Chilton Meadows Care Home

Chilton Meadows Care Home is a care home providing accommodation, nursing and personal care for up to 120 older people, some of whom may be living with dementia and/or have nursing needs. People are accommodated across three buildings named Beech House, Munnings House and Gainsborough House. At the time of our inspection there were 66 people using the service.

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

The service had experienced challenges recruiting permanent staff. As a result, the staff team was running on a high level of agency staff who were not always familiar with people’s needs. People and their relatives also reported challenges with communicating with some agency staff.

Risks to people were not always assessed and mitigated. Systems and processes had not always ensured effective managerial oversight or identified potential risks to people's safety. Improvements were needed to ensure the consistent safe management of medicines.

People were protected from the risk of abuse; staff received training and knew how to recognise and respond to safeguarding concerns. People were supported by staff who had been recruited safely and in line with recommended guidance.

Staff used personal protective equipment (PPE) appropriately and understood the importance of good hand hygiene. The home was clean and free from malodour. Visitors were screened and tested before entering the building to prevent the risk of infection from COVID-19.

Since our last inspection, the provider had implemented new care plans, risk assessments and checks on the quality of the service and the oversight of the service, overall, had improved. These improvements need to be fully embedded into day to day practice to ensure consistent safe and well-led care.

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 Inadequate (published 23 August 2021).

This service has been in Special Measures since 23 August 2021. During this inspection the provider demonstrated that improvements have been made, despite still being in breach of the regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they 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 and Well-led which contain those requirements.

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.

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 changed from Inadequate to Requires Improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chilton Meadows on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach of the regulations in relation to the safe management of people’s medicines. Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chilton Meadows Care Home is a care home providing personal and nursing care to 120 older across four units.

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

Whilst people using the service told us they felt safe, we found that the service did not always have clear and robust measures in place to reduce the risks to people. Where risks had been identified, there was not always appropriate care planning in place to guide staff on how those risks should be reduced.

People were not always protected from the risks of malnutrition.

The environment was not consistently safe and environmental risks had not been identified and acted upon prior to our inspection. Infection, prevention and control procedures were not always implemented effectively across the service.

Medicines were not always managed and administered safely, and in line with the instructions of the prescriber.

The deployment of staff meant that people did not always receive support from staff when they required it, either to keep them safe or to ease emotional distress.

Whilst some of the shortfalls we found had been identified in provider audits in January and February 2021, action had not been taken consistently across the service to ensure that clear and documented measures were in place setting out how risks to people were reduced.

The management and oversight of the service was not effective, as the quality of the service had deteriorated since our previous inspection in 2019. Improvements made between 2015 and 2019 had not been sustained.

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’ (Report published 22 May 2019)

Why we inspected

We received concerns in relation to the number of falls and incidents in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: At this inspection we found a number of improvements had been made. A lot of work had taken place since our last inspection to improve the safety and quality of the service.

Staff recognised any signs of abuse or harm and they reported their concerns in line with correct safeguarding policies and procedures.

Any risks continued to be appropriately assessed and mitigated to ensure people’s safety was considered.

People’s medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Effective infection control measures were in place to protect people.

Staff received an induction and ongoing training and support to fulfil their role and extend their knowledge.

People enjoyed the food at Chilton Meadows and were supported to maintain a healthy and balanced diet.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. Staff encouraged people to maintain their independence.

People received support from staff who were kind and treated them with respect.

The leadership, management and governance of the service ensured the delivery of good quality care. The registered manager and management team strived to achieve high standards through continuous improvement. The quality and safety of the service was closely monitored through regular checks and audits.

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

Rating at last inspection: The rating at the last inspection was ‘Requires Improvement’. The last report for Chilton Meadows was published on 26 April 2018.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Follow up: We will continue to monitor the service through the information we receive.

Chilton Meadows Residential and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This inspection took place on 6 and 13 February 2018 and was unannounced.

The registered manager had already left the service in August 2017 and was working at another location for the provider company. The replacement manager had commenced their role at Chilton Meadows in August 2017 but had not yet registered. They had only just started the process to apply to do so. We have referred to this person as the home manager throughout this report. A registered manager is a person who has registered with 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.

At our last comprehensive inspection in January 2017, we found that improvements were needed to the safe management of medicines. We found improvements were also needed to ensure that all staff received medication training and their competency in this area was assessed. Suitable arrangements were needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance. Minor improvements were required to ensure particular decisions which had been made in people's best interests were recorded. Work was required to ensure that people's care plan documentation was accurate and up-to-date and that people had opportunities to lead meaningful lives and to participate in social activities of their choice. We also found that work was required to ensure that appropriate infection control practices, policies and procedures were applied and also that auditing arrangements demonstrated where actions required had been addressed.

We received an action plan from the provider telling us the improvements they were making to meet regulatory requirements. We rated the service ‘Requires Improvement’ overall and in all of the key questions we ask. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chilton Meadows Care Home on our website at www.cqc.org.uk

At this inspection in February 2018, we found that whilst there was progress at the service, there was still further work to be completed. Improvements continued to be needed to the safe management of people’s medicines. Notifications of events and incidents were not always submitted in accordance with statutory regulations. Registered managers and providers are required to submit to CQC statutory notifications in accordance with regulatory requirements however we found a number of serious injuries and potential safeguarding incidents that had occurred at the home which we had not been notified of. We also found whilst risk assessments were in place, improvements were needed to how staff responded to emergency situations such as falls, to ensure they followed the guidance within people’s care plans.

Staff were able to recognise signs of abuse should they occur and knew how to report concerns if they suspected a person was at risk of harm. There was a complaints procedure available in the service for people and relatives to raise concerns.

People received effective care from staff who had the skills and knowledge to meet their needs. Staff monitored people's health and well-being. People had access to healthcare professionals according to their needs.

People were cared for by staff who were observant and ensured people were comfortable. People told us, and we saw, that staff were kind and caring.

Staff knew the needs and preferences of the people they cared for and people were given reassurance and encouragement when they needed it. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

People and their relatives felt the service was well managed and acknowledged the improvements that had been made to date. There were clear lines of accountability. Each of the individual houses had managers in post who were supported by the overall management team on site. There were quality assurance audits in place. However the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

We found the service was in breach of two regulations 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 asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the provider had shared with us at regular intervals their action plan detailing their progress to meet regulatory requirements and to achieve compliance with the fundamental standards. At this inspection considerable progress had been made to meet regulatory requirements, however some further improvements were still required.

Chilton Meadows Residential and Nursing Home provides care and support to a maximum of 120 older people, some of whom living with dementia and/or had complex nursing needs. People were accommodated across four ‘houses’ called Beech House, Munnings House, Gainsborough House and Constable House. At the time of our visit there were 78 people using the service.

The inspection was unannounced and took place over two days, on the 30 and 31 January 2017.

At the time of the inspection the home did not have a registered manager in post, however a manager was in post and following their appointment had submitted their application to be formally registered with the Care Quality Commission. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run. Following the inspection the manager was formally registered with us on 20 March 2017.

Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate a better understanding and awareness of the importance of having good quality assurance processes in place. This was a significant improvement and this had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive and relatives spoke of the improvements made by the provider and management team following our last inspection in May 2016. This referred specifically to better visible management presence within the service and there now being optimism and confidence that the provider and management team were doing their utmost to make the required improvements to the service. Nonetheless, some improvements were still required to ensure that where issues were highlighted as part of the management teams auditing arrangements, information was available to show actions required had been addressed.

All staff spoken with at the time of the inspection described the management team as supportive and approachable. However, suitable arrangements were still needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance. Staff told us and records confirmed that a range of training opportunities were available and provided to them, nonetheless staff had not received updated medication training or had their competency reassessed in this area for some considerable time. An assurance was provided by the provider that this would be addressed as a priority.

Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and liberties were not restricted. People were now routinely asked to give their consent to their care, treatment and support and people’s capacity to make day-to-day decisions had been considered and assessed. Minor improvements were required to ensure particular decisions which had been made in people’s best interests were recorded and evidence of Lasting Power of Attorney [LPA] arrangements sought.

Care records for people were much improved as they now centred on the individual rather than containing generic information. Care plans reflected people’s needs, choices and preferences and included information relating to people’s life history and experiences. Relatives confirmed they were now given the opportunity to be involved in the assessment and planning of their family member’s care. However, minor improvements were still required to ensure that people’s care plan documentation was accurate and up-to-date and care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Although suitable control measures were now in place to mitigate risks or potential risk of harm for people using the service, some risk assessments contained inaccurate and contradictory information.

Arrangements had been made following our last inspection in May 2016 to protect people from the risk of social isolation and loneliness. Additional staff had been employed so as to provide and undertake a programme of social activities for people living at the service. People and those acting on their behalf confirmed that social activities were available with the exception of weekends. Improvements were still needed in the way staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for those living with dementia or who had complex care needs. Although further improvements were still required, it was recognised that this only related to two of the four houses.

We observed that staff followed safe procedures when giving people their medicines, medicines were stored safely and records showed that people were receiving their medicines as prescribed. Errors that had been identified were reported to the management team and actions taken. Whilst medication practices and procedures were generally safe, improvements were required relating to the length of time the medication rounds could take, accuracy of records to show when medication was administered and more detail required for medicines prescribed to treat people’s psychological anxiety so as to ensure these were used consistently and appropriately.

Improvements were required to ensure that appropriate infection control practices, policies and procedures were applied, understood and followed by the management team and staff.

Significant improvements were noted at this inspection by the provider and management team to recognise matters that affected the safety and wellbeing of people using the service. Suitable arrangements had been carried out by the manager to take action when abuse had been alleged or suspected. People were protected from abuse and avoidable harm and people living at the service and others confirmed they were kept safe and had no concerns about their safety. Safe recruitment practices were now in place and being followed so as to keep people safe.

Comments about staffing levels at the service were variable. There was an anxiety about future staffing levels at the service following the embargo on new admissions to the service being lifted. Although these concerns were expressed the deployment of staff across the service was observed to be appropriate and there were sufficient staff available to meet people’s needs to an appropriate standard. Systems were now in place to determine the dependency needs of people using the service and these were used to support the service’s staffing levels.

People were supported to have enough to eat and drink. Significant improvements were now in place to monitor and record people’s nutritional and hydration intake so as to identify at the earliest opportunity those people who were at risk. Suitable arrangements were now in place to support people where they required assistance to eat and drink. People were supported to maintain good healthcare and have access to healthcare services as and when required. Records now confirmed people had appropriate access to external healthcare professionals.

Staff knew the care needs of the people they supported and people told us that staff were kind and caring. In general staff responded to people’s need for support and demonstrated appropriate concern for their wellbeing. People and those acting on their behalf told us that they were happy with the care and support provided by staff.

Staff told us that the overall culture across the service was now open and inclusive and that they felt supported by the management team. Staff told us that communication between staff and the management team was positive and that they felt listened to. Staff told us that morale within the staff team at all levels had much improved.

The inspection was unannounced and took place over two days, on the 4th and 5th May 2016.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

We identified significant shortfalls in the care provided to people across all four houses at the service. This was linked to a lack of oversight from the registered manager and provider.

Relatives and people using the service raised concerns with us about their safety. People were put at the risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm. We observed that staff were not proactive in reducing the risks to people. , The service did not support people to have input from other health professionals such as GP’s or dieticians where this would have been appropriate.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). All staff were unable to demonstrate that people were appropriately supported when they were unable to make choices about their lives. Potential restrictions on people’s freedom and movement were not assessed and formal best interest processes were not followed.

People were not supported to eat and drink sufficient amounts to maintain good hydration and nutrition.

People were not supported to live full, active lives and to engage in meaningful activity within the service. We observed that people were socially isolated and disengaged from their surroundings. People told us there was little to occupy them, that they were bored, and that the activity that was offered by staff was not always appropriate to their needs. This had not been independently identified by the service so no action had been taken by the registered manager to address this.

People’s care plans and assessments were generic and not person centred. Care planning did not include enough information about people’s past lives and experiences for staff to understand them. People and their representatives were not consistently involved in the planning of their care, and their views were not reflected in their care records.

People told us and we observed that there were not enough suitably trained and experienced staff available to meet people’s social, emotional and physical needs. Staff told us they struggled to meet people’s requests for support. Staffing levels were not calculated by the management based on the needs of people using the service and there was no system in place to monitor the effectiveness of the staffing numbers.

People told us staff did not always behave in an appropriate way when supporting them. Staff were not consistently supported to develop their skills within the caring role. There was no system in place to assess staff competency and performance. Supervision of staff was not carried out consistently. Where areas for improvement had been identified, there were no plans in place to support the staff member to improve or to monitor their performance to ensure people received safe and appropriate care.

Staff recruitment was not always conducted in such a way that ensured prospective staff had the skills, background, experience and knowledge for the role.

Systems in place to monitor the quality of the service were ineffective in identifying shortfalls and areas for improvement. Audits and inspections carried out by senior staff did not identify the serious shortfalls we identified during our visit. There was not an open culture within the service. Staff told us they did not feel listened to by the registered manager and there was confusion among staff as to whom they should report concerns about people to.

People told us they knew how to make complaints but they felt it would not be taken seriously. One person said they had made negative comments about the food on several occasions but said the staff laughed and nothing was done.

Throughout the two inspection visits we identified such serious concerns that we fed these back to the registered manager so action could be taken to protect people from harm. In addition, we shared information about the concerns we identified with the local council’s safeguarding team and local commissioners. Following the inspection, we wrote to the provider to request information about how they intended to make the urgent improvements required to protect people from the risk of coming to significant harm. We also took urgent action to stop this service from admitting anyone new by amending their conditions of registration. In addition, we placed further conditions on the registration of this service to ensure that immediate improvements were made to safeguard people.

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

People told us the food was well presented and cooked to a very good standard, with plenty of choice. One person said, 'I like the vegetables, always taste nice.'

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. The environment was clean and well maintained. The care plans were concise and up to date and the service carefully sought the person's consent at every opportunity. The service had an up to date complaints process and was working with other providers of care to ensure that people needs were being met.

We examined seven care plans and found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that health risk assessments for moving and handling, falls and prevention of pressure sores were up to date. These then formed the basis of care plans.

A program of refurbishment of the whole site was underway. Relatives told us that they thought the developments were going to be of benefit to people living at the service.

We examined the roster for each of the houses for the week of our inspection and found there were enough qualified, skilled and experienced staff to meet people's needs. Relatives we spoke with told us that there were enough staff on duty at the service. One person who lived at the service said, "The staff here are very good. They really look after you". Another person said "All the staff are lovely, but I particularly like the men best. They will do anything for you".