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Inspection carried out on 18 November 2019

During a routine inspection

About the service

South Chowdene is a residential care home providing nursing and personal care to up to 42 people aged 65 and over. Accommodation is provided in a purpose-built building over two floors. At the time of the inspection 35 people were living at the service.

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

People were at the heart of the service and their views were valued and listened to. One relative said, “All the residents are treated as a person, not a commodity. [Staff] have time to sit and talk and have a bit chat. The level of care is outstanding, not just good. It's like a true family here.”

The registered manager was enthusiastic and committed to foster an open and transparent culture. The provider and registered manger had developed especially strong links with the local community and went above and beyond to ensure the home was as accessible as possible. Quality assurance was robust, involved people living at the home and used to learn lessons and drive improvement.

Staff were kind and treated people with dignity and respect. The registered manager and staff regularly went above and beyond to meet people’s needs and preferences. People could participate in a diverse programme of meaningful activities, including regular opportunities to integrate with the local community. People received especially compassionate and dignified end of life care.

People, relatives and staff confirmed the home and service were safe. Staff felt confident to use the safeguarding and whistle blowing procedures, if needed. The registered manager ensured staffing levels were sufficient to meet people’s needs. The provider followed safe recruitment practices when employing new staff. The home was clean and well maintained. Incidents and accidents were reviewed to identify learning and keep people safe.

Staff received good support and completed the training they needed. Staff supported people to have enough to eat and drink and to access healthcare services.

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 needs were assessed and the information used to develop personalised care plans. People could participate in a wide range of activities. Complaints were thoroughly investigated.

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

Rating at last inspection

The last rating for this service was good (published 20 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 16 October 2017

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 31 January and 1 February 2017 and rated the service Good. After that inspection we received concerns in relation to the safe management of medicines, inappropriate moving and assisting techniques, people being left unattended and not having their personal care needs met due to staff shortages. As a result we undertook a focused inspection on 16 October 2017 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for South Chowdene on our website at www.cqc.org.uk.

South Chowdene is registered to accommodate up to 42 older people who require nursing care. There were 35 people living at the home at the time of the inspection.

The home had a registered manager. 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, relatives and staff consistently told us people were safe living at South Chowdene.

Staff had a good understanding of safeguarding and the provider’s whistle blowing procedure. They told us they had not needed to use the whistle blowing procedure but would not hesitate to do so if needed. Safeguarding concerns had been fully investigated in line with the local authority’s safeguarding procedures.

There were sufficient staff on duty to meet people’s needs. People and staff confirmed this was the case and we saw that staff answered call bells quickly. Staffing levels were monitored on a regular basis.

Staff supported people to mobilise in line with their assessed needs and using the correct equipment.

Medicines were managed appropriately. Staff were trained to administer people’s medicines and accurate records were provided to confirm medicines were administered safely. Only trained staff whose competency had been assessed administered people’s medicines.

Regular health and safety checks were carried out including checks of fire, gas and electrical safety. Where potential risks had been identified, a risk assessment was in place to minimise the risk. Procedures were in place to deal with emergency situations.

The provider had effective recruitment checks in place to help ensure new staff were suitable to work at the home. For example, requesting and receiving references and checks with the disclosure and barring service (DBS).

Incidents and accidents were logged, investigated and monitored. Records showed action had been taken to prevent the situation from happening again.

People, relatives and staff gave us positive feedback about the registered manager. They told us she was supportive, approachable and making improvements to the home.

The provider has a range of quality assurance checks to help maintain people’s safety and wellbeing.

The registered manager had been proactive in submitting the required statutory notifications.

There were opportunities for staff to give feedback about the home through attending staff meetings or speaking to the registered manager directly.

Inspection carried out on 31 January 2017

During a routine inspection

This was an unannounced inspection which took place over two days 31 January and 1 February 2017. The service was last inspected in April 2016 and breaches were found in staffing, safe care and treatment and good governance of the service. Requirement notices were issues to the provider.

South Chowdene is a nursing home situated in a residential area of Low Fell in Gateshead. It is registered to accommodate up to 42 older people who require nursing care. There were 28 people living at the home at the time of the inspection.

The service had not had a permanent registered manager since November 2015; there was a new manager in post who was intending to register with us. 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. It is a legal requirement of the provider’s registration to have a registered manager in post.

Staff knew how to keep people safe and prevent harm from occurring. The staff were confident they could raise any concerns about poor practice in the service and these would be addressed to ensure people were protected from harm. People in the service felt safe and able to raise any concerns they might have.

Staffing was organised to ensure people received adequate support to meet their needs throughout the day and night. Recruitment records demonstrated there were systems in place to employ staff who were suitable to work with vulnerable people.

People’s medicines were managed by nursing staff who were trained and monitored to make sure people received their medicines safely. The medicines storage area was organised and effective ordering and supply procedures were in place with a local pharmacy. The service had plan in place for senior staff to assist with medicines and suitable training and preparation were in place to support this.

Staff received support from senior staff to ensure they carried out their roles effectively through mentoring and support. Supervision and appraisal processes were now in place to enable staff to receive feedback on their performance and identify further training needs.

People could make choices about their food and drinks and alternatives were offered if requested. People were given support to eat and drink where required. We observed a mealtime where senior staff and the manager assisted.

Arrangements were in place to request external health and social care services to help keep people well. External professionals’ advice was sought when needed and incorporated into care plans. External healthcare professionals spoke of effective joint work with the staff and manager.

Staff demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005. The service had made applications for people who may be deprived of their liberty and there was a robust review and renewal process in place.

Staff provided care with kindness and compassion; we saw smiles and interaction between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say.

People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and to make choices. The staff team knew the care and support needs of people well and took an interest in people and their families to provide individualised care.

People had their needs assessed and staff knew how to support people according to their preferences and choices. Care records showed that changes were made as people’s needs changed and in response to requests from people using the service, relatives and external professionals.

Staff knew people as individuals and respected their choices. People were supported to enjoy activities although this wa

Inspection carried out on 19 April 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 24, 26 & 30 June 2015. Seven breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet these legal requirements. These related to the breaches of regulation regarding safeguarding people, safe care and treatment, staffing, meeting nutritional and hydration needs, person centred care, receiving and acting on complaints and good governance.

We undertook this focused inspection to check if the provider was now meeting the legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for South Chowdene on our website at www.cqc.org.uk.

South Chowdene is a nursing home situated in a residential area of Low Fell in Gateshead. It is registered to accommodate up to 42 older people who require nursing care. There were 26 people living at the home at the time of the inspection.

The service had not had a registered manager since November 2015; there was an acting 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.

Staffing numbers were assessed using the provider’s dependency rating tool and there were sufficient staff to meet people’s needs. Staff and people told us they had more time to spend with people and were less tasks focussed in their work.

Some medicine care plans and records could not demonstrate that people received all their medicines as prescribed. Care plans and records around creams and ointments did not demonstrate these were being used as prescribed. Action was not always taken when issues about medicines management were identified by audits.

Staff had not received appropriate supervision and appraisal. We found that little progress had been in made since our last inspection on providing staff with supervision. Staff had not received an annual appraisal of their performance.

People were supported to eat and drink to maintain their wellbeing. Systems and processes were now in place to ensure that people ate and drank enough to maintain their wellbeing. We observed a positive mealtime experience where staff had time to support people in a dignified manner.

We saw that care plans were personalised and were subject to regular review. These plans contained personalised details about peoples likes and dislikes, detailing how best to support them.

The service had a process to respond to and learn from complaints; we saw that actions had been taken to learn from complaints.

The service had not had a registered manager in post for six months. Staff and relatives told us this had a negative impact on the service.

The processes in place to complete agreed actions was not robust. We saw that actions had not been completed in agreed timescales and the process used to manage these was not robust. Feedback from people and relatives had been sought and acted upon to improve the service offered.

Inspection carried out on 24, 26 & 30 June 2015

During a routine inspection

This was an unannounced inspection which took place over three days, 24, 26 and 30 June 2015. The last inspection took place on 10 September 2014. At that time, the service was not meeting the regulations inspected and we asked them to take action for meeting peoples nutritional needs.

South Chowdene is a nursing home situated in a residential area of Low Fell in Gateshead. It is registered to accommodate up to 42 older people who require nursing care. At the time of the inspection there were 36 people living there.

The service had a registered manager who had been in post just under a year. At the time of inspection they had already given notice and were leaving the post. The provider has since made arrangements for management cover of the service. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us they felt safe and were cared for by staff who knew them well. Staff told us they only had time to carry out essential care tasks and were rushed in their work. We found that where people had raised concerns about care they were not always acted upon correctly and that records were not complete.

Risk assessments had been carried out, but some records and files did not clearly demonstrate how care plans had been changed as a result. Care plans did not give the details needed for staff to meet people’s changing needs and some plans lacked the detail to describe how people preferred to be supported.

Staff were recruited in a way that ensured the safety of vulnerable people. Supervision and appraisals were not given at the provider’s stated frequency, meaning that staff were not always managed and supported effectively. The registered manager had not reviewed the staffing numbers and was not able to demonstrate how they ensured that staffing levels met people’s needs.

People’s medicines were not always managed safely. Some recording and care planning around the use of creams and ointments was not consistent and did not demonstrate whether people were getting their medicines as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. There were a number of people subject to DoLS and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals of authorisation were requested promptly to protect people’s rights.

People were supported to eat and drink in a dignified manner, but the mealtime experience was inconsistent. Recording to support people to maintain a healthy fluid and food intake was not completed as required.

People were given support to access external healthcare services and maintain their wellbeing. External health care professionals’ advice was sought and referrals were made for specialist input as people’s needs changed.

People’s consent to their care and treatment had not always been sought or recorded in their care plans.

Care was delivered by staff in a positive manner and there was evidence of good relationships between people and the staff. All staff we spoke with knew people’s needs well and spoke about them in a positive way.

People’s choices and rights to privacy and dignity were respected. Staff knocked on doors before entering, offered people choices in their daily living and looked at alternative ways of supporting people if this was requested.

People knew how to raise a complaint, but the records kept and learning from complaints was not consistent so that opportunities to improve may have been missed.

We found that audits and reviews of the quality of the service were undertaken by the provider, but these were not acted upon quickly, and some improvements made were not maintained. Surveys of people’s views were also undertaken but they did not affect changes in how the service was provided.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 13 May 2014

During a routine inspection

South Chowdene is a nursing home situated in a residential area of Low Fell in Gateshead. It is registered to accommodate up to 42 older people who require nursing care. At the time of our inspection there were 36 people living at South Chowdene.

Our inspection team was made up of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Below is a summary of what we found. The summary is based upon observations during the inspection, speaking to people who used the service and the staff supporting people.

We observed people during the lunch time meal. We noted that there was no serviettes available and the support people received to eat their meal appeared rushed. We noted that some people were given support to cut up their food, however there was limited communication from staff and people were not always asked if they required support. We noted that choices were limited and people were not always able to tailor the meal to suit their individual preferences. In addition, we saw that people did not always have equipment supplied to support them in being independent whilst eating.

This meant there had been a breach of the relevant legal regulation (Regulation 14). You can see what action we told the provider to take at the back of the full version of the report.

During our inspection staff we spoke with had a good understanding of safeguarding and could describe to us the training they had received and what they looked for when working in the home. The registered manager told us that they were aware that further training needed to be done on the Mental Capacity Act and that this was booked for two key staff members in June 2014.

We saw that the home was clean and free of any malodours however we noted that peddle bins were not available in a number of the communal bathrooms. This meant that staff or people using the service had to lift the bin lid up manually to deposit the waste and this increased the risk of cross infection.

People we spoke with told us their privacy and dignity was always respected and people’s family members spoke positively about the home and how they were kept informed and felt involved. During a period of observation we noted that staff did not always react promptly when people required support, however we did see that staff spoke to people in a caring manner.

People told us that activities throughout the home were varied. We saw a weekly activity timetable was advertised which included activities such as dominos and board games, as well as outings and church visits.

The registered manager told us that they worked very closely with the local GP practice and due to this the GP visited every Monday to visit people in the home and was joined on the visit by an Older People Specialist Nurse.

We looked at the staff rota for the four weeks prior to the inspection and noted a consistent number of staff were always on duty. During our inspection we spoke to 11 residents, of which four said they felt there was a need for more staff. One person said, “It sometimes seems to take a long time to respond to the bell.” We spoke to staff about the staffing levels who said they were meeting basic needs but could always do with an extra pair of hands.

Inspection carried out on 16 January 2014

During an inspection looking at part of the service

We found the provider had made progress with ensuring that people were assessed appropriately for the risk of poor nutrition. We also found the provider had introduced a daily check of Medication Administration Records (MARs) to ensure they were completed fully and that action was taken in a timely manner to investigate any gaps in signatures.

Inspection carried out on 3 October 2013

During a routine inspection

People were asked for permission before receiving care. They confirmed they were supported to nake choices and decisons. Family members said they were kept informed about their relative's care. One family member commented, �Staff are on the ball and contact me straightaway if anything happens."

People had their needs assessed and the assessments were used to develop personalised care plans. One person commented, �The care is fine.� A family member told us �Staff are approachable and do what is needed.� Another family member commented, �So brilliant, it�s untrue the care in here�, and, �Such a nice place.�

The provider had systems in place to ensure people received their medication appropriately and in a timely manner. Medication was only administered by qualified nurses who had had their competency assessed.

People who used the service told us they had no concerns about the ability of the staff who cared for them. One person commented, �The carers without exception are excellent.�

People we spoke with said they were happy with their care and told us they knew how to complain if they needed to.

We found some care records we looked at were incomplete and inaccurate.

Inspection carried out on 15 November 2012

During a routine inspection

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation, speaking with four people who used the service who could share their experiences, and speaking with a visiting relative.

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, "It's good here, all of the staff are polite. If I need anything I pull the cord and the staff come to me." A relative told us, "It's a good home. They keep me informed. They answer any questions I have straight away. They respect my mam's wishes. They'll always put her to bed whenever she asks to go, and get her anything she wants."

We reviewed four care records and saw that people's preferences and care needs had been documented. We spoke with four members of staff. Staff were knowledgeable about people's care needs and what they should do to support them.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

The provider had made suitable arrangements to protect vulnerable people from the risk of abuse.

We found there was an effective system in place to monitor and assess the quality of the service provided.

Inspection carried out on 3 February 2011

During an inspection looking at part of the service

All of the people living in the home who were spoken to said that they were very happy with the service provided by the staff. They said that staff responded promptly and politely to any requests for assistance. One person said that she felt that the staff �knew what kind of things she needed help with� and that she was very satisfied with the �quality of care given� another said that the staff treated her with �kindness and respected her wishes�. People said that they were asked about what help they needed when they started to receive a service and consulted about any changes in their care provision. All of those spoken to were aware that they had a care plan but none had wanted to see it and were happy with the way that the staff discussed the contents with them when any changes were made. The relatives spoken to said they had been consulted about the care plans.

One relative spoken to after the visit said that the way that the staff communicated with her and her relative had been particularly effective. She felt that staff had ensured that care was personalised to the resident�s individual needs. This involved discussion with the resident, the way that she wanted things to be dealt with and an agreement as to the way that her family should be involved.

People said that the staff knew their jobs and they thought that they had the training they needed. They said that the food was good and that there was always a choice at mealtimes. People told us that they were very happy with the accommodation and the improvements that had been made since the new manager had arrived.

Reports under our old system of regulation (including those from before CQC was created)