Chester House Care Home

Chester House Care Home is a residential care home providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 14 people.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People were happy living in the home and felt safe. Risks were well managed. Medicines were managed safely, and staff worked with other healthcare professionals to meet people's needs.

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. People's needs were assessed. Care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet. Staff were suitably trained and received regular supervisions.

People were positive about the service. People told us staff were kind and caring. People were treated with dignity and respect and were fully involved in their care planning and delivery. People's right to privacy was upheld. The registered manager provided people with information about local advocacy services, to ensure they could access support to express their views.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed. People were entertained and stimulated by the activities provided for them. People knew how to complain, and felt concerns raised would be listened to and acted upon.

The registered manager worked in partnership with a variety of agencies to ensure people received coordinated care which met their needs. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

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 21 April 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 8, 9 10 and 30 August 2016 we rated the service as ‘Inadequate' which meant the service was placed in ‘special measures.’ At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, safeguarding service users from abuse and improper treatment, fit and proper person’s employed, safe care and treatment, staffing, person-centred care, dignity and respect and good governance.

Following the inspection the provider sent us information detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

We saw that significant improvements had been made and all the regulatory reaches identified at the last inspection had been met.

Chester House Care Home is located in Hazel Grove, Stockport and can provide care for up to 14 adults with a range of needs.

Accommodation is provided on three floors, accessible by two stair lifts. There are twelve single bedrooms and two bedrooms that have the capacity to be used as shared rooms. However at the time of this inspection the rooms occupied were all single occupancy. At the time of our inspection there were eleven people living in the home.

No en-suite faculties are available.

The home has a lounge/dining room and a conservatory which is currently used as a smoking area as well as an outside garden to the rear of the property.

Since our last inspection the registered manager had left the service which meant there was no registered manager in post at the time of the inspection. 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 home is currently being managed by the two registered providers who are both registered nurses and an assistant manager who is a qualified doctor.

The assistant manager and one of the registered providers were present during all three days of the inspection and were responsive to our feedback and were committed to further improving the service delivered to people living at Chester House Care Home.

We observed staff giving kind and caring support to people. We saw that people’s privacy and dignity were respected and the atmosphere felt relaxed, friendly and homely. From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

From looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained and future training had been planned.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

We saw that some refurbishment had been undertaken since the last inspection and was ongoing to improve the environment for the people living at Chester House. The home was clean and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

There were no restrictions in place on people’s movement within the home. On the ground floor the communal areas consisted of a newly refurbished lounge and dining area and a conservatory.

Since the last inspection the service had improved the recruitment processes to ensure only suitable staff were employed and staff were now receiving on-going supervision and dates for annual appraisals had been arranged.

Staff understood how to recognise and report abuse which helped make sure people were protected. People living at Chester House, a visiting relative and a healthcare professional spoken with all said they thought safe care and treatment was provided.

People had access to healthcare services and we saw specialist advice was sought in a timely manner, for example from the General Practitioner (GP), district nurse, dentist, optician and chiropodist. People were supported to attend hospital appointments as required.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. People living at Chester House were complimentary about the food provided and choices were available to people.

People were supported by a caring staff team and we saw that since the last inspection the home had employed the services of a permanent member of domestic staff, a part time activity coordinator, a part time gardener and a permanent cook. This meant there was more time for the care staff to spend with people.

A notice informing people how to make a complaint was displayed in the main entrance of the home and in the updated statement of purpose which everybody had recently been given a copy of. There was a system in place for receiving, handling and responding to concerns and complaints.

Since the last inspection improvements had been made to the systems used to monitor the quality and safety of the service. For example reviews of accidents and incidents had been carried out, along with a review of staff recruitment files, staff training and general cleanliness and infection control within the home. There was a monthly audit of all aspects of medication administration and regular staff and resident/relatives meetings had been implemented. Staff told us that everything about the home had improved since the assistant manager had taken up post.

We saw that meaningful activities were provided based on people’s personal preferences.

We last inspected Chester House Care Home on 2 December 2013. At that inspection we found the service was meeting the regulations we assessed.

Chester House Care Home is located in Hazel Grove, Stockport and can provide care for up to 14 adults with a range of needs and requirements.

Accommodation is provided on three floors, accessible by two chair lifts. There are twelve single bedrooms and two bedrooms that have the capacity to be used as shared rooms. However at the time of this inspection the rooms occupied were all single occupancy. No en-suite faculties are available.

The home has a lounge/dining room and a conservatory which is used as a smoking area as well as an outside garden to the rear of the property.

At the time of our inspection 8, 9 and 10 August 2016 there were nine people living in the home. When we inspected on 30 August 2016 there were ten people living in the home.

A Registered Manager was in post although they were not available during the first three days of inspection due to being on four weeks annual leave but were available on the 30 August 2016. 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.

During this inspection we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Some medicines were not managed safely. We found there were not always clear, detailed written directions for the use of medicines to enable staff to apply prescribed creams as intended by their GP. This meant there was a risk prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort to the person.

We had concerns in relation to staff supervision because staff were not receiving supervision on a regular, ongoing basis and there was no evidence that staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.

Some of the routine safety checks had not been undertaken for example checks of window restrictors and nurse call bells. This meant the provider could not be sure people using the service were safe at all times.

We saw that some people’s identified care needs did not have a corresponding plan of care to direct care staff on how to meet the individual care need. This meant there was risk that people could receive unsafe and inappropriate care.

There was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant people might be at risk of receiving unsafe and inappropriate care. We saw and staff told us that as part of their paid care hours they were expected to undertake cleaning, laundry and cooking duties. Staff told us they thought due to this they were sometimes too busy to spend time with the people living at Chester House Care Home.

People were not always supported to access regular, meaningful activities within or outside the home. This meant people were not always encouraged to meet their full potential.

Prior to this inspection it came to the attention of CQC that an allegation of abuse had been made of which the CQC had not been notified. During this inspection it was identified that the registered manager had not complied with their duty to notify us of a further notifiable incident which was a Deprivation of Liberty Safeguard authorisation.

We saw evidence that staff had completed a basic, homes own induction training. However from April 2015 all new health and social care workers should be inducted according to the Care Certificate framework. This replaces the Common Induction Standards and National Minimum Training standards. There was no evidence that staff were inducted according to the Care Certificate framework.

From looking at the staff training matrix (record) we found there were gaps in staff training. This meant some staff were not be appropriately trained and skilled to meet the needs of the people living at the home.

We found that systems had not been implemented to monitor the quality and safety of service people received.

The visitors we spoke with told us they thought Chester House Care Home was a safe and caring place to live and they thought people were well looked after. However we found people were at risk of receiving unsafe or inappropriate care. We found the registered manager did not demonstrate a good understanding of potential risk or the appropriate measures needed to be put into place to minimise risk to people.

The complaint policy was out of date because it made reference to outdated regulations. The policy stated that staff should be trained in dealing and responding to complaints but we found no staff had received such training. However the visitors we spoke with told us they had never made a complaint and were happy with the care provided.

Staff spoken with understood the need to obtain consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

We saw staff had good relationships with the people they were caring for.

The healthcare professional we spoke with said they did not have any concerns about this service and staff were always very helpful. During the inspection we found staff were helpful but we had concerns that people were at risk due to the shortfalls we identified.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During the current inspection we spent time talking with the people who lived in the home as well as the registered manager. People told us that the owner of the home was a regular visitor and that they felt they could approach them about matters relating to their care.

We looked at the records which the provider kept both in relation to the quality of service provided and for the administration of medicines. We looked at the arrangements in place for the storage and administration of medicines. We found that Chester House Care Home complied with the requirements relating to both these activities.

One of the reasons for this inspection was to check that an Action Plan which had been supplied by the home following an inspection in November 2012 had been implemented. We saw that planned actions in relation to care planning, administration of medicines, and supporting workers were in place.

During this inspection we also saw how people were involved in their care and were able to make choices. However on this occasion we did not see adequate arrangements for the storage of medicines or comprehensive audit systems which would monitor the quality of service provision in the home.

They said 'I am involved with the care plans and staff discuss these with me.'

There were positive comments about the staff and the service that was being provided.

The person said 'The staff are nice, helpful and supportive.'

The person we spoke with was complimentary about the environment and told us there was always enough food on the plate.