Archived: Chasedale Care Home

Chasedale Care Home is registered to provide accommodation, nursing and personal care to a maximum of 60 older people, including people who live with dementia. At the time of the inspection there were 58 people living at the home.

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

Systems and processes for identifying patterns and trends were in place. These had not always been utilised effectively, meaning patterns and trends had not always been analysed or identified to reduce the risk of incidents happening again.

Care planning was person-centred initially but then not reviewed meaningfully. Some daily records were not person-centred and some external advice to support risk assessments was not always easily accessible. The provider had plans in place to improve records.

People were not always supported to have maximum choice and control of their lives and to live in the least restrictive way possible and in their best interests; policies and systems in the service supported this practice but staff actions did not always follow those policies. The provider had identified these concerns prior to our inspection visit but further retraining and awareness was required. We have made a recommendation about this.

The provider had recognised the majority of the areas for improvement required, prior to our inspection visit, and had begun to implement changes and improvements.

People felt safe and supported. Staff helped people promptly and regularly checked on their wellbeing. Relatives told us they had confidence in the ability of staff to look after their loved ones in a safe way.

People’s care plans were up to date but needed more person-centred detail to improve them. The provider had plans in place to improve records.

The environment was clean. Areas of the home were in need of refurbishment to ensure it was more welcoming and dementia-friendly. The mealtime experiences were at times task-focussed and the provider needed to do more to ensure dementia-friendly best practice enabled people to have a more enjoyable mealtime. We have made a recommendation about this.

Medicines administration was safe. Staff were trained, supervised and had their competence regularly assessed. Records were clear and stock checks and audits ensured the risks of errors were reduced.

There were sufficient staff to keep people safe. The provider had reduced reliance on agency staff. People and relatives were happy with the levels of staff support.

People were kept safe from the risk of abuse. The provider had relevant policies and procedures in place. Staff reacted promptly to individual incidents and concerns, but there was a lack of meaningful oversight.

Staff were recruited safely. The registered manager had held regular individual supervisions with staff and team meetings. Staff felt they could raise concerns where they had them.

Staff demonstrated a good understanding of people who used the service and a desire for them to receive good quality care.

Utilities and equipment were regularly checked and well maintained.

The provider worked well with external professionals.

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 10 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good 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 Chasedale Care Home on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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

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.

Enforcement and Recommendations

We have made recommendations that the provider reviews understanding and implementation of Mental Capacity Act guidelines, reviews and improves the environment and experience for people living with dementia, and reviews and improves the person-centred nature of care plans.

Follow up

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

Chasedale Care Home provides care for up to 60 people. There were 59 people living in the home at the time of the inspection, some of whom were living with dementia.

We last inspected this service in May 2016 when we rated the service as good. At this inspection we found the evidence continued to support the rating of good overall but there had been a deterioration in caring which we have now rated as good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A new registered manager had been appointed since the last inspection and registered with the Care Quality Commission in August 2018. 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 received mixed views about staffing levels which were immediately reviewed by the regional manager during the inspection. They redeployed staff to cover perceived gaps but we have made a recommendation to keep staffing under review considering the feedback we received.

Safeguarding procedures were in place and staff had received training. The registered manager was aware of their responsibilities in relation to reporting incidents of a safeguarding nature.

Medicine procedures were suitable and checks on stock levels were completed. Staff were aware of the correct procedures to follow.

The safety of the premises and equipment were monitored and individual risks to people were assessed and plans were in place to mitigate these.

The premises were clean and well maintained although there were plans for further cosmetic refurbishment. Attention had been paid to dementia friendly design features which we were advised would be further developed during future redecoration. new baths had been ordered and we made a recommendation to closely monitor the timescales for the replacement of baths to ensure there is no impact on choice for people using the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received regular training, supervision and appraisal and said they felt well supported.

People were supported with eating and drinking. The registered manager was auditing the mealtime experience with plans to enhance this for all people.

We previously rated the caring domain as outstanding. At this inspection, we found staff remained very caring and passionate about their work but expressed concerns about not having the time to do more than basic care at times. We therefore could not be sure that people continued to receive consistently outstanding care so we have rated this domain as good.

We received positive feedback about the responsiveness of the service. People’s needs were met by staff and relatives were involved in care planning and discussions about care.

A complaints procedure was in place which people and relatives were aware of and was followed by the registered manager.

A variety of activities were available to people. Records were kept showing what activities people had done and recorded their reactions.

Staff and relatives told us they were happy with the new registered manager and said they were helpful and approachable. They carried out a range of audits and quality assurance checks and were being supported by a regional manager as they had been appointed relatively recently.

There were clear lines of responsibility and accountability in the home, and staff were well supported by their supervisors.

We previously fully inspected Chasedale in May 2013, at which time the service was compliant with all regulatory standards. There have been two responsive inspections in the interim. In December 2013 a warning notice was issued regarding record keeping, however in February 2014, the service was fully compliant.

The service had a registered 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.

The service had an excellent person centred culture. The management and staff were fully committed to delivering a service which was caring and compassionate. The people and relatives we spoke with valued their relationships with the staff who they described as “second to none” and “genuinely interested”. Relatives told us they felt their loved ones were really cared for. Privacy and dignity was upheld and people were respected by the staff and treated as individuals. External professionals told us Chasedale was regarded as a service who supported people who display behaviours which can challenge staff very well.

Staff told us they were “a network of support for people and their relatives”. We saw staff were highly motivated and inspired to provide individual care and attention to people by managers who were described as “great leaders”, “supportive” and “approachable” by staff and relatives. Staff spent time with people and their relatives and made memory boxes which people enjoyed looking through and reminiscing. Picture and pen portraits were on display outside bedroom doors.

Relatives in particular were consulted in imaginative and creative ways in order to gather their opinion and were encouraged to get involved in the running of the service. A real time electronic ‘Quality of Life’ survey was available in the reception area for visitors to instantly record their responses at the push of a button to questions posed about each visit. Coffee morning drop-in sessions and scheduled ‘resident/relative’ meetings also took place. People and their supporters were actively encouraged to become involved with management decisions and in developing the service further through these meetings and a regular newsletter.

People told us they felt safe living at Chasedale and relatives confirmed this. Records and management systems were in place to support the staff to provide the service. Staff used the systems well which enabled them to provide safe, quality care. The records we examined were accurate and up to date.

There were a range of policies and procedures in place to support staff and ensure the smooth running of the service. These included a safeguarding policy which staff displayed an understanding of and they were able to tell us about their responsibilities towards protecting people from harm or improper treatment. We reviewed the staffing levels and found there to be an adequate amount of staff on duty to deliver safe care. There were no major concerns reported to us about staffing during the inspection.

Accidents and incidents were recorded and monitored to identify trends. Staff routinely updated care records after an incident and recorded reduction and preventative measures in risk assessments. People were referred to external healthcare professionals when there needs changed to receive additional support.

The premises were well maintained. Checks on the safety of the home were routinely carried out by maintenance staff and by external contractors where necessary. Personal emergency evacuation plans were in place.

Medicines were well managed and safe working practices were followed. We observed medicines being administered during the inspection; we found these were handled safely and hygienically. Medicine administration records were accurate and well maintained.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. We found that the manager had a thorough understanding of the principles and had acted in accordance with the law.

Records showed staff had received an induction and were trained; formal supervisions and appraisals were undertaken. Specific training was sourced from a range of training providers including healthcare professionals.

Staff supported people to maintain a well-balanced, healthy diet. Food appeared healthy and nutritious. The kitchen was well managed and people’s individual needs and preferences were catered for. People were offered choices and staff encouraged them to make decisions about daily life where appropriate.

People participated in a range of meaningful activities. The activities coordinators had spent time researching the benefits of activities which would suit the needs of the people who used the service. People were supported to maintain personal and community links as the staff welcomed family, friends and visitors into the home.

Complaints were recorded and investigated as necessary and the registered manager had shared complaints with external bodies as required. Everyone we spoke with knew how to complain and would do so if necessary. ‘Residents/Relatives’ meetings and surveys were used to gather feedback about the home and the service the staff provided. External professionals and other visitors were also asked for feedback on the service.

The manager held records which showed the safety and quality of the service was monitored through manager and provider audits as well as an internal inspection process.

We found that people's personal records including medical records were not always accurate or fit for purpose. Care plans had not been regularly reviewed, were not always up to date and could not easily be located.

People's needs were assessed and care was planned in line with their needs. One person who used the service told us, "I am well looked after; they are good people." A relative told us, "The girls are tip top; really good carers. If you need anything you just really have to ask." Another relative stated, 'I'm really pleased with the care. No complaints."

The building was safe, warm and functional although the decoration looked tired and in need of refreshing in certain areas. The manager told us a rolling programme of decoration was being undertaken by the provider.

We concluded there was enough equipment to promote independence and comfort and ensure the safety of people.

We saw there were effective recruitment and selection processes in place.

The provider had systems in place to monitor quality and care delivery and ensure the health, welfare and safety of people was maintained.

The provider had not maintained accurate and appropriate care records which meant people were not protected from the risks of unsafe or inappropriate care and treatment.