Archived: Chilworth House

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found the service was not safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had submitted one application to their Supervisory Body which received standard authorisation. This was to ensure the person was deprived of their liberty in the correct way and this was done only in the person's best interests and in the least restrictive manner. This meant people who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the DoLS.

A staff member told us they relied on care plans, spoke with people's next of kin and read assessments in order to know what people's care needs were. However, we saw no evidence of assessments undertaken in two care plans. This meant people's welfare and safety were at risk because the care delivered could not accurately reflect their; needs, preferences and diversity through adequate assessments.

We saw there was adequate numbers of staff and appropriate arrangements were in place when staff were on holiday or reported sick. This meant people's welfare and safety were protected because the service had sufficient numbers of appropriate staff.

We found care reviews were not regularly undertaken. For example, for one person we saw evidence of monthly care reviews being undertaken in 2013. However, the only review of care completed in 2014 was on 25 March 2014. This showed the service did not have clear procedures that were followed in practice to ensure personalised records were kept and maintained for each person who used the service and reflective of their current needs.

Is the service effective?

We found the service was not effective.

In one care plan we saw it had noted 'under consent and inclusion for treatment', a person was happy for staff to observe any changes to their medication conditions and apply the required treatment by the doctor. However, we saw a health professional report which stated the person was severely cognitively impaired and therefore unable to give consent. This meant relevant information about people who used the service from other health care professionals, was not used to meet people's care needs.

We discussed what supervisory support staff had received and how regularly this occurred. One staff told us, 'This did not happen as much as I would like.' Another staff commented, 'This should happen every six to eight weeks however, I only had two one to one meetings with my previous manager.' A review of staff supervision and appraisals records showed there were no suitable arrangements in place to support staff.

Is it caring?

We found the service was caring.

During our inspection we observed positive interaction between staff and the people they supported. Care was not rushed and staff had time to interact and had jovial conversations with people. Where people had stopped eating, we observed staff gently encouraging them to eat more. We observed positive staff engagement with people who were being assisted with their meals. For example, a staff member showed warmth and care whilst assisting a person with a meal. This meant people were supported by staff who cared.

Is it responsive?

We found the provider was not responsive.

Care plans reviewed showed nutritional screening assessments were undertaken for people at risk of poor nutrition and dehydration. However a review of nutritional screening and weight records did not show how identified risks were managed. This meant people could not be confident necessary action would be taken when poor nutrition or dehydration was identified.

Is it well-led?

We found the service was not well-led.

We found audits were not undertaken regularly and when carried out there were no follow ups to see if identified actions from audits had been completed. Care reviews were carried out inconsistently and care records were not easily accessible, factual, accurate, and kept securely. We saw no evidence to show how identified risks to people who used the service were to be managed in two care plans. The service failed to notify the Care Quality Commission of incidents that affected a person's health, welfare and safety. This meant systems put in place to identify, analyse and review risks were not effective.

We returned to the service on 12 December 2013 to check whether improvements had been made. We found improvements had been made in each of the areas we assessed. Measures had been put in place to ensure the improvements were maintained. For example, staff handover sessions had been revised to include a check of medication records. This ensured any gaps or other issues were picked up and dealt with in a timely manner. We saw prompts had been added to checklists about notifying the relevant authorities of safeguarding and other incidents. This would ensure procedures were followed in future, to protect people from the risk of harm.

We received positive feedback from people we spoke with. People told us there were staff around when they needed them. One person added 'They're all alright.' A second person said staff supported them to be as independent as possible. Another person told us staff had helped them recover from ill health when they had been very poorly. Each person said call bells were answered within reasonable times after they rang for assistance. People said staff treated them with dignity and respect when carrying out personal care. For example, when being helped to bathe.

People we spoke with said they felt safe at the service. One person told us they liked to lock their door and had been provided with a key by the manager. Another person said 'I've got no worries here.' None of the people we spoke with had any concerns about their care at Chilworth House. Some people were not entirely happy at alterations taking place at the home. This meant they had needed to move bedrooms. However, we noted people had been given choices of which bedroom they moved into.

We looked at how the home safeguarded people from abuse. We had concerns about how the provider had responded to an allegation of abuse. They had not followed procedures by informing the local authority. This meant there had not been any oversight of the investigation and outcomes by the lead authority on safeguarding vulnerable adults.

There were concerns about management of people's medicines. We also found staff were not following good medication practice in line with The Royal Pharmaceutical Society guidance.

Records had not been maintained to appropriate standards. The medication records we looked at showed proper audit trails were not in place at the home. This was because the records we read did not accurately show what medication had been given to people. There was the potential for people to be placed at risk of harm due to current practice.

We found the manager had not notified the Care Quality Commission of an event they were required to. This meant the home's regulatory body had not been informed of a significant occurrence at the home.

We spoke with five people who use the service. People were generally satisfied with their care. Two people felt activities could be improved to provide them with more to do.

We found the premises were suitable for the care of older people. There was adequate heating, lighting and ventilation. The needs of people with disabilities had been considered. People told us their rooms were comfortable and kept clean.

A range of safety checks and inspections had taken place. Measures had been taken to comply with a recent fire safety report. Food hygiene standards had been given the highest rating of 5 stars.

There was sufficient staffing. Staff had access to a range of training opportunities to equip them with the skills and knowledge to meet people's needs.

There was a statement of purpose in place. This provided all required information about the service and would be useful to people looking for a care home placement.