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Inspection carried out on 20 March 2019

During a routine inspection

About the service:

Cherington is a care home registered to provide nursing and residential care and accommodation for 42 people living with various health conditions, including dementia. There were 37 people living at the service on the day of our inspection. Cherington is located over three floors accessed by a lift, with shared lounges and dining areas. The service is in Bognor Regis, West Sussex.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• Since the previous inspection, sufficient improvements in relation to safety, person centred care delivery, quality monitoring and governance had been made. However, these improvements to systems and care would need to be sustained and monitored over time to ensure a good level of quality and safety was maintained.

• People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

• Our own observations supported this and we saw friendly relationships had developed between people and staff. One person told us, “The staff are lovely. They always take time to talk to you, and ask if they can help when they are getting you up in the morning, and they will share a bit of a joke and a chat with you sometimes”.

• People enjoyed an independent lifestyle and told us their needs were met. They enjoyed the food, drink and activities that took place daily. A visitor told us, “When they did the assessment of [my relative’s] needs before he came in, I was there and they asked me lots of questions about how he was, what he could do and what he couldn’t. It was very thorough and I really got the feeling it was centred around him personally. Obviously, the home has to have a certain amount of routine, but overall, I think his care is about him and not standardised”.

• People felt the service was homely and welcoming to them and their visitors. One person told us, “My son comes in to see me sometimes and the staff are always very welcoming. I’ve no complaints with them at all”. A visitor added, “I think the staff are very kind, to my [relative] and to me and my family as well. Whenever I come in, the first thing they do is offer me a cup of tea or coffee and update me on how he is”.

• People told us they thought the service was well managed and they enjoyed living there. A visitor told us, “There’s flashier places than this, but the care might not be as good. I think they are quite clued up here and I’m happy that he’s in good hands. I would happily recommend them based on the care they have provided for my [family member]”.

• Staff had received essential training and it was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “The shadow shifts and training I’ve had have helped me a lot”.

• The provider supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes.

• Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated. A member of staff told us, “We give the best care we can, I love working here”.

Rating at last inspection: Requires Improvement (report published 19 December 2018).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

Inspection carried out on 24 September 2018

During a routine inspection

The inspection took place on 24 and 25 September 2018 as was unannounced.

Cherington is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cherington is registered to provide nursing care for up to 42 people living with dementia. At the time of the inspection there were 35 people living at Cherington. Accommodation is on three floors, accessed by a lift, and included shared lounges and a dining room.

At the time of the inspection the registered manager was on extended leave, and we had been notified. An acting manager was covering the role, with support from the general manager. 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.

At the last inspection on 28 July 2016 we rated the service good, but found a breach of regulation 13. This was because people’s liberty may have been deprived without lawful safeguards and so we rated the key question of effective as requiring improvement. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of effective to at least good. At this inspection these concerns had been addressed and people who needed them had capacity assessments and authorisations. However, we found breaches of other regulations.

The provider had not ensured clear management oversight of the service and good governance. The quality assurance framework was not sufficiently robust and had not identified all the issues we found during the inspection. When actions had been identified, the quality assurance process had not always ensured that these were completed. The provider had not ensured that we were notified of all incidents, which they are required by law to do. The provider had not ensured that CQC were notified about authorised deprivation of liberty safeguards. We took criminal enforcement action by way of a fixed penalty notice.

Risks about people and the premises were not always appropriately assessed, monitored and mitigated. The provider had not ensured that staff were providing support to people in line with any assessments made.

People were not always treated with dignity and respect. Staff did not always respond when people living with dementia tried to engage with them and interactions were not always explained and discussed with the person.

People’s social needs had not always been assessed and planned for. Whilst some people’s preferences were recorded, these were not always met. Staff’s interactions with people were tasks led rather than social and person centred.

People’s personal information was not always kept confidentially. Staff did not always have access to up to date information about people and the support they needed, or know where to find this information. Records were not always clear and up to date to support the delivery of safe and consistent care.

There were sufficient staff available to meet people’s immediate needs. Procedures were in place to ensure safe recruitment and staff told us they were supported with supervision and training.

When people did not have capacity to make decisions, there were assessments which included their views and those of relatives and professionals, where relevant.

People were supported to access healthcare professional when they were unwell, and staff worked in partnership with other agencies.

People and relatives told us that if they raised concerns these were addressed by the staff team. We saw that complaints were responded to in a timely manner.

We found three breaches of the

Inspection carried out on 28 July 2016

During a routine inspection

This inspection took place on 28 July and 1 August 2016 and was unannounced.

Cherington is a nursing home registered for up to 42 older people living with dementia or mental illnesses. At the time of this inspection there were 35 people accommodated. Everyone accommodated had some difficulty communicating with others in a meaningful way.

A registered manager was in post when we visited. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was present during our visit.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. However, DoLS authorisations for two people had expired but had not be renewed even though care reviews indicated there had been no change to their circumstances.

Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed. For example, people at risk of pressure wounds had received appropriate nursing care to reduce the risk of their occurrence or recurrence.

People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs.

Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

Inspection carried out on 04 and 05 June 2015

During a routine inspection

Cherington is a nursing home for up to 42 older people living with dementia. At the time of this inspection there were 35 people accommodated. Everyone accommodated lived with dementia and had some difficulty communicating with others in a meaningful way.

A registered manager was in post when we visited. 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 were informed the registered manager was in the process of voluntarily cancelling their registration. This was because a new manager had been appointed, and was in the process of registering with the Commission. The new manager was present during our visit and made herself available to us throughout the inspection. She informed us she had been in post six months and had been responsible for the management of the home during this time.

Care records had not been kept up to date to confirm care had been delivered in a safe and timely manner. Care plans did not include sufficient information about individual needs to ensure the care delivered is person centred.

People did not have access to fluids throughout the day to ensure they were not at risk of dehydration. People and their relatives said that the food at the home was good. Where necessary, people were given help to eat their meal safely and with dignity.

Activities provided were no sufficient to meet the needs of people accommodated. This meant that people living with dementia were at risk of isolation and withdrawal.

Staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). They confirmed they had received training in these areas. However, where people did not have the capacity to make decisions for themselves, the manager was unable to demonstrate people’s human rights had been maintained. The manager informed us capacity assessments had been carried out on two people. Yet, despite this, DoLS applications had been made to on behalf of 33 people. The manager also told that DoLS applications had been made because representatives of the local authority had told her this must be done.

A quality assurance system was in place to monitor how the service had been provided and to identify shortfalls. However, it was not sufficiently robust to identify the breaches we found at this inspection.

People and their relatives said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. They told us that the manager was approachable. Staff knew how to identify the signs of possible abuse, and knew how to report any allegations of bullying or abuse.

People and their relatives told us that they were happy with care they received. We heard staff speaking kindly to people and they were able to explain how they developed positive caring relationships with people.

People and their relatives told us that there were enough staff on duty to support people at the times they wanted or needed.

We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.

Inspection carried out on 24 June 2014

During a routine inspection

Cherington is a care home registered to provide nursing care for up to 42 older people who have dementia. We were informed that, at the time of our visit, 35 people were accommodated. This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? 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 a selection of records. We spoke with four people, a relative and three members of staff who were on duty. We also looked at the care records of the four people with whom we spoke.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There were enough staff on duty, including nursing staff, to meet the needs of the people living at the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were advised no DoLS applications had been made. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty.

Some medication records had not been sufficiently well maintained. This increased the risk to people associated with the unsafe administration and disposal of medication. A compliance action has been set in relation to this and the provider must tell us how they plan to improve in relation to the safe management of medicines.

There was no system in place to make sure that the manager and staff learned from events such as falls, accidents and incidents. This increased the risk of harm to people and failed to prevent such incidents in the future. A compliance action has been set in relation to this and the provider must tell us how they plan to improve in relation to learning from incidents and events that affect people's safety.

Is the service effective?

From our observations people were happy with the care that had been delivered and their needs had been met.

A relative told us, "The care is excellent. Now that �X� is here I feel I can go away and know they are well looked after. There is a family atmosphere here, which I like".

It was clear from the majority of our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew how to provide for them.

People's health and care needs had been assessed and reviewed. Care plans had been drawn up. However they lacked detailed information to ensure staff delivered care consistently to meet people's needs.

The majority of care and nursing staff demonstrated they understood the care needs of people and how care for people with dementia should be delivered.

Is the service caring?

People were mainly supported by kind and attentive staff. We saw that the majority of staff showed patience and in the main, gave encouragement when supporting people.

We noted that the lunch period was well paced and allowed people the time they needed to eat their meal. People were offered protective aprons to ensure they did not dirty their clothes if they spilled any food.

We observed mainly good interactions between people and staff. The majority of care staff who assisted people to eat their meal ensured the pace was dictated by the person.

We observed poor care being delivered by one member of staff over lunch. The care was not delivered in a manner which enabled people to maintain their dignity and independence. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

Relatives and friends of people using the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

A relative told us, �The manager is approachable. I know I can go to see her if I am concerned and need to have something sorted out.�

Is the service well-led?

The manager held staff meetings every three months. The manager has used them to communicate issues related to the day to day running of the home.

Staff we spoke with were clear about their roles and responsibilities.

Staff also demonstrated they had a good understanding of the ethos of the home.

Staff informed us they felt well supported by the management team.

Inspection carried out on 29 April 2013

During a routine inspection

We spoke with three people, three relatives, two care staff, the nurse in charge and the manager. We spoke to a specialist dementia team on the telephone. We also spoke with a team who support homes in gaining education on dementia. All comments about the home were very positive.

People and their relatives were involved in their assessment and admission to the home. All care needs were assessed and met.

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 were cared for by staff that was trained and supported to fulfil their role. People told us they were happy in the home. One person told us they were "ever so pleased" with the care in the home. A relative confirmed that "the home coped well with their family members needs"

People could complain and complaints were dealt with and lessons were learnt from them.

Inspection carried out on 5 July 2012

During a routine inspection

Not all people in the home were able to give us an opinion of the service but one person told us that they �liked it here� and the food �was not bad at all�. Another person told us that the home was helping their recovery after a recent hospital admission.

We gathered evidence of people�s experiences by observing care, speaking to relatives and a health professional and looking at survey results.

We spoke with three relatives. We were told that �The home really looks after people� and that �They are treated very well� and �My (relative) is a very fussy eater and they manage that without any trouble� We were told that the manager was approachable and any concern would be addressed. One relative told us that people are not taken out for walks for staff, that it is up to relatives to do this and that clothes get creased or go missing in the laundry. Another relative did not have any problem with the laundry and also confirmed that people were taken out by staff.

We spoke with staff who told us that they had time to speak to people and that they received supervision and training.

We spoke with one health professional from the mental health team who told us that they were happy with the care on offer in the home and that care had been offered according to their instructions

We also looked at the collated report of the last quality questionnaire conducted by the home which told us overall the majority of people were satisfied with all aspects of the home.

We observed care and found that people were communicated with, offered choices and treated with respect and dignity.