Archived: Chylidn

About the service

Chylidn is a residential care home providing personal care and accommodation for up to five people with learning disabilities or autistic spectrum disorders. Five people were living at the service at the time of this inspection. Two people lived in self-contained flats and three people lived in the main house sharing the kitchen, dining room and lounge. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

The service did not employ enough staff to meet people’s support needs. Three agency staff had been allocated to support the service. Agency staff and a team of bank staff had been deployed to support the service, however the service regularly operated at or below emergency safe staffing levels at the weekend and in the evening.

Agency staff were routinely scheduled to work long shifts. Risk assessments had been completed to manage the risk of excessive working hours impacting on the accuracy of record keeping and staff wellbeing. These risk assessments did not recognise the impact of long working hours on the quality of care people received. One member of agency staff had worked a large number of consecutive, long care shift contrary to these risk assessments.

The provider had a team of bank staff who knew people well and were able to support them to access the community during weekdays. However, at weekends and in the evening the service often operated at minimum safe staffing levels which restricted people’s freedoms and opportunities to go out at those times.

Staff and the acting manager understood local safeguarding procedures and whistle blowers had contacted the commission prior to the inspection to raise concerns about the impact of current low staffing levels on people’s wellbeing.

People were supported to have choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care was designed to maximise people’s choice, control and independence. However, low staffing levels meant people were not always able to engage with activities when they wished.

Right care:

Staff cared for the people they supported and acted to ensure their dignity and human rights were protected. Staff responded promptly and were proactive in preventing situations that impacted negatively on people’s wellbeing.

Right culture:

There was a significant risk of closed cultures developing at Chylidn. During the inspection we identified numerous warning signs and indicators of closed cultures within the service operations. However, staff reported that they were well supported by their managers and audits had recognised that staffing levels had impacted on the service’s performance.

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 12 August 2019).

Why we inspected

We received concerns in relation to staffing levels and staffing working hours from whistle-blowers prior to this inspection. A decision was made for us to inspect and examine those risks and the overall performance of the service.

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.

We have found evidence that the provider needs to make improvement. Please see the Safe, Responsive and Well-led sections of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Person Centred Care, Safe Care and Treatment and Staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations in relation to the medicine’s competences, the storage of potentially confidential information and how to ensure staff understood people’s communication preferences.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chylidn provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. The premises are comprised of two self-contained apartments, with one person living in each apartment. The main house has three en-suite bedrooms where three people live. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People and their relatives told us they felt safe living at the service and staff treated them in a caring and respectful manner. People were observed to have good relationships with the staff team. Comments included, “We are delighted with the care and support [person] receives at Chylidn” and “Chylidn is a lovely home which is perfect for [person].”

People received care and support that was individual to their needs and wishes. Care plans were regularly reviewed and updated and were an accurate reflection of people’s needs and wishes. Staff actively encouraged people to maintain links with the local community, their friends and family.

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/ did not support this practice. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff helped people to plan meals and shop as well as preparing and cooking meals. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff received induction, training and supervision to assist them to carry out their work.

There was a clearly defined management structure and regular oversight and input from senior management. Staff were positive about the management of the service and told us the registered manager was supportive and approachable.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 17 January 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.

Chylidn provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service.

During our previous inspection we found that people’s needs were not being met and some people’s autonomy was restricted due to adverse interactions between people living in the service.

At this inspection we found the provider had taken significant action to address and resolve this issue. A new self-contained flat had been created for one person who particularly valued personal space. During this inspection we found that people were now more comfortable and relaxed. Staff told us, “I do think the changes mean it works a lot better for [everyone]. [People] don’t have to be worried about anything now.”

People relative’s told us, “I think [My relative] is safe and well looked after” while staff said, “People are safe and seem to be happy.” Staff understood there role in protecting people from abuse and avoidable harm and records showed all necessary pre-employment checks had been completed to ensure people’s safety.

Risk were managed appropriately to ensure people’s safety while enabling each person to live full and active lives. Where accidents or incidents occurred these were fully investigated. Where necessary people’s care plans were updated with additional guidance on how to protect the person for any additional risks identified during the incident investigation process.

On the day of our inspection the service was short staffed because a member of staff had become unwell. Staff rotas and daily care records showed this was unusual and that the service was normally fully staffed. Staff confirmed the service was normally staffed at safe levels and told us, “Staffing levels have got a lot better” and “Staffing levels have been great, there is the odd bit of sickness but it is not a problem here.”

All new staff received two weeks of formal training before they began working in the service and records showed established staff received regular training updates. Staff said, “The training was very useful, I think it was pretty good” and “All my training, except food hygiene and infection control, is up to date and those two are booked in.”

In December 2015 we found that staff had not received regular supervision. At this inspection staff told us they were well supported by the registered manager. Staff had received regular formal supervision and annual performance appraisals were due to be reintroduced.

Managers and staff understood the requirements of the Mental Capacity Act 2005, and appropriate applications had been made to the local authority for the authorisation of potentially restrictive care plans.

Relatives told us, “The food is absolutely the tops” and we saw people were supported by staff to plan, shop for and prepare meals within the service.

Staff knew people well and understood how communicate effectively with the people they supported.

People’s care plans were detailed and informative. They provided staff with clear instructions on how to meet each person’s individual care and support needs. Staff told us, “All of the information is accessible and easy to use” and “The care plans definitely have enough information.”

The quality of daily care records had improved since our previous inspection and these documents now accurately reflected the care and support people had received.

People were supported to live active and varied lives and their relative told us: “[My relative] has been doing lots of activities. He gets to do what he wants.” On the day of our inspection people were supported to engage with a wide variety of activities both within the service and the local community.

The service was well led by the registered manager. Staff told us the registered manager was; “really easy to talk to” and “brilliant to work for.” Staff felt confident that any issues they reported to the registered manager would be addressed and resolved. People relative’s commented, “[The manager] is on the ball and has really pulled all the stops out for [My relative].”

There were systems in place to ensure any complaints received were fully investigated and relatives told us, “If you report things they do get addressed by [The registered manager].” In addition, the service valued people‘s feedback and the registered manager actively supported people to comment on the its performance.

In May 2016 we received concerns in relation to staffing levels, staff training and the management of the service. As a result we carried out this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chylidn on our website at www.cqc.org.uk

Chylidn provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service.

There were sufficient numbers of staff to support people to take part in individual activities and carry out daily routines. Staff were experienced and had undertaken a thorough induction and training in areas identified as necessary for the service. Training in areas specific to people’s individual needs was not regularly updated. Staff received regular individual supervision sessions from their line managers.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. Mental capacity assessments and best interest meetings had taken place when necessary and were recorded as required. Staff had received training in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS).

People were supported to adopt healthy lifestyles and encouraged to eat healthily. However, staff told us the food budget was limited which meant people's choices were restricted but staff also told us people did not go hungry. We observed two people eating lunch and noted the food portions were good.

Staff were friendly and respectful in their approach to people. They demonstrated a concern for people’s well-being and a shared approach to support. Staff morale was good and staff told us things had improved recently. A system of core teams and key workers had been identified to help ensure support was consistent. Key workers have responsibility for overseeing an individuals plan of care. A core team is a group of care workers who are assigned to work with a specific individual for the majority of their time.

Chylidn provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service.

The registered manager had stepped down from the position the day before our inspection visit. 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 was being run by the deputy manager with the support of the divisional manager. The divisional manager told us they would be making arrangements to fill the role in the near future. The deputy manager had a good knowledge of the service and people’s needs.

This inspection was brought forward in response to information the Commission had received regarding staffing levels at Chylidn. On the day of the inspection we found there were sufficient staff on duty to support people to take part in individual activities. Although new staff had recently been recruited more experienced staff had left the organisation. This meant people with complex needs were being supported by an inexperienced team who lacked a comprehensive understanding of people’s needs. New employees were sometimes shadowing care workers with limited experience. There was no robust system of supervision or staff meetings in place to help ensure staff received the support necessary to fulfil their roles.

People living at the service had complex needs and these sometimes impacted negatively on each other. While this had been identified and strategies put in place to minimise the effect on people this had not prevented the incidents occurring. People’s autonomy within the service was affected as they were unable to access shared areas of the home as and when they wanted.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. Mental capacity assessments and best interest meetings had taken place when necessary and were recorded as required. Staff had received training in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS).

Systems to record changes in people’s support needs and communicate them across the staff team were not robust. A recommendation by an external healthcare professional that one person visit a GP had not been recorded in the communication book. As a result the appointment had not been made leading to deterioration in the person’s health. Daily logs intended to record details of the care and support given to individuals contained gaps.

Staff were caring and respectful in their approach to people. They demonstrated a concern for people’s well-being and reassured anyone who became distressed or anxious. Throughout the inspection visit staff checked that people were happy to talk with us or show us their rooms.

We found breaches 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 this report.

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

If you want to see the evidence support our summary please read the full report.

Is the service safe?

People at Chylidin were safe.

People were supported by sufficient numbers of staff to ensure they were safe and well cared for. One person told us they were 'happy' at the service and staff said they enjoyed their work and had received appropriate supervision and training.

Care plans were personalised, detailed and informative. The care plans included sufficient information and guidance to enable staff to provide safe and effective care.

Risks had been effectively assessed and staff provided with appropriate guidance on the management of identified risks while enabling people to make choices and live full and active lives.

We saw where accidents or incidents had occurred these had been appropriately investigated by the registered manager and the provider. The investigation process was designed to ensure risks were reduced and the service learned from each incident.

We observed staff interact with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We spoke to three relatives all were positive about the care their family member received at Chyldin. Comments we received included: 'X is clean, comfortable, looked after, well fed, seems quite happy, we are grateful for the care X receives' another said 'it's been a great partnership'.

We examined people's care records and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staff said they had received sufficient training to enable them to carry out their roles competently and felt there was sufficient staff on duty.

People who used the service, their representatives, and staff were asked for their views about their care and treatment and they were acted on.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care and knocked and waited for permission (before entering bedrooms and bathrooms.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed them.

Staff said they had received sufficient training to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from financial abuse need to be more robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights