found the service was compliant with all regulations covered in the inspection.

Some aspects of the service needed to be improved to ensure people’s safety and well-being. Staffing was not always maintained at safe levels. This was because the home looked after people with increasing care needs; some of whom need two members of care staff to assist them. As the home only had two members of care staff during the day, there were times when no staff were present in the communal areas. The registered manager had not used a dependency tool to review the number of staff needed to meet people’s changing needs. The home’s recruitment processes did not in all cases question gaps in employment history or ensure references were sufficient to demonstrate staff were suitable for employment. These issues were discussed with the registered manager at the time of the inspection and we were told they would be addressed.

On the day of our inspection there was a homely and friendly atmosphere at Le Chalet. People were relaxed and happy. People, their relatives and health care professionals all spoke highly about the care and support provided. One person said “I love it here” and another said “I’ve got no worries about anything”. One health care professional said it was “home from home”.

People said they felt safe. Staff undertook training to ensure they understood how to recognise and report abuse. All the staff said they would not hesitate to raise any concerns.

Care records were comprehensive and up to date. They contained detailed information about how people wished to be supported. People’s risks were managed, monitored and reviewed to help keep them safe. People had choice and control over their lives and were supported to take part in activities both inside the home and outside in the community. Activities were meaningful and reflected individual interests and hobbies.

Staff were caring and compassionate towards people. They respected people’s privacy and dignity. People were complimentary of the staff. Comments included “Everyone is nice to me and I’m safe” and “I’ve got no worries about anything; I know I’m being looked after.” One relative said the “Staff are fine; dedicated” and another said “I am impressed” at how their relative was looked after.

Staff received on-going training to help them develop their skills. One health care professional said staff took advantage of any training offered. The registered manager was intending to introduce an improved induction training programme for new staff.

The service followed the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who were not able to make important decisions themselves. The registered manager was organising enhanced MCA training for all staff.

People had their medicines managed safely and received them on time. Staff knew people well; they recognised changes in people’s health and took prompt action when required. Good communication networks had been made with health and social care professionals. Where specialist advice was sought, one health care professional said “They follow correct procedures and advice”. Other health care professionals said “If staff are worried about anything, they get in touch” and “They call appropriately.”

The home used a specialist frozen food service for main meals. People received balanced and nutritious meals but gave mixed views about whether they liked the food. Comments ranged from “Food is excellent” to “Food is not too bad.”

People and their relatives were able to talk to staff and the manager about any concerns they had and were confident they would be dealt with. Staff felt supported and valued. There was strong leadership in the home but it was not clear who took charge of the home when the registered manager was on leave. This could affect the continuity and consistency of care to people.

There were effective quality assurance systems in place that monitored people’s satisfaction and improve the quality of the service. Investigations following incidents and accidents were recorded and audited so that any learning for future practice could be considered.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 13 November 2013

During a routine inspection

Our inspection was unannounced. During this visit, we inspected five outcome areas; all five were compliant.

There were 12 people living at the home, one of whom was having respite care. We spoke with 5 people living at Le Chalet. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We spoke with five staff members, the registered manager, the provider and two relatives. We looked at four sets of care records, focussing on how people�s health and well-being were supported, including people�s dietary and medication needs.

We saw people looking relaxed and at ease with staff and each other. People�s health and well-being care needs were assessed, and care was provided in a way that suited people's individual needs. Medication was well managed, as were people�s nutritional needs. People were offered choices in relation to meals and drinks, and meals were a social event. The manager recognised people�s changing health and emotional care needs, and requested additional support where necessary.

Inspection carried out on 30 November 2012

During a routine inspection

During this unannounced inspection, we spoke with five people who lived at the home and to four members of staff, including the cook. We observed care and support being delivered in a kind and respectful way.

We looked at some key documents including care plans, risk assessments, staff training and supervision records. This helped us to make a judgement about how well the home was being run.

We heard positive comments from everyone we spoke with. One person told us, for example ''I have been here two years now. They do look after us well. If they didn't they would get the length of my tongue. They (staff) have to put up with a lot sometimes. They do very well.''

Care was being planned and people were involved in making decisions about their care and treatment and activities of daily living. We saw that people were encouraged to be engaged in various activities and we heard from the manager that the provider had given the staff team some additional hours to take people out and about in the local community and organise planned activities within the home.

Staff had received support and training to do their job and this was being monitored by the provider and manager via team meetings and one to one supervison.

We saw that records were kept secure, were accurate and up to date. There were two entries within daily records for people that were not objective. This has been addressed via additional training and support to staff.

Inspection carried out on 6 December 2011

During a routine inspection

We brought forward a planned review of this service in light of some information of concern we received. This related to peoples� bedrooms being cold and hot drinks not being offered frequently enough.

We visited Le Chalet unannounced on 6 December 2011. We spoke to six people currently living in the home and to both staff on duty that day. We observed staff interacting with people and we had lunch with people. We also looked at some records in the home. These included, care plans, medication records and staff recruitment and training files.

We spoke to a commissioning team member and to the district nurse team following our inspection visit. Neither had any issues concerning the home, both said that the home provided good quality care and kept them informed of any issues with people placed there.

People who live at Le Chalet told us that they were well cared for and that they enjoyed living there. Comments included. �� Staff are very good here.�� and ��we are well looked after, food is lovely, all the girls are lovely and it�s a nice small friendly home.��

We saw that care plans provided good basic information about how staff should provide care and support for each person. There were risk assessments in place to help minimise any identified risks with moving and handling for example. We saw that where changes in care had been identified, plans had been changed to show new or increased needs.

Staff were able to say how they worked with people to ensure that they were given choice and helped to make informed decisions in their everyday lives. We did not see any formal documentation to show what should happen if a person lacks capacity to make decisions about their care and treatment. Staff gave examples of how this worked in practice. For example they told us one persons family had been with them to see their doctor and sign for consent for flu vaccination, as the person lacked capacity to make this decision for them selves.

The staff team was small and many had worked at the home for a number of years. They knew the needs, wishes and preferences of the people they cared for. We saw that training was in place to help ensure that they were skilled to provide safe and appropriate care. We have said that a small improvement is needed to ensure that new staff have an induction programme that is documented, to ensure that all relevant topics are covered.

We looked at all communal areas and bedrooms. We found that a couple of the bedrooms were cooler in temperature than the rest of the home. We were told that the staff always open the windows in the bedrooms so that they are aired and there are ��no malodorous lingering smells�� We saw that two people had decided to stay in their bedrooms, and these rooms were not as cold as the others. We were told that if someone chose to stay in their bedroom, then staff did not air the room, but where people were in the lounge, they took the opportunity to clean and air bedrooms. We saw that the home was very clean and fresh smelling. We have asked that bedroom temperatures are monitored.

We saw that drinks were offered at regular intervals throughout the day. We asked staff if people could request additional drinks and we were told yes, but that ��generally our residents have at least six hot drinks a day plus cold drinks, but often they forget they have had their morning tea for example.�� We did see an example of this when we visited.

Reports under our old system of regulation (including those from before CQC was created)