We carried out an unannounced inspection of this service on 10 and 13 February 2017. We also carried out a focused inspection on 17 August and 11 September 2016 in response to previous concerns that we had received. From the focused inspection we did not find any breaches of regulation but we did note that improvements were required to aspects of risk assessment updating, care plans and consistency of management. Improvements had been made and recently the service had identified further improvements required to care recording as people’s needs changed and to ensure these changes were consistently recorded from the care plan to the care folders that were kept in each person’s bedroom.
Cheverton Lodge is a 52 bed nursing home which provides nursing and personal care for up to 46 older people and 6 young people with physical disabilities. Each person had their own bedroom and there were communal lounges and dining areas on each floor of the home.
The home did not have a registered manager. However, a manager had been appointed in September 2016 and they had submitted an application to register with the Care Quality Commission (CQC). 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.
Care plans described people’s support needs but the care and support provided was not clear in some cases. Updating care records to reflect the level of personal care required, for example how frequently they wished to have a bath or shower, for some people needed to be more accurate and also reflect positive changes in care as people’s conditions improved. However, we noted that this issue had recently been recognised by the provider who told us of the steps they were taking to address it.
The turnover of managers within the home had previously led to an unstable management structure. Information we had previously received from a healthcare professional and relatives indicated that the lack of consistent management had impacted on communication with them. The situation had improved. More effective communication had been established with health and social care professionals, which we had been told by professionals, for example commissioning and nursing and assessment team members in the local authority. Feedback at the most recent relative’s meeting was also positive and the issues around communication that had arisen last year were improving.
Medicines were managed well and safely. However, there had been an error on the typed medicines audit for January 2017, which was later clarified.
There had been several staff vacancies within the home from the middle of 2016. The recruitment programme which the provider had focused on had achieved success with almost all permanent staff posts now filled. There was much less reliance on temporary staff. Staff were recruited safely. There were enough staff on each floor during our visits and we saw that staff were able to spend time with people at other times when not supporting people with care tasks.
The staff team had access to the organisational policy and procedure for protection of vulnerable adults from abuse. They also had the contact details of the local authorities who largely placed people at the service. Staff said that they had training about protecting people from abuse and we were able to verify that this training did occur. Staff we spoke with had a good knowledge and understanding of their responsibilities to keep people safe from harm.
Risk assessments had improved and these were being recorded and updated in a timely way, which is an improvement to what we had found at our previous focused inspection. Information provided at handovers between staff was also clear.
People were provided with a wide choice of food and this reflected people’s preferred choice with other options being readily available. Most people and their relatives were complimentary about the standard of meals provided at the service.
There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service had applied the principles of the MCA and DoLS appropriately and had made the necessary applications for assessments when these were required.
People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. People told us they felt that healthcare needs were dealt with well and we saw that staff supported people to make and attend medical appointments when necessary.
Improved systems had been established to assist clear communication between staff and management at the home, and this received praise from staff.
People’s views were respected and we received positive comments about how caring and attentive staff were. We observed respectful and considerate interactions between staff and those using the service and there was a relaxed atmosphere around the home.
All staff we spoke with did know people well and what their current needs were. However, signed consent to evidence people, and / or their relatives, involvement in care planning, including end of life advanced care planning, required improvement. The provider was taking action to address this.
The service complied with the provider’s requirement to carry out regular audits of all aspects of the service.. The provider sought people’s feedback on how well the service performed and responded to feedback about areas of improvement that people thought may be required.
As a result of this inspection we found that the provider was not in breach of any regulations but improvement was required in the area of responsive.