Chatterwood Nursing Home

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 requires improvement. At this assessment the rating has remained 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.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt to continually identify and embed good practice.

There was not a consistent approach to learning from incidents. For example, following a safeguarding concern over a year ago, the service told us they would improve fluid monitoring for people. However, at this inspection we found fluids were still not sufficiently monitored for those at risk of dehydration. For more recent incidents such as falls, the manager investigated the incident and implemented measures to reduce the likelihood of reoccurrence. Referrals to healthcare professionals were made as required and equipment was implemented to support safety.

In addition, we saw a good example of how the provider applied learning from another service in their organisation when a safety incident occurred. This meant people benefited from safer care at Chatterwood.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments were carried out before people were admitted into the home, to ensure their needs could be met. However, pre- assessment records did not always contain personalised or detailed information and was mainly a series of yes/no questions. Despite this staff knew people’s needs well.

There were clear processes to ensure people’s current information was safely shared with health and social care professionals. Staff made timely referrals to health and social care partners and agencies. People were positive about the support they received from external professionals.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. However, records did not demonstrate the principles of the Mental Capacity Act (MCA) 2005 had always been followed.

People and their relatives told us they felt safe at Chatterwood. For example, 1 person said, “I really feel very, very safely cared for, and other than living in my own home I really couldn’t ask for more.” People appeared happy and relaxed, and we observed kind and respectful interactions between staff and people. The provider had safeguarding and whistleblowing policies and procedures which staff knew how to use. Staff were confident the registered manager would listen and act if they raised a concern.

When people were deprived of their liberty, legal authorisations were applied for in line with legislation. Some practices that restricted people's privacy and freedom were in place to aid safety. However, records did not always demonstrate this was in line with the MCA or in people’s best interests. This meant people's human rights could be compromised. Following the inspection, the registered manager told us they had improved practice around adhering to the MCA.

Records relating to risk management needed improvement. For example, some people at risk of constipation and dehydration had no risk assessments. Where risk assessments were in place for risks such as pressure sores, actions to reduce risks were not always recorded. This meant staff may not have the guidance to manage people’s risks effectively. Monitoring charts did not always evidence people had been supported safely or in line with their care plans. Poor records can increase the risk of harm to people due to a lack of oversight or if staff are unfamiliar with people’s needs. Following the inspection, the registered manager told us they had made changes to risk assessments in response to our feedback. However, despite the issues with records we did not find this negatively impacted people. Staff we spoke with knew people well and provided clear information to us about how to reduce risks for people.

People and relatives provided positive feedback about how their risks were managed. For example, a relative told us, “They [staff] have been very good about this [managing the risk of falls]. She [Person] has a sensor mat and even had one on her chair, so that each time she gets up they can check on her. She does get up and down a lot, but as she’s so near the nurse’s station they can see exactly what’s happening.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The building, equipment and furnishings were well-maintained. The provider took appropriate action to reduce potential environmental risks such as fire and Legionnaire's disease. Equipment, such as hoists and lifts were serviced and checked regularly. Relatives told us the environment was safe. A relative said, “She’s [Person] in very safe hands there, for example, if the fire alarm goes off, all the doors in the home close automatically.”

Staff were not always safely recruited. The provider made sure there were enough qualified, skilled and experienced staff. Staff received effective support, supervision and development.

Records did not always demonstrate staff were safely recruited. For example, checks about previous employment were not always sufficient, the reason staff left previous jobs was not always recorded and gaps in employment history were not always explored. This meant we could not be assured the provider had taken all appropriate checks to ensure staff were suitable to work with vulnerable adults. The registered manager took action to ensure existing staff were safe to work with vulnerable adults and told us of the action they would take to strengthen recruitment processes.

Staffing levels were determined by the number of people using the service and the level of care they required. People and relatives spoke positively about the staffing levels. We observed staff respond promptly to people's requests for support and staff spent time chatting and socialising with people. The service had enough staff to support people to take part in activities and enable visits out of the home which people benefited from.

People and their relatives told us staff were well trained and understood how to meet the needs of the people they supported. For example, a person told us “I feel as if they [staff] are very competent at what they do, as well as being gentle and caring.” Staff told us they received enough training to fulfil the requirements of their role. The provider supported staff to develop and were working with a university to enable nurse training.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service and equipment were clean. Staff followed the provider’s infection prevention and control policies to keep people safe. Personal protective equipment (PPE) was available which staff used and disposed of appropriately. People and relatives provided positive feedback about infection prevention and control. For example, 1 relative said, “The place [Chatterwood] always seems very clean, and they [staff] always take great care when doing personal care, aprons and all that.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Some people were prescribed creams for skin conditions. Some creams had no labels, no open date and no guidance on how to apply these. In addition, their application was not always recorded. This meant people were at increased risk of issues with their skin.

There were shortfalls in the management of covert medication. For example, pharmacist’s recommendations on the use of crushed medication were not available for some people. This meant people were at risk of not receiving their medicines in a safe way. We discussed our concerns with the registered manager who told us of their plans to make the necessary improvements.

The provider had arranged for a pharmacist to undertake an audit of the medicines. Following our inspection, the provider sent us evidence of how they were improving their processes.

People and relatives were happy with the way their medicines were managed. For example, 1 person said, “Medicines are always given at exactly the right time; they [staff] are very efficient.” A relative told us, “His [Person] pain management is well looked after, because I’m kept up to date with all his meds.”