Chypons Residential Home

Chypons Residential care home is a residential care home providing personal care to up to 27 people. The service provides support to older people and people living with poor mental health and dementia. At the time of our inspection there were 25 people using the service.

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

The staff used an electronic medicines management and recording system. Medicines were stored in lockable cupboards in people’s rooms. People received their medicines as prescribed. The recording of medicines that required stricter controls was not always effective. We found errors in these records. There was no regular audit of these medicines.

There were enough staff to meet people's needs and ensure their safety. Two new staff had been recently recruited which had improved the pressure recently felt by the staff team. However, new staff had not always been safely recruited.

Personal money was held at the service on behalf of some people living at Chypons residential care home. The money was held securely however, records for this money did not always tally with what was held in cash.

Identified risks were assessed and recorded. However, they were not always regularly reviewed and updated when changes had taken place in people’s needs. Care plans did not always contain guidance and direction for staff on how to meet people’s current needs. However, staff were meeting people’s needs and there was no impact on people as a result of the lack of written guidance.

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. However, the registered manager did not have an overview of applications made for restrictive care plans to be authorised. Information provided regarding which people had an authorisation in place for restrictions placed upon them was not accurate.

The registered manager did not always have effective oversight of the service. There was not an effective audit programme in place to help identify any areas of the service that may require improvement. Accidents and incidents had not been audited since June 2022. The concerns found at this inspection had not been identified by the registered manager or the provider prior to our inspection.

Experienced kitchen staff had good knowledge of people’s dietary requirements. Food looked appetising and people told us they enjoyed it. Staff recorded people’s intake when required and were available to support people where needed.

We toured the premises and found them to be in good condition and free from malodours. People’s rooms were comfortable and filled with personal items to give them a familiar feel for people.

The service had notice boards which displayed information for people and staff on how to report any safeguarding concerns.

Staff sought people's consent before providing personal care and assistance. Staff were kind and caring and sought people’s consent before care and support was provided.

People and families were asked for their views and experiences through surveys. Relatives told us, “(Person’s name) is happier and has put on weight since being here,” “I visit regularly and never tell them I am coming. It is always welcoming, clean and lovely here. They always call me if anything changes with (Person’s name)” and “(Person’s name) is thriving living there and is much happier and healthier.”

The registered manager understood their responsibilities under the duty of candour. CQC was advised of any notifiable event which may have taken place as is required. Relatives were kept informed of any changes in people’s needs or incidents that occurred.

The registered manager and staff worked closely with local health and social care professionals to meet people’s needs.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 7 March 2018).

Why we inspected

Prior to this inspection CQC had received concerns from a member of the public in relation to staffing levels, monitoring records, nutritional support and the management of medicines. As a result, 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. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well led sections 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.

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

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.

We found the following examples of good practice:

• We had received a concern that staff were not wearing full Personal Protective Equipment (PPE). However, we found on this unannounced visit that all staff were wearing correct PPE. Staff were aware of what PPE they needed to wear and in what circumstances, and posters were on display in the staff room to remind staff of what PPE must be used. This was also discussed in staff meetings. Staff told us there was “plenty of PPE” and were always aware of the importance of wearing PPE to minimise the risk of cross infection.

• Staff took designated breaks so that social distancing could be maximised.

• Due to the current national lockdown, visiting was currently restricted. Where visiting was permitted (for example for people on end of life care) suitable infection control procedures were in place, in regard to visitors entering and moving around the building. For example, visitors were accompanied around the building by staff, and only spent time in the person’s bedroom. A risk assessment and relevant checks with any visitors was also completed. Visitors were required to wear masks and, as necessary, other PPE.

• In between the two lockdown periods family members had visited people at the service. These visits were pre-arranged with one visitor allowed for a specified time period. Visitors were escorted by staff to people’s rooms taking a route that did not enter communal areas subsequently minimising the risk of cross infection. Visitors were required to wear masks, and as necessary other PPE to minimise the risk of infection to people and staff. These measures ensured the risk of infection was minimised.

• Contact with peoples loved ones were actively encouraged. We saw people talking on the phone to their family and used video calls. The service sent personalised photograph postcards to family members to provide assurance that their loved one was being well cared for. Staff assisted people to use IT and the telephone as necessary. Additional IT equipment had been purchased to assist people to keep in touch with family and friends.

• Good self-isolating procedures were in place if people needed to isolate, and /or who were admitted to the service.

• Suitable testing routines had been arranged for staff and people who used the service. The registered manager said both staff and people who used the service had been happy to participate in regular testing.

• Robust admission procedures were in place, for example, the service required documentary evidence of Covid-19 test results before people moved in, followed by a period of self-isolation.

• The service was providing a range of social activities for people to help to keep them entertained and occupied.

• Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid 19 pandemic. During the inspection we observed staff demonstrating suitable knowledge of good infection control practice. Other staff training had also been maintained.

• The service had comprehensive policies and procedures in respect of Covid 19 and its implications on the running of the service. From our discussions and observations these had been effectively implemented.

• The service was clean. Effective cleaning routines were implemented to ensure infection control risks were minimised and people were kept safe. Suitable cleaning routines were in place to help keep hygiene standards to a good standard.

• Suitable staffing levels were maintained at the service. Staff absence was covered by the permanent staff team so that agency staff were not used.

Rating at last inspection

The last rating for this service was Good (published 7 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control practises. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

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.

Chypons accommodates up to 25 people older people who do not require nursing care. The service is located over three floors, passenger lifts and chair lifts were provided to support people with difficulty mobilising. At the time of our inspection 24 people were using the service.

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 two full time registered managers. This meant a registered manager was on duty each day to provide any leadership and support required. Both registered managers worked together one day per week to ensure they took a consistent approach to any issues. Staff told us this system worked well and their comments included, "They are both good, approachable. If you need them they will help” and “I prefer having two registered managers, it means there is always someone there to support you.”

People told us they were happy living at Chypons and were well looked after by staff who they described as, “Kind”, “Friendly” and “Caring”. Relatives were also complimentary of the service and told us, “I’d give it 10 out of 10”, “If I had to end up in a care home I would come here” and “The staff have been here a long time. They stay, so they know mum well and that really helps.”

Staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse and harm. Records showed managers had made appropriate safeguarding alerts and investigated reported issues to ensure people’s safety.

Risks to individual’s had been assessed. Care plans provided staff with guidance on how to manage identified risk to ensure people’s safety. When accident and incidents occurred these were documented by staff and investigated by a registered manager to identify any changes to procedures that could be made to prevent similar incidents reoccurring.

There were enough skilled staff available to meet peoples’ care needs and records showed planned staffing levels were routinely achieved. One staff member was absent due to sickness on the day of our inspection and prior to our arrival the registered manager had arranged for an off duty staff member to cover the shift. Staff told us, “Generally staffing levels are quite good” and “I think there are enough staff.”

Necessary staff pre-employment checks had been completed for new staff and there were systems in place to provide new staff with an appropriate induction. Staff training needs had been met and there were systems in place to ensure training was regularly updated. Staff comments included; “We do training every year and little assessments through the year to check that we remember what we have been taught” and “The training is in depth and very relevant.” Staff told us they were well supported by the registered managers and records showed they had received regular supervision.

People got on well with their care staff and requested support without hesitation. People told us, “Staff respond quickly if I press the call bell” and we saw that staff responded promptly to people’s requests for support.

People’s medicines were managed safely by staff that were trained and sufficiently skilled. All medicines were stored securely and provided as prescribed.

People needs were assessed before they moved into the service to help ensure those needs could be met. Based on information gathered during the assessment process individualised care plans had been developed. These documents provided staff with clear guidance on how to meet each person’s individual needs. The service had introduced a digital care planning system in October and staff used tablet computers to access people’s care plans and record details of the care and support provided each day. Staff told us, “It’s a nice clear way to do it. Quite concise, accessible and understandable” and “There is enough information in the care plans.”

The service did not have a dedicated activities coordinator. However, staff told us, “There is an extra member of staff in the afternoon until 16:00 to do activities.” Records showed that external entertainers visited regularly and that people had been supported to go out on bus trips to local areas of interest.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and people’s care plans provided staff with information on how to present information to support people to make decisions and choices. However, the registered managers did not fully understand their responsibilities under the Deprivation of Liberty Safeguards (DOLS). We have recommended that both managers complete additional training to ensure they fully understand the legislation.

The service had a complaints procedure in place and people’s feedback on the service’s performance was valued and acted upon. Residents meetings were held regularly and issues raised had been addressed. Quality assurance processes were appropriate and designed to drive improvement in the service performance.

The provider was in the process of making significant improvements to the service environment to ensure people’s comfort and safety. Recent works had included the replacement of a number of windows, improving internet access throughout the service, upgrading sluice facilities and installing new boilers. Further works were planned to update fire detection systems, install a wet room and replace carpets in communal areas.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe and well cared for. Systems were in place to help the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Chypons had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people's needs were met.

Chypons had maintenance contracts and maintenance certificates were seen to be up-to-date.

Is the service effective?

People's health and care needs were assessed with them, although we did not see that people were involved in writing or reviewing their plans of care. Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

Is the service caring?

We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'they show good empathy' and 'Very considerate carers'.

People's preferences and interests had usually been recorded although life histories were noted to be brief.

Chypons had regular support from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

Many people who lived at Chypons had complex health needs and were either not able, or chose not to join in group activities. The care records did not always evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

Chypons had a registered manager and two deputy managers. We were advised that there had not been regular meetings held with the staff for a couple of years. This showed the management did not consult with staff regularly to gain their views and experiences and improve support for people who lived at the service.

People were able to make choices about where and how they spent their day. Some people voiced that there was not enough to do on a daily basis. We saw there were some planned activities.

People we spoke with during the inspection told us the home was always clean and tidy. However, we found that systems had not been implemented or followed to ensure people were protected from the risk of infection. Some areas of the home, for example the flooring in the communal areas and some equipment, required maintenance to ensure the safety of people who used the service, staff and visitors to the home. We were told the provider planned to address these issues.

We saw there were enough staff on duty during our inspection to meet the assessed care needs of people who used the service. We were told that at times staff were very busy, which sometimes meant people had to wait to be attended to.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People we spoke with during this inspection visit told us they felt well cared for at Chypons. Comments people made included 'the carers are wonderful, I couldn't fault them at all', 'they [the staff] are very lovely people', 'I am looked after well' and 'the staff are marvellous, we have a lot of laughing here'. One person told us they would like to be supported to go out into the community. The manager was receptive to our feedback regarding this and gave us assurances they would address the issue.

We spoke with one person who was visiting their relative. They were generally satisfied with the care their relative received but commented that they or their relative had not been involved with the development of their care plan.

Staff were positive regarding working at Chypons and told us changes had been made since our last inspection which had improved the care provided to people.

Staff were aware of the procedures and the action they would be required to take should they witness any possible safeguarding incidents.

People we spoke with generally felt well cared for at Chypons. Three people told us they liked the staff and found them kind and helpful. One person said the staff were 'very jolly and always ready for a laugh'. However, two people told us they felt 'lonely'. One person told us 'most of the carers are kind, one or two are very rough and a bit hard or short. I'm not used to this and I go as fast as I can'. Another person told us 'there is one [staff member] who is a bit brusque'. They added this put them off ringing the bell for assistance if this person was on duty.

We were concerned how two members of staff supported one person with their personal care needs. We heard one member of staff speak to another person who used the service in a way that did show them respect, kindness or compassion.

The environment did not ensure the control of infection was promoted and some areas of the home required improvement to ensure the safety of people who lived at Chypons.

We were concerned the staff were not fully aware of the safeguarding procedures, including the local multi agency procedures, in Cornwall and had not acted appropriately when safeguarding issues had been identified.

All of the people we spoke with told us that staff were kind and helpful to them. One person who used the service told us "all the staff are nice and friendly". A visitor to the home said the staff were 'lovely' and looked after their relative very well. They told us they felt able to approach any of the staff or the manager with any concerns and were confident these would be addressed.

One person commented to us that some staff 'had superb empathy towards me and are very caring'. They added that others were not as good but generally they were satisfied with the care provided to them.

We found that people were not always treated with respect in that their toiletries were left in communal areas, and not named, so staff did not know who they belonged to. Therefore people did not always have access to their belongings.

People told us they were able to make choices about how and where they spent their day in the home.

We found that some compliance actions set at the last inspection in July 2012 had not been met. These related to the quality monitoring of the service including maintenance of the premises, care and welfare and respecting and involving people who used the service.