This inspection took place on 13 and 14 August 2018 and was unannounced. This meant the provider was not aware we intended to carry out an inspection. At a previous inspection in July 2017 we rated the service as ‘Good’ overall. We undertook this inspection because we were aware the service had been placed in organisational safeguarding by the local authority and we had received professional and anonymous whistleblowing concerns with regard to the operation of the service.
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.