Chipchase House and Ferndene

We found the following examples of good practice.

Staff followed safe infection control procedures and were knowledgeable about how to use their PPE effectively in line with government guidance.

The provider had invested in mobile technology that included an IPC resource centre to help staff have easy access to IPC guidance and procedures. There were nominated IPC champions to help promote good IPC practice. The management team met regularly to review new IPC guidance and standards and discuss emerging risks so timely action could be taken.

We found the following examples of good practice.

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infections. There had been no known cases of Covid-19 at the service. One person told us, “It’s as safe as it can be here. The staff wear PPE (personal protective equipment).”

¿ The environment had been adapted to support social distancing. Two adjoining lounges had been opened up to form one large area. Meal-times had been staggered to reduce the number of people in the dining room. Additional cleaning was being carried out.

¿ Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. Infection control champions were in place. These were staff who monitored staff practices to ensure the correct procedures were followed. The provider continuously passed on important information about Covid-19 to staff. Various signs and posters were displayed around the service to inform staff and people of best practice guidelines to keep everyone safe. Information was also available in an easy read format.

¿ Staff supported people’s emotional and social wellbeing. People kept in contact with their friends and relatives via the phone and various social media outlets. There was a room which was accessible from the outside and marquee in the garden which relatives used when they visited.

¿ Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and dedication which staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing.

Chipchase House and Ferndene is a residential care home providing accommodation and personal care to 48 adults in one adapted building and 10 separate bungalows. People who live at Chipchase House and Ferndene have varied health and social care needs, including mental health, physical disabilities, learning disabilities and dementia.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People had seen an improvement to the service they received. The management team had strived to achieve high standards through continuous improvement and development. The quality and safety of the service was monitored through necessary checks and audits.

People’s care needs were thoroughly assessed. Risks to people’s health, safety and well-being were identified and minimised. Medicines were well managed. Staff provided support which met with people’s current needs and the records reflected this. Accidents and incidents were investigated and reported as required.

Staffing levels had increased. Staff were now well supported to provide high quality, person-centred care to people. Staff recruitment continued to be safe and staff training was up to date. Competency checks were carried out to ensure staff remained suitable for their role.

People felt safe at Chipchase House and Ferndene, with support from caring staff, who knew them well. People’s privacy and dignity were protected, and staff were respectful. Staff encouraged independence, and people were involved making decisions and developing their care plans.

People were well engaged in social activities and supported to pursue their hobbies and interests. This promoted socialisation and community involvement and helped to reduce loneliness.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 October 2018). We identified three breaches of regulations related to safety, staffing and governance of the service.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about Chipchase House and Ferndene until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chipchase House and Ferndene 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 service is registered to provide support for up to 51 people. At the time of the inspection there were 48 people using the service. The majority of people who use the service have a physical disability. A small number of people also had mental health issues or a learning disability. The service is separated into two parts. Chipchase is a multi-storey building supporting people who have their own rooms or flats. Ferndene is a separate building where people live in self-contained accommodation but continue to receive regular support from staff. The home is part of the Percy Hedley Foundation which is a registered charity that provides services for disabled people and their families. The home is situated in Forest Hall, North Tyneside.

The care service had regard for the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The service has been established a number of years and so is larger than would now be considered appropriate. However, there remained an awareness of registering the right support and consideration was given to ensuring people with learning disabilities and autism using the service could live as ordinary a life as any citizen.

At the time of the inspection there was a registered manager in post. The registered manager had been formally registered with the Commission since November 2014. 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. We were supported on the inspection by the registered manager and the deputy manager.

Prior to the inspection we were aware the service was in organisational safeguarding. Some of the matters related to the organisational safeguarding are still ongoing and we will monitor the outcome of these investigations. Most staff we spoke with were aware of safeguarding issues and told us they felt confident in reporting any concerns around potential abuse. They said, if necessary, they would report any concerns higher up in the organisation, as part of the provider’s whistleblowing policy, or to the local authority safeguarding adults team.

Checks were carried out on the equipment and safety of the home. The majority of checks carried out on systems and equipment were satisfactory. Risk assessments linked to people’s care were available but not always clearly linked to the delivery of day to day care or did not reflect current issues highlighted in daily records or reviews. Risk assessments with regard to moving and handling were in the process of being reviewed and updated. We had received information from visiting professionals that cleanliness and infection control issues were not always being appropriately addressed. We found action had been taken with regard to this matter and equipment and the environment were clean and tidy.

Staff and people who used the service had mixed views on staffing. Some told us basic care was good but there was limited time for more individual care activities, although some did take place. The provider had in place a system to help determine staffing levels, although this mainly concentrated on the physical needs of people who used the service. We have made a recommendation the provider review staffing and review dependency processes for the service. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience.

We found some issues with the safe management of medicines. Medicine administration records (MARs) were not always fully completed and instructions for the use of creams and lotions were not always detailed. Where MARs had been produced by the service itself these had not been checked and signed by two staff to ensure they were correct. One person had a significant number of controlled medicines stored by the service, although had not received any medicines for the past three months.

Staff told us they had access to a range of training and some certificates were available in staff files. The manager showed us a copy of an overarching training record, although this was not easily followed. Staff told us they did not always receive appropriate supervision in a timely manner. The registered manager told us supervision had been an issue at the service due to staff sickness. Some staff told they had not had an annual appraisal recently. Staff had an understanding of issues related to Equality Act 2010 and ensuring people who used the service were treated fairly and appropriately.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Appropriate applications for DoLS had been made. The majority of people who used the service had capacity to make their own decisions. There was evidence in service records people had been supported to do this.

People were supported to access health care services to help maintain their physical and psychological wellbeing. A health professional told us there were improving relationships between the service and local health facilities. People were supported to access adequate levels of food and drink.

Certain areas of the home were in need of refreshing or redecoration. The nominated individual told us plans were being developed to relocate the service to a purpose built facility, although this was still at an early stage. The registered manager agreed ongoing updating of the facilities was still required.

Prior to the inspection we had receive whistleblowing information suggesting the approach of some staff was not always appropriate when delivering care. We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Staff displayed a good understanding of people as individuals and of treating them with dignity and respect. People we spoke with told us they had been involved in determining their care needs and care review processes.

People’s needs had been assessed and individualised care plans had been developed that addressed identified needs. Some care plans had detailed information for care staff to follow. Other care plans lacked specific detail about how to support people. Reviews of care plans were regularly undertaken and any changes noted, although these sometime lacked detail. People were supported to attend various events and activities in the local community and activities also took place within the home. Some people told us they would like more opportunity to go out into the community but staffing was not always available. People were supported and encouraged to make choices.

The provider had in place a complaints policy and people told us they could approach the registered manager to deal with any concerns they had. Complaints records were up to date and records showed appropriate action had been taken in relation to any matters raised.

Regular checks and audits were carried out on the service by managers and senior staff within the organisation. Whilst the range of audits was comprehensive, these checks had not highlighted the issues identified at this inspection. In particular, recommendations made by an outside pharmacist had not been fully implemented and actions in response to a recent staff survey had not been developed. Daily records were not always detailed and did not fully reflect people’s presentation during the day.

Staff were positive about the registered manager and felt she was effective in running the service. They also told us she was approachable if they had any concerns. Staff told us there was a good staff team and felt well supported by colleagues. Regular staff meetings took place and staff told us they were able to raise issues in these meetings. The provider was meeting legal requirements with regard to notifying us of incidents and displaying the current quality rating for the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment, Staffing and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Chipchase House and Ferndene is a care home without nursing operated by The Percy Hedley Foundation. The service is situated within a large site in a quiet, residential area in Forest Hall, North Tyneside. Chipchase House is a two storey residential care home offering single rooms with shared adapted facilities or self-contained bedsit style accommodation with integrated kitchen and private bathroom. Ferndene is a neighbouring row of purpose built one bedroom bungalows.

The service can accommodate 51 people and at the time of the inspection provided care and support to 50 adults who were living with a physical disability. Some people living at the service also live with a learning disability.

A registered manager was registered with the Care Quality Commission at the time of the inspection. The registered manager had not changed since our last 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 told us they felt safe living at the service. Staff understood how to identify potential concerns and knew how to respond. Any safeguarding concerns, incidents or accidents were recorded, investigated and responded to appropriately.

Safe recruitment practices were followed and recommendations made at the last inspection in relation to staffing levels had been responded to. Improvements continued to be made in relation to the recruitment of additional staff in response to people’s level of need. A group of bank (as and when needed) staff were available to provide additional staffing as required.

Recommendations made in relation to the meal time experience had also been responded to. There were now two sittings at lunch time to ensure people had plenty of space in the dining room and meals were not rushed. The evening meal was held in a much larger dining area. Medicines were no longer administered in the dining area and people said they were happy to go to the treatment room for their medicines.

Medicines were stored, administered and recorded in a safe way. All necessary documentation was in place and records were accurate.

Risks were appropriately assessed and care plans were in place which provided staff with the details needed to support people appropriately and safely. People told us there were involved in developing and reviewing their care plans and some people directed their own support.

Staff were appropriately trained and supported to ensure they had the skills and confidence to meet peoples' needs.

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 were supported in a kind, caring and compassionate manner and their rights, privacy and dignity were respected.

Staff supported people with all aspects of their lives including nutrition, health and taking positive risks. People told us they were included in decision making about their care and also in relation to the management of Chipchase House and Ferndene.

People knew how to complain and we saw any comments were recorded, investigated and responded to, to people’s satisfaction.

The service continued to be well-led and people said they knew, and liked the management team. People, and staff, were included in identifying improvements to the service via representation on the board of trustees. People had been instrumental in supporting the head of residential services with a strategic plan for Chipchase House and Ferndene which included modernisation and redevelopment.

Quality assurance and governance systems were in place which identified areas for improvement. A quality improvement plan identified the outcomes of improvements, target dates for completion and an assessment of impact and risk.

This inspection took place on the 22, 23 and 24 March 2016 and was unannounced. We last inspected this service in July 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The service had a registered manager in post. 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 told us they felt safe living and Chipchase House and Ferndene. Staff understood their responsibilities with regards to protecting people from harm and improper treatment. There was mixed opinions amongst people and staff as to whether there were enough staff employed at the service. We discussed this with the registered manager and the head of residential services who told us they always ensured people’s assessed care needs were met. The service used agency staff most weeks to cover vacant shifts. The registered manager was in the process of recruiting more staff to strengthen their team of permanent care workers. We have made a recommendation about staffing levels.

Policies, procedures and systems were in place to ensure the smooth running of the service. Care needs were thoroughly assessed and plans were person-centred. Risks were regularly assessed and preventative methods were in place to instruct staff on how to deal with a situation.

Accidents and incidents were recorded, investigated and monitored. Action plans were in place to reduce the likelihood of a repeat event. The registered manager reported all incidents to external bodies as necessary.

Routine checks on the safety of the home were carried out by on-site maintenance staff as well as by external professionals where necessary. Personal emergency evacuation plans were in place.

Medicines were managed well and in line with safe working practices. Medicine was administered safely and medicine administration records were well maintained and accurate.

Resident steering groups were held and an annual survey was used to gather feedback and opinions from people and their supporters about the home and the service they received. The service employed their own advocate to ensure people were involved in the development of the service.

The registered manager had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. Only one person who lived at the home was assessed as lacking mental capacity and the registered manager had applied to the local authority for a deprivation of liberty authorisation.

People were supported by staff to maintain a well-balanced, healthy diet, although people’s opinions of the food and their experience at mealtimes were mixed. We have made a recommendation about mealtimes.

We found staff received an induction and were trained; however some formal supervisions and appraisals were overdue within the staff files we examined.

Staff displayed caring attitudes and treated people as individuals. We heard staff gave people choices and encouraged them to make small decisions. People were respected by staff and their privacy and dignity was maintained.

People participated in a variety of activities. The staff supported people to maintain links with their community by encouraging visitors into the home. Individual and group activities were on offer and the service had the use of transport to facilitate day trips and outings further afield.

Everyone we spoke with told us they knew how to complain and would feel confident to approach the staff or registered manager if there was a need to do so. Staff also said they wouldn’t hesitate to assist a person to make a complaint.

The registered manager held a comprehensive set of records which showed they monitored the quality and safety of the service.

Staff told us they were proud to work for the provider and had a good relationship with the people who lived there and the management team.

We considered all the evidence we had gathered under the regulations 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?

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who used the service and that these assessments contained enough detail to minimise risk to people.

We saw people were safe and protected from abuse. Staff demonstrated an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

The provider maintained accurate records and these were available to us on the day of our visit.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and the manager and deputy manager had received training in the Mental Capacity Act 2005 (MCA) and DoLS.

Is the service effective?

People who used the service were asked about the support they received and if they understood their rights. They told us they were given the information they needed to make informed decisions about their care.

People who used the service were asked about the support they received and if they understood their rights. People we spoke to were aware of their rights and what to do if there were any problems.

Is the service caring?

People's preferences, interests and needs were recorded in their care records. Staff were able to give examples of these when we spoke with them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

People's health and care needs were assessed with them and they were involved in this process.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a registered manager in place at the service.

The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service which meant the provider could monitor the service delivered and address any concerns identified promptly.

We found people were involved in decisions about their care whenever possible and their privacy and dignity was respected.

During the inspection we spoke with people about their experiences of the care and support they received from this service. One person said, 'I've lived here 50 years next September so that's got to be a good thing, I like it here.' We found the planning and delivery of care did not always meet individual needs or ensure their welfare and safety.

We saw the premises were well maintained and designed to be accessible to all people.

We noted that not all staff had received an appraisal or had regular supervision and staff training needs were not being met.

The provider did not have an effective system to regularly assess and monitor the quality of the service that people received. We found that where informal comments had been made, appropriate action was not always taken.

There was an effective complaints system available.

We found that care records did not always contain accurate or appropriate information.

People and their relatives told us, and records confirmed that consent was gained before care was carried out. We saw that people were asked for their consent and the provider acted in accordance with their wishes.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that they were "very happy" with the service. One person told us "I've been here 48 years and seen a lot of changes, but it is still very nice."

We witnessed steps had been taken to provide care in an environment that was suitably designed and adequately maintained to meet the specific needs of people in a way that kept them safe. We noted that staffing was structured in such a way as to promote people's independence and meet their individual needs. Relatives were complimentary about the staff who worked there. One person told us, "All the staff are lovely and let us know what is happening."

We noted that the provider had a complaints system in place and acted on comments and complaints received.