Archived: Chadderton Total Care Unit Limited

Chadderton Total Care Unit Limited is a residential care home providing nursing and personal care for up to 146 people. The home consists of 6 units all on ground floor level, which cater for a range of social and nursing needs, such as physical and learning disability, acquired brain injury and dementia related disease. At the time of the inspection 109 people were living at the home.

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

Improvements were required with medicines management and the audit and governance process. This included contemporaneous record keeping such as personal hygiene, oral care, repositioning and food and fluid charts.

People felt safe living at Chadderton Total Care Unit Limited. Relatives told us the home provided safe care and felt their family members were well cared for. Enough staff were deployed to meet people’s needs; however, some staff, people and relatives commented on the current high use of agency staff on some units and how the quality and competency of these staff varied. Staff received training in safeguarding and knew how to report concerns. Safeguarding alerts had been made to the local authority where required. Accidents, incidents and falls had been documented and reviewed to help identify patterns and trends. We found the home to be clean, with effective cleaning and infection control processes in place.

Staff received enough training to ensure they could complete their roles safely and effectively. Staff supervision had not been completed consistently, however; a new process had been introduced to address this. People and relatives provided mixed feedback about the meals provided. Recording of people’s food and fluid intake was being completed but further detail was needed. Clear guidance for staff was also needed, to ensure they knew what to monitor, why and what to do if people had not eaten or drank enough each day. Overall, people looked clean and well presented although record keeping around personal hygiene and oral care to was inconsistent. 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. People’s healthcare needs were being met, with referrals to professionals made timely when any issues had been noted or concerns raised.

Care files explained people’s needs and how they wanted to be supported, although the quality and quantity of information varied and depended on whether people had one of the new care plans recently introduced. Peoples’ social and recreational needs were met through an activities programme, facilitated by activity coordinators and staff members. The complaints process was displayed around the home and people told us they knew how to complain and would speak to staff or management if needed. Any complaints received had been dealt with in line with the provider’s complaints policy.

Regular relative and resident meetings had not taken place. However, people and relatives views were sought through surveys, which had been circulated every 3 months. People and relatives were complimentary about the home and care provided, with the majority stating they would recommend the home to others.

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 27 November 2020) and there were 2 breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. We initially inspected the Key Questions of Safe and Well-Led. However, due to identifying ongoing concerns with medicines management and governance on the first day of inspection, we widened the scope of the inspection to include the Key Questions of Effective and Responsive.

This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of the full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chadderton Total Care Unit Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and governance processes, including record keeping at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chadderton Total Care Unit Limited is a residential care home providing nursing and personal care for up to 146 people. The home consists of five separate units all on ground floor level, which cater for a range of social and nursing needs, such as physical and learning disability, acquired brain injury and dementia related disease. Each unit has its own manager who is responsible for the day to day running on the unit. At the time of the inspection 96 people were living at the home.

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

We found improvements were required with the management of medicines and the systems and processes to assess the safety of medicines. Issues we identified with the administration, recording and storage of medicines had not been identified through internal audits.

People felt safe living at the home. Staff knew how to identify and report any safeguarding concerns, with training provided and refreshed annually. Enough staff were deployed to meet people’s needs, with plans in place to cover shortfalls due to sickness or absence. Accidents and incidents had been documented and reviewed to identify trends to prevent reoccurrence and keep people safe.

People spoke positively about the care provided, referring to staff as kind, caring and friendly. People’s privacy and dignity was respected and they were encouraged to maintain their independence by completing tasks they were able to do.

People and staff were involved in the home with their views sought through meetings and questionnaires. The home had been creative in providing ways for people to maintain contact with loved ones during the COVID-19 pandemic. Relatives had sent numerous messages of thanks, many of which were displayed.

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 April 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chadderton Total Care Unit Limited on our website at www.cqc.org.uk.

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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: We found improvements were required in key areas including medicines management, staff deployment and treating people with dignity. Internal and provider level audits had picked up on the majority of issues we noted during the inspection, however senior/nursing staff had not always reported issues of concern to the registered manager.

Medicines were not always managed safely. People did not always receive the medicine they were prescribed and the storage conditions had not been recognised as being unsuitable to keep medicines at the correct temperature.

Staff had appropriate skills and knowledge to deliver care. Staff understood where people required support to reduce the risk of avoidable harm.

People told us Chadderton Total Care was safe and staff were kind and treated people well. Staff had built positive caring relationships with people they supported and their families.

All the people we spoke with told us that the registered manager and staff listened to their views, acted to resolve concerns, when needed, and met people's needs.

People's capacity to consent had been assessed in line with legal requirements.

Where people required support at the end of their life, this was carried out respectfully, compassionately and with professionalism.

We have made a recommendation that the provider reviews the deployment of staff on all units to ensure that staff have appropriate oversight to keep people safe.

We have made a recommendation that the provider increases staffing levels on the young disabled person’s unit to ensure that people receive individualised care and that staff are refreshed with the necessary training and supervision to ensure that people are always treated with dignity and respect.

At the last inspection we identified one breach of Health and Social Care Act (Regulated Activities) Regulations 2014 relating to person-centred care. At this inspection we found that the majority of people at Chadderton Total Care received person-centred care and the provider was no longer in breach of this regulation.

At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to medicines management and good governance. You can see what action we told the provider to take at the back of the full version of this report.

More information is in the full report.

Rating at last inspection: Requires improvement (report published February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we identified some areas which required improvement.

Enforcement: Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to the reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme. If any concerning information is received we may inspect sooner. Chadderton Total Care will complete an action plan detailing how then plan to meet the breaches of Regulations laid out in this report.

The service was last inspected in September 2015 and rated Requires Improvement. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to poor care planning and recordkeeping; inappropriately stored food; poor use of equipment and concerns around governance and supervision. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in these areas but we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to person centred care. You can see what action we told the provider to take at the back of the full version of the report.

Chadderton Total Care Limited is situated in a residential area approximately two miles from Oldham town centre. The home is registered to provide accommodation for 151 adults who require nursing or personal care. At the time of our inspection there were 136 people living in the home. It is a purpose built home, providing accommodation and facilities all at ground floor level. The service provides care for people with a variety of social and nursing needs including physical and learning disability, dementia related disease, and acquired brain injury. Many of the people supported at Chadderton Total Care had multiple and complex needs. The service is separated into five units. The Dales Suite is designed to care for people who have been assessed as needing residential dementia care. The Middlewood Suite is a small unit that cares for people with a variety of nursing needs. The Saddleworth Suite is a purpose built Dementia unit, which has recently undergone some redesign and modernisation to provide a more dementia friendly environment. The Young Disabled Suite provides care for adults aged 18 to 65 years old, and the Lakeland Suite is separated into three much smaller units named, Borrowdale, Ullswater, and Windermere, which provide care for people who have nursing needs.

A Registered Manager was 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 that they felt safe at Chadderton Total Care, and when we spoke with staff they demonstrated a good understanding of how to prevent abuse. We saw that the service had safeguarding procedures in line with legislation and local authority policies so when allegations of potential abuse were raised these were reported and appropriate action taken to protect people from harm.

Staff were well trained and the service made appropriate checks during the recruitment process to ensure that new staff had the right attributes and character to work with vulnerable people. All new staff received a full induction, and systems were in place to provide supervision for staff. The service recognised staff achievements and provided them with opportunities to develop their skills. We saw that there were generally enough staff on duty, but care workers informed us that staff would occasionally call in sick at the last minute and their shift would not be covered, leaving units short of staff.

When we looked at care plans we saw that potential risks to people’s safety were assessed and measures put into place to minimise the risk, although in some the level of risk was not always clear. Environmental risks were also monitored; wide corridors and walkways allowed easy access, free from obstacles, and regular checks were made to ensure the building and equipment was well maintained. When accidents occurred the cause was analysed with steps to prevent further injury.

Since our last inspection the service had introduced a new system to manage medicines, which reduced the risk of errors, and allowed for a competent system to order, store and administer any medicines as prescribed.

The staff we spoke with demonstrated a good understanding of consent and choice, and there was some evidence to show they would advocate on behalf of people who used the service to ensure that their needs and wishes were met. However, where people lacked capacity there was sometimes an overreliance on the views of relatives for information which could lessen the person’s independence.

The service had developed good relationships with health professionals such as general practitioners (GPs), opticians, dentists and dieticians to ensure health needs were met, and food and dietary requirements were considered. The service had recently employed a new catering manager who was reviewing the menus and food quality to ensure that people’s preferences were taken into account.

Staff spoke fondly about the people who used the service and when supporting them with tasks they showed positive regard. However, we saw that staff were not always vigilant to people’s needs.

Care files contained detailed information about people’s needs,. Daily reports cross referenced care plans, but we saw that information was presented in a way which focussed on required tasks rather than the individual and how they would like their support to be given.

Throughout our inspection we saw a range of activities were offered, and activity coordinators showed a good understanding of what people enjoyed doing.

The service was managed by experienced people who showed a good understanding of how to meet people’s needs and preferences. When we spoke with staff they told us they felt well supported and valued by their managers. Where people had cause to make complaints we saw that these were appropriately investigated and action taken to improve service delivery. We saw the service also ensured regular audits around the quality of the service were undertaken and the home owner had invested to review and develop the service to meet the changing needs of the population.

Chadderton Total Care Limited is situated in a residential area approximately two miles from Oldham town center. The home is registered to provide accommodation for 151 adults who require nursing or personal care.

Chadderton Total Care is a purpose built home, providing accommodation and facilities at ground floor level. The service is separated into five units. The Dales Suite is designed to care for people who have been assessed as needing residential dementia care. The Middlewood Suite is a small, unit that cares for people with a variety of nursing needs. The Saddleworth Suite is a purpose built Dementia unit. The Young Disabled Suite provides care for adults aged 18 to 65 years old and the Lakeland Suite is separated into three much smaller units named, Borrowdale, Ulswater, and Windermere, which provide care for people who have nursing needs.

A Registered Manager was 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.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the systems in place to manage medication. The records of the administration of medication did not give us confidence that medicines were always managed safely.

There was a lack of evidence to show nursing staff were receiving clinical supervisions and kitchen staff were receiving regular supervisions or appraisals. Supervision and appraisal meetings support and help staff to discuss their progress at work and also discuss any learning and development needs they may have.

Systems were in place to help ensure people’s nutritional needs were met. However cooked food was inappropriately stored in the cooling fridge, without the correct labelling and looked least appetising for people on a pureed diet. There was no evidence to show choice or involvement of people was considered when creating menus for people who required pureed meals.

We reviewed records for one person who was at risk of aspiration. There was no evidence of a care plan being developed for the risks associated to aspiration or support needed to mitigate risk.

We saw five people who were using wheelchairs without footplates which is not safe and not good practice.

Staffing levels were sufficient to meet the needs of the people who used the service.

We looked at fourteen staff recruitment files and found that all of the staff had been recruited in line with the regulations and had appropriate pre-employment checks.

Staff we spoke with told us they had received training in safeguarding and ‘whistle blowing’ (exposing bad practice) and were fully aware of their responsibilities for recognising and reporting any suspicion of abuse.

Accidents and incidents were monitored, but there was insufficient evidence of lessons learned from the analysis.

Infection control policies and procedures were in place to support staff to deal with the risk of cross infection and regular checks were undertaken to ensure cleanliness was maintained throughout the service.

Care staff told us they had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They told us they would always support people to make their own decisions and choices.

We found that 5 DoLs applications had been completed by the service but not submitted to the Local Authority due to the Local Authority advising of delays.

People who could speak with us told us that they received the support they required when needing to see their GP, district nurse or appropriate health care professional

When we asked a person if they felt the staff were caring towards them they made positive comments such as, “the girls [staff] really do care for me very well. If they can’t do something, there is always somebody else who will help me.

People who used the service spoke positively of the kindness and caring attitude of the staff. They told us staff respected their dignity and privacy when they provided care

Our observations during the inspection showed that staff were respectful in their interventions with people who used the service.

Care records had not always been regularly reviewed and updated to ensure they accurately reflected people’s needs.

People told us that they felt able to raise concerns with any of the staff.

People who use the service and their relatives were given the opportunity to express their views on the care they received through regular meetings.

There were a number of quality assurance processes in place but these had not been sufficiently robust to identify some of the shortfalls found during the inspection.

We saw that in depth risk assessments and care plans were in place for people. These were easy to understand and we saw they were usually updated at least every month. Other healthcare professionals were consulted appropriately if a need arose.

The Manager had in place a programme of quality control audits covering all aspects of the home. We saw evidence that when the need for improvements was identified action was immediately taken.

Staff had been trained in the Mental Capacity Act 2005 and had a good understanding of the action to take if a person did not have the capacity to make their own decisions. People were treated respectfully and we saw they had choices in how they spent their days.

Robust recruitment procedures were in place to confirm staff members were of good character and had the required skills to perform their work.

We saw the results of the latest residents' satisfaction survey carried out in early 2013. Comments included 'You are treated as an individual', 'I have privacy and feel welcome' and 'All my needs are met'.