Chase House Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At our last assessment, the provider was in breach of the legal regulations relating to safe care and treatment and safeguarding. Improvements were found at this assessment and the provider was no longer in breach of these regulations. However, the provider was in breach of the legal regulation relating to governance. Systems to identify, monitor and respond to risks, including safeguarding concerns, were not always effective.
 

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous inspection, we identified concerns in relation to how incidents and safeguarding events were recognised, recorded and used to support learning. This inspection found the provider still did not always address these effectively.

The provider did not have a fully embedded approach to learning from incidents and improving safety. While staff completed records to document incidents, including when people became distressed, these were not always completed in a way that supported learning or informed care planning. Records did not consistently include sufficient detail about what interventions were effective in supporting and reassuring the person.

In response to our concerns, the provider met with staff to reinforce expectations around reporting, recording and escalating incidents and reviewed their standard operating procedures.
Where people had experienced accidents, such as falls, these were appropriately recorded and action had been taken to reduce risk.

At our previous inspection, we identified concerns in how risks were assessed, managed and monitored, and this inspection found these were not always addressed effectively.
The provider did not consistently maintain safe systems of care or effectively manage and monitor people’s safety. While action had been taken to seek medical advice and involve healthcare professionals where required, care planning and safeguarding processes were not always effective. Care plans did not consistently provide clear or reliable information about people’s risks, and records did not always demonstrate that people had been repositioned in line with their assessed needs. Safeguarding concerns were also not always recognised or escalated appropriately. This meant that while systems were in place to support people’s safety, they were not consistently implemented in practice.
 

At our previous inspection, we identified concerns in relation to how safeguarding concerns were recognised, recorded and escalated, and this inspection found these concerns had not been fully addressed.

People were not always protected from the risk of abuse. We identified several incidents involving one person who had recently experienced increased periods of emotional distress which should have been recognised as safeguarding concerns but had not been reported to the local safeguarding authority. These incidents had not been consistently recorded within oversight systems until they were identified by CQC during the inspection, which reduced the provider’s ability to identify patterns of risk and take timely action to minimise harm. A person told us, “I’m scared to sit with [Person], [Person] throws things.” However, another person told us, “I feel very safe living here – the staff make me feel safe.”

This meant staff had not always used the provider’s systems effectively to recognise, record and escalate safeguarding concerns. However, staff we spoke with demonstrated an understanding of how to raise concerns, had received safeguarding training, and safeguarding information was clearly displayed within the service. A staff member said, “If the nurses don’t do anything we can go higher… it’s about keeping them safe.” Where people needed to be deprived of their liberty, the appropriate legal authorisations were in place.

In response to our concerns, the provider took action to retrospectively report these incidents, provided additional training to staff and reviewed their systems and processes.

At our previous inspection, we identified concerns in relation to how people’s risks were assessed, planned for and reflected in the care they received. This inspection found these were not always addressed effectively.

The provider did not always ensure people were supported in a way that consistently managed their risks. Although care plans identified risks, these were not always translated into care delivery. For example, guidance relating to gender preferences for personal care was not consistently followed, and support to help people reposition to maintain skin health did not always align with assessed needs.

Care plans for people with health conditions, such as diabetes, identified risks but did not always provide clear guidance for staff on recognising deterioration or responding appropriately, increasing risks to people’s health and wellbeing. They also contained conflicting information, including staffing levels required and mobility needs.
 

At our previous inspection, we identified multiple concerns in relation to how risks within the environment were identified and managed. During this inspection, we found significant improvement, and the provider had taken action to ensure the environment was generally safe, clean and well maintained.
However, not all risks had been addressed in a timely way. Concerns relating to fire safety, specifically excessive gaps around fire doors identified at the previous inspection, had not been resolved until raised again during this inspection. The provider told us that the previous management team had advised these issues had been addressed. In response to our concerns, the provider took immediate action and arranged for repairs to 37 fire doors.

This demonstrated that while environmental risks had been largely addressed, systems were not always effective in ensuring known risks were followed up and resolved in a timely way.
 

At our previous inspection, we identified concerns in relation to staffing levels, deployment and the impact this had on people’s care. During this inspection, improvements had been made, and overall there were enough staff to support people’s immediate safety.

However, we observed occasions where a person requiring one-to-one support for their safety and wellbeing was left without this support for short periods, increasing risks to them and others. Relatives described delays during busy periods. One relative told us, “Sometimes they are pushed for staff [my relative] has to wait sometimes.” Staff told us they had enough staff to keep people safe, but not always enough time to spend meaningfully with people. A staff member said, “They say we are fully staffed, but sometimes the needs of the residents… is not enough staff.”

Some staff had not received regular supervision. The provider and management team were aware of this and had begun taking action to improve oversight and support. The provider had also audited recruitment files and identified missing documentation, and action had been taken, including completing risk assessments and obtaining outstanding information.

The provider assessed and managed the risk of infection. They detected and controlled the risk of spread and shared concerns with appropriate agencies promptly. The environment was clean, and staff had access to and used appropriate personal protective equipment. Systems to manage infection risk were in place and followed.

At our previous inspection, we identified significant concerns in relation to the safe management of medicines, including issues with storage, record keeping and administration, which placed people at risk of harm. During this inspection, these concerns had been addressed and medicines were managed safely.

The provider ensured medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes occurred. Systems for storage, administration and recording were in place, and staff had received medicines administration training.