Chatterwood Nursing Home

Chatterwood Nursing Home is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 37 people. Chatterwood Nursing Home accommodates people over two floors in single or double rooms, the majority of which have ensuite facilities.

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

People and relatives told us the service provided safe care. However, the reporting of incidents including those which could indicate abuse required improvement. We found not all incidents were identified or investigated to ensure people were safe and used to inform learning and improvements. The recording of incidents where people had been supported in their ‘best interests’ when they were resistant to care did not always explain how staff had provided this support. We have made a recommendation about this.

The system in place to monitor the safety and quality of the service had not identified the incidents we found. The provider acted to address this. Incident reporting needed to be more robust to ensure the provider could always meet their responsibilities under the duty of candour. The provider had started to collect feedback from people, relatives and other professionals at the time of our inspection. Relatives told us they did not always feel involved in the service and the provider is acting to address this.

Staff reported the culture in the service had improved since the previous inspection and all those we spoke with told us the home was a ‘happy’ place to work. People told us they were happy living at Chatterwood and feedback on the internet showed the home had received many positive comments.

Risks to people had been assessed and plans were in place and implemented to minimise these. People had achieved positive outcomes as a result. Staff were safely recruited and there were enough staff to meet people needs. Peoples medicines were managed safely, and we were assured the procedures in place to promote safety and prevent the spread of infection were being implemented.

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. Staff completed an induction and training in their role. People had been effectively supported to reduce risks to them from poor nutrition and hydration. People’s oral health care was assessed but actions taken to support people who refused oral health care were not always clear. We have made a recommendation about this. People’s healthcare needs were met by health professionals in the service and in the community. The environment was in good decorative order with adaptations to meet people’s needs. Some signage could be improved.

People and relatives spoke positively about the caring approach of staff. Staff told us the improvement in the culture of the home had impacted positively on teamwork and the care people received. Staff understood how to promote people’s dignity when delivering care.

Peoples care plans reflected their current needs and were person centred. Relatives told us they were not involved in care planning although they were informed of concerns or incidents. The provider told us it had been difficult to involve people meaningfully during the covid 19 pandemic and they planned to improve this going forward. Relatives had praised the home for the quality of the care shown to their relatives at the end of their life.

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

Rating at last inspection and update

The last rating for this service was Inadequate ( published 22 October 2019) and there were multiple breaches of regulation. We placed conditions on the provider’s registration requiring them to undertake certain activities and audits and to report to us on a monthly basis and placed the service in special measures. The provider sent us an action plan to show what they would do and by when to improve. At this inspection we found the provider was still in breach of one regulation.

This service has been in Special Measures since 01/08/2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 coronavirus and other infection outbreaks effectively.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chatterwood Nursing Home is a residential care home providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. The service can support up to 37 people.

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

People were not always protected against the risk of harm. Unexplained injuries were not always reported or investigated. Assessment of risks for people were not always completed effectively, mitigation plans were not implemented, and staff did not always follow care plans. Processes to ensure people were supported by suitable staff were not always operated. Risks posed by the environment were not managed effectively.

People’s health was not always monitored effectively and guidance from healthcare professionals was not always requested in a timely way. People did not consistently receive personalised care. People told us they were involved in making decisions about their care, but where people may have difficulty communicating decisions, they were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests. The provider had not ensured that staff received robust induction to the service or had access to the training they needed to be able to support people effectively, based on people’s needs. Staff practice demonstrated people were not consistently treated with dignity and respect.

The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated. Systems were not in place to allow continuous learning and improving care. There was not a robust process in place to monitor, act upon and analyse incidents, accidents and near misses. The placed people at continued risk of harm.

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 (last report published 14 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, gaining consent, staff training and support, treating people with dignity and respect and governance systems.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Chatterwood Nursing Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 24 older people. The home is currently in the process of being extended and extensively refurbished to provide a larger kitchen and laundry area, additional bedrooms and living accommodation. This refurbishment will also provide people living at the home to have their own private en-suite shower rooms. Building works were on-going at the time of the inspection.

The home is situated over two floors and most rooms on the ground floor offer en-suite toilet and sink facilities as well as a communal shower room. Upstairs most rooms offer people with a sink for hand washing and basic personal care tasks such as cleaning teeth for example. There is currently no bathroom on the upper floor due to the building works however plans are in place to replace the previously used bathroom to ensure this facility is available to those living upstairs. The ground floor offers a communal lounge which leads through to a dining room and conservatory area. In the dining room a small area is available for people, visitors and staff to make hot and cold drinks. The conservatory doors open onto a patio area with seating for people to enjoy. The home is situated in a semi-rural residential area on the outskirts of the village of Liss. At the time of the inspection 17 people were living at the home.

The home has a registered manager in post. 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.

Relatives of those using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.

People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff shortages the provider sought to use existing staff including the registered manager to deliver care.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff.

New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.

People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. Whilst it had not always been documented people had been assessed of their ability to consent to any such deprivation applications. These had been appropriately submitted and authorisations granted by the relevant supervisory body to ensure people were not being unlawfully restricted.

People were supported to eat and drink enough to maintain their nutrition and hydration needs. We saw that people enjoyed what was provided. People’s food and drink preferences and eating support required were understood and appropriately provided by staff.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff.

People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives. Staff were motivated to ensure that people were able to participate in a wide range of activities and encouraged them to participate where possible.

The registered manager fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

Relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager. The registered manager provided strong positive leadership and promoted the providers values. These values were known by staff and evidenced in their working practice.

Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. The provider routinely and regularly monitored the quality of the service being provided in order to drive continuous improvement.

At this inspection we followed up on three areas of previous non-compliance, to ensure that the provider had addressed the issues related to these outcomes. These were in relation to care and welfare, management of medicines and records. We found that overall the provider had taken appropriate actions to address the issues as detailed in the action plan that they had provided to the Care Quality Commission following the previous inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service responsive?

' Is the service caring?

' Is the service effective?

' Is the service well led?

This is a summary of what we found: If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Where risks to people had been identified there were risk management plans in place to safely manage them. We saw that there were sufficient staff to meet people's needs. Where people were required to be hoisted there were enough staff to ensure this was done safely.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lack the mental capacity to make decisions about where to live are not deprived of their liberty, other than in accordance with the law. At the time of our inspection no-one was subject to DoLS; however, we saw evidence that the service was aware of how to make an application. There was a policy in place to provide guidance for staff. Both the registered manager and the new manager informed us that they had received appropriate training and were familiar with the process.

The system to manage medicines had been changed since the last inspection to make it safer. We saw that there were records in relation to the receipt and disposal of medicines. Staff told us that the new system was much safer. People told us 'We get our medicines as we need them.'

Relevant checks had been made in relation to the recruitment of staff.

We found that at this inspection appropriate records had been kept to ensure that people's care was provided safely.

Is the service effective?

We saw that people had appropriate care plans in place to meet their identified needs. For example, where people required a thickening agent in their drink we saw that this was documented in their care plan. People had their own thickeners with prescribing guidelines printed on them.

We spoke with people who told us that their needs were well met. One person said 'They understand what I want and how' and 'I don't think my daughter could have found me a better place'.

Is the service caring?

We observed that staff interacted with people throughout the inspection. They were kindly and respectful in their communications. One person's relative told us 'I have never heard a cross, impatient or unkind word.' People told us 'Staff are kind and caring' and 'Staff treat me as a person.' We observed that staff knocked before they entered people's rooms. They asked people's opinions and provided them with choices.

We noted that when a person was hoisted in the lounge, staff used a screen to ensure their privacy. We spoke with staff who told us that they always used a screen if they provided care to people who shared a room to ensure their dignity was maintained.

We observed that staff took their time when they attended to people and did not appear to rush them. At lunch staff went and checked that people were alright and gently encouraged people to eat.

Is the service responsive?

Appropriate checks had been completed to ensure people's pressure reliving mattresses were on the correct setting. Where it had been identified that people had redness to their skin, their care was reviewed and there were care plans in place.

We spoke with people who told us that they thought the service was responsive to changes in their needs. One person told us 'They are very good at getting us to hospital appointments.' Another person's relative told us 'X had a problem with her eyes and cream was obtained.'

People felt able to raise issues. One person told us 'Yes, I can speak up, staff are approachable.' A person's relative told us 'The manager actively encourages feedback and is quick to respond.'

Is the service well-led?

The registered manager told us that they were due to leave the service at the end of May 2014. In order to ensure an effective handover between managers, the new manager had commenced their role at the beginning of May. This ensured that the new manager was given time to work with the registered manager in order to gain an understanding of the people who use the service and the operation of the service.

There had been a recent change in the senior management team and the new regional manager had taken measures to make the systems for monitoring the quality of the service provided more robust. The registered manager told us that they found that the regional manager was effective as they provided practical advice and set targets for work to be completed. Staff told us that they felt supported by the management. One staff member told us 'We work well as a team; care staff raise issues as they arise.'

The care plans were variable, as some were detailed and others did not always reflect people's current needs. People were supported with their food and fluids.

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. Medicines management was not robust and put people at risk of not receiving their medicines as prescribed.

People were supported to raise their concerns. Those using the service, and their relatives spoken with, felt confident any issues raised would be addressed.

People's records were not always maintained accurately and may impact on their care. The food and fluid records and care records were not accurate and reflective of people's needs.

Everybody we spoke with was positive about the care and support provided by the service. Comments included; 'I have no complaints about the staff, they are so gentle' and 'There is a feeling of humanity, kindness and patience here.'

We observed staff interacting with people in a professional and patient way. For example, at mealtimes, staff described each part of the meal and supported people to eat at their own pace.

The registered manager was the infection control lead. Their role was to oversee local prevention and control of infection policies. We were able to see a copy of the home's infection control policy. The service had procedures in place to monitor this essential standard.

Staff we spoke with told us about the supervision and appraisal processes that were in place. They confirmed they had received supervision regularly throughout the year and their annual appraisal was now due.

People and their relatives were given the opportunity to comment on the care and support at the home. One of the relatives we spoke with told us: 'If we find anything wrong we raise it and it is dealt with.'