Cherington

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect. We found a breach of legal regulation in relation to dignity and respect.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity.

We asked people and their relatives if staff treated them well and with dignity and respect. One person said, “I get on with some staff and some I don’t. They don’t expect you to answer back. They expect what they say goes. They say one thing and do another. They say, “Come downstairs and you sit in a chair for 3 hours at a time and then you get up, you get so stiff you can’t move, and everybody is asleep in their chairs. I prefer to be up here [in my bedroom], but they don’t want you upstairs asleep when it’s not night.” Another person told us, “Staff can come in without knocking”, and we observed this. A relative commented, “They treat everyone with respect, even if they’re challenging … they let people be themselves, after all it’s their home.”

The high use of agency staff, as well as staffing levels, impacted on the consistency of care delivered. One carer said, “We keep people 12 hours in the lounge so they don’t escape from the service or mess their rooms.” Our observations were that many people stayed in the communal lounge all day, with some having their lunchtime meals off overlap tables. Other people did move to the dining room for their meal, then returned to the lounge area as soon as they had finished. We observed some instances when staff treated people in a caring way, but overall staff appeared rushed and did not have time to spend with people.

At 10.39hrs we observed 1 person was had an episode of incontinence which remained unnoticed for approximately 10 minutes. Instead of supporting them to be changed, the staff member placed a blanket over their lap and left them sitting in wet clothing. At 11.15hrs, a staff member approached them while the person was asleep and attempted to wake them, then a second staff member approached and attempted to wake them up. At 11.21hrs, the person was assisted to stand up. The back of their clothes was saturated, and the odour from the urine was intense indicating they had been wet for some time. In front of other people and relatives they were assisted to walk across the lounge in full view. The armchair was removed to be cleaned.

With only 1 staff member consistently present in the communal lounge, many people relied on support from their (or others) relatives. We saw 1 relative notice a person’s drink had leaked from their beaker onto their clothes. The relative approached the person gently by name and explained what they would do, taking a napkin to wipe their mouth and chin before drying the outside of the beaker and ensuring the lid was secured before passing it back to the person.

After the inspection, the provider told us they had increased the number of care staff on duty in the communal lounge to 2.

The provider did not always support people as individuals or make sure people’s care, support and treatments met people’s needs and preferences. They did not always take account of people's strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Our observations showed that some people did not always receive consistent support or care. The high use of agency staff meant that care was not person-centred, but task led. A staff member said, “We have some people who need turning [repositioning if cared for in bed], but we have to tell agency staff what to do.” This staff member went on to describe the constant oversight and prompting that agency staff required which impacted on the care people received. They talked about agency staff not always completing monitoring charts and added, “You are just reminding and reminding, and they are still doing the same mistakes.” We fed this concern back to the management team and they told us agency staff were required to complete monitoring charts as part of their role. An agency carer expressed their concerns and said issues were not always the fault of agency staff, and they had worked at the home for a few years, so knew people well.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

We found no evidence to show how people’s independence was promoted by staff. One person told us, “What I can do for myself, I do.” During the lunchtime meal, people were either able to eat independently or needed full assistance from staff. We observed many incidences where people were left with their meal, untouched in front of them. Whilst some staff tried to encourage people to eat, many were too busy to provide ongoing support. We observed 1 person had hardly touched their first course at lunchtime before staff took it away, with no attempt to offer help. Pudding was then put down in front of the person on their overlap table. The person put their fingers in their pudding. Staff did not notice the person had slid down their armchair and their posture made it difficult for them to eat safely. Later a staff member did cut up this person’s pudding, and the person began to eat.

Although a relative told us their family member were offered alternatives if they did not like a particular meal, our observations were that if people did not eat their meal, it was taken away. A relative said, “Staff usually bring in as many meals as they can and 1 carer tries to feed 7 people [in the communal lounge].” At 13.11hrs, the last lunchtime meal was brought to the lounge, more than an hour after the first meal was served. We saw many people were reliant on their relatives to provide assistance as there were not enough staff.

There were no restrictions on visiting times. Whilst a notice in the dining room stated that mealtimes were protected, that is, visitors were not encouraged at prescribed times, many people were reliant on their relatives to provide assistance at mealtimes.

After the inspection, the registered manager told us they had increased the number of care staff by 1, together with a supernumerary nurse, to provide additional support. They stated, “This strategic staffing decision aims to enhance the overall meal service experience for residents.”

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always response to people’s needs in the moment or act to minimise any discomfort, concern or distress.

The deployment of staff and staffing levels meant people’s care and support needs were not always promptly addressed, One person said, “I don’t feel not cared for.” A relative told us, “I do feel [family member]is cared for because I’m here most days. I think if I wasn’t she’d have passed away by now. I push and push staff and have to remind them. I monitor what happens.” Another relative commented, “There’s a problem with the crossover. He wakes early and they [night staff] get him up and dress him, but they don’t do his teeth. The day staff don’t go back and do his teeth. It’s a problem with the crossover. They don’t check his teeth however many times I mention it.”

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

The registered manager told us, “If a staff member came to me and I felt they needed counselling, then I would source that myself for them. We have an internal phone line and a whistleblowing policy.” With the high use of agency staff, permanent staff often had to step-in and assist or advise on people’s preferences and choices. When asked if they felt supported by the management team, 1 staff member said, “Management and head office are closer than management and staff here. They stay in the office a lot. There’s not much hands-on support from management. Whatever we say, nothing is resolved. We’ve raised things directly with head office and nothing is resolved.” An agency carer expressed satisfaction with the management team and said, “They explain everything and they don’t get tired.”

Throughout our time on site, the registered manager spent the majority of the day in their office. The deputy manager worked with the nursing and care staff, providing assistance on the floor as needed.