Chiswell Residential Home

Chiswell Residential Home provides accommodation and personal care for up to six people with mental health needs in one adapted building. On the day of our inspection, there were six people using the service.

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

People felt safe living at the service, relatives and healthcare professionals confirmed the care and support provided maintained people’s safety. Training had been provided to give staff the skills to safeguard people from potential abuse. Risks to people’s safety and well-being were assessed and mitigated as much as possible. The provider ensured pre-employment checks were completed before new staff were employed. People, staff and external professionals confirmed staffing levels were appropriate to meet people’s needs.

People’s medicines were managed safely. The provider undertook assessments of staff practice to satisfy themselves that staff were competent to safely administer medicines. The home was clean with no malodours. Staff had received infection control training and protective clothing including gloves and aprons was available to them. There was a process in place for reporting, recording and investigating any accidents and incidents.

People’s needs and preferences had been individually assessed and were kept under constant review. People’s relatives and external professionals told us the care and support provided met people’s complex needs. The staff team were very experienced in providing care for this group of people. Some training had not been refreshed in a timely way which meant the staff team may not all be fully up to date with current practice in some areas. However, there was no evidence this had an impact on the quality of care provided to people. Staff felt fully supported by the provider and often worked alongside them providing care and support to people.

People enjoyed the home cooked food provided for them. People accessed healthcare services as needed. Specialist services were available to help guide staff on making positive changes in people’s lives, including their mental health needs. 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 were supported by an established staff team who knew them well. Staff treated people with respect and dignity. People were fully involved in their care as much as they could be. The service operated as a family home and people's wishes were central to the provider’s ethos. People’s right to privacy and confidentiality was respected and integral to the ethos of the home.

People received care and support that was entirely flexible and responsive to their individual needs. People were encouraged and supported to be part of the local community they lived in. Opportunities for engagement were routinely brought into the home for people to enjoy. Relatives and other visitors were welcomed into the home at any time. The provider had a policy and procedure to support people to raise complaints. The provider and staff team were very clear that Chiswell Residential Home was people’s own home and they would be supported to stay in their own home should their health deteriorate.

The provider and staff team demonstrated a clear culture of ensuring people and their needs were a priority. Staff greatly enjoyed working at the home, they felt supported and involved. The provider was in day to day contact with the service and always available for staff should they need advice. Quality assurance processes were in place to help ensure the provider’s standards were upheld. People, their relatives and external professionals were encouraged to give feedback about the way the service operated. The provider maintained their skills and knowledge and kept themselves up to date with changes in legislation and practice.

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

The service provides accommodation and personal care for up to six people with mental health needs. On the day of our inspection, there were six people using the service.

The home 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.

There were systems in place to keep people safe from harm. Staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care. Staff were well supported to deliver a good service. They felt supported by their colleagues and the management team.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. This also included checks on agency workers who occasionally. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs. Medicines were administered safely by staff who had received training.

Staff cared for people in a friendly and caring manner and knew how to communicate effectively with people. Staff supported people well and spent time with them. We observed staff engaging in meaningful activities with people.

People were supported to make decisions for themselves where possible and they were encouraged to be as independent as possible. Where people were not able to make decisions for themselves, best interest decisions were made on their behalf which involved advocates and other professionals. People’s choices were respected and we saw evidence that people, relatives and/or other professionals were involved in planning the support people required. People were supported to eat and drink well and to access healthcare services when required.

The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner, as well as, an effective system to monitor the quality of the service they provided.

At the last inspection on 15 October 2014, the service was found to not be meeting the standards in relation to safeguarding people from abuse; obtaining consent; supporting staff; record keeping; respecting and involving people who used the service and the quality monitoring of the service. We found that the provider had made significant improvements and was now meeting most of the regulations. However, people had not had their capacity assessed and applications to deprive people of their liberty were not in place. Record keeping still required further development and action plans were in place to help ensure they achieved the required improvements.

There was 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.

People received care that met their needs and staff knew them well. People were involved in planning their care where possible. There was some family contact however this was minimal due to distance so people’s relatives were not routinely involved in people's care and support planning.

Staff had been trained and this was being reviewed and developed as part of the on-going action improvement plan. We found that staff were able to recognise any signs of abuse and knew how to report concerns. There were adequate numbers of staff on duty to meet their needs safely at all times.

People were supported to live as independently as they could. Risks to people`s health, safety and wellbeing were identified and actions were put in place to reduce risks to people when possible. People were encouraged and supported to participate in activities and hobbies; this included some events in the community and shopping trips.

There was a robust recruitment procedure in place to help ensure that staff employed were suitable to work in a care setting. Staff employed at the service had completed an induction when they commenced working at the home and had received some training updates relevant to their roles.

People`s medicines were administered safely and staff had received training. There were systems in place for the safe storage of medicines and we saw that medicine records were completed correctly.

People who used the service felt they were treated in a kind and caring way. Staff respected and promoted people’s privacy and dignity. People were supported to maintain their health and wellbeing.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS)

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that people living at the service were not always able to make their own decisions. We found that people who had been identified by the provider as not having the ability to consent had not been formally assessed or reviewed under the MCA. This meant that some people who lived at the home could be being deprived of their liberty unlawfully. The manager and staff had some understanding of their role in relation to DoLS, but were seeking further support in respect of the completion of MCA assessments.

The provider had a procedure in place for dealing with complaints and concerns. There were some quality monitoring processes in place and these were being developed by the provider. The provider had commissioned an external quality monitoring survey and was in the process of putting actions in place in response to recommendations.

We found that the home was meeting the standards we had inspected. People were treated with dignity and respect and their consent was obtained by staff before any care was provided. The home was clean and had been well maintained. There was sufficient numbers of staff on duty to meet the needs of people.

We found that people's privacy and dignity had been respected and that they had been involved in the decisions about their care and support. People had an assessment of needs carried out and the care plans we had reviewed demonstrated that their needs were being met appropriately. We noted that the staff had been provided with relevant training and that they had received regular supervision so that their work had been appraised. There had been an effective system in place to manage and administer medicines so that people received their medication regularly and on time. There had been a quality assurance system to assess, monitor and evaluate the quality of service provided.