Archived: Chant Square (15 & 17)

15 & 17 Chant Square is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during the inspection.

The home did not have a registered manager. The service manager had applied to register and the home had been without a registered manager since July 2017. 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.

The home was last inspected in October 2016 when we identified breaches of regulations regarding person centred care, dignity and respect, safe care and treatment and good governance. We asked the provider to take action to make improvements. Although the provider had addressed specific concerns around choking, the mealtime experience and moving and handling equipment, breaches of regulations were found on this inspection.

We found care plans lacked detail regarding the specific nature of the support people needed and people’s preferences were not always clearly captured. Risks people faced had been identified, but the measures in place to mitigate them were not clear. Information for staff about how to support people to take their medicines was insufficient to ensure medicines were managed in a safe way. The manager had not responded to allegations of abuse in an effective or timely way. Staff had not received the training and support they needed to perform their roles. The governance and audit arrangements had failed to identify or address the range of concerns found during the inspection. Notifications were not being submitted as required.

We identified breaches of six regulations. 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.

Staff had been recruited in a way that ensured they were suitable to work in a care setting. There were enough staff on duty to ensure people’s needs were met.

The home was clean and there were systems in place to ensure the prevention and control of infection.

Staff took appropriate action in response to incidents. However, it was not clear that the service took the opportunity to learn lessons following incidents.

People’s needs were assessed and care plans had goals in place. The home operated a keyworker system where a named member of staff took the lead on supporting an individual. Keyworkers met with people on a monthly basis to monitor their progress towards their goals.

The service had taken action to address our concerns about the mealtime experience and people were now involved in choosing their meals. We saw people were supported to eat in a safe way by staff who demonstrated a patient and kind attitude.

The home had recently been redecorated and was fully accessible to people who lived there. The bathrooms had equipment in them to ensure people were able to access them.

People were supported to attend healthcare appointments and staff recorded details of the advice given by healthcare professionals. However, the information about people’s healthcare needs was not always clear and consistent.

The service was working within the principles of the Mental Capacity Act 2005 and had made appropriate applications to deprive people of their liberty.

Staff had developed positive, caring relationship with people living in the home. We saw compassionate care and support being delivered by staff.

The provider had ensured the complaints policy was available in a format that was accessible to people living in the home. There had been no complaints about the service since our last inspection.

The provider had supported people and staff through a recent bereavement. However, people and their relatives had not been supported to consider their own end of life wishes.

There were house and staff meetings where people and staff were given the opportunity to be engaged with the development of the service.

The provider had a clear values structure which focussed on supporting people to be as independent as possible.

The overall rating for the service is Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

Chant Square is registered to provide support to 8 older people with a learning disability across two sites which were adjacent to each other. Six people received care in the main accommodation and one person lived in a supported living flat on the first floor.

There was no registered manager in post at the time of this inspection. 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.

We asked the provider about the lack of a registered manager. They told us that there was currently a scheme manager in post. The scheme manager had previously been employed at the home as the deputy manager. The provider told us the scheme manager will apply to become the registered manager and this application has been received.

Risk assessments were not up to date and staff did not demonstrate that they understood the risks people faced especially those with swallowing difficulties. Some staff were supporting people with swallowing difficulties to eat but had not fully read the guidelines.

Moving and handling equipment was not fit for purpose, checks to ensure their safety were not effective. Equipment that had been deemed unsuitable was still being used during our inspection. The scheme manager and team leader advised after the inspection that assessments were taking place but some people were still awaiting new equipment.

Medicines were handled safely and staff understood and could explain how to administer and record medicines appropriately. We found one instance where a cream had not been signed for and this was addressed with the scheme manager and member of staff.

Staff knew how to identify abuse but some staff were not aware how to escalate concerns outside of the scheme manager.

Staff were recruited safely and the service ensured new staff had completed pre- employment checks before they were able to start work.

Staff also performed daily health and safety checks to keep people safe at the service, which included checking water temperatures and fridge and freezer checks.

Staff felt supported but training was not up to date, staff received supervision but this had not been taking place on a regular basis.

Deprivation of Liberty (DoLs) authorisations were lawful and records showed the scheme manager was prompt in applying for extensions for people's DoLS.

Staff sought consent from people before giving care however, in people’s care files the consent section was blank where people were meant to sign with no explanation that they were unable to sign the document.

People’s choices were not always respected or sought in particular in relation to food and drink. People who could verbalise their choices did so to the detriment of others living at the service. Staff would engage more with people who could speak and were not observed to ask people who could not speak if they would like to change their mind for food or drink. People’s choices were respected when choosing clothing as staff would show people options to choose from.

People did not have positive experiences during mealtimes as some staff were observed to not engage with people while they were eating and were speaking to people in an unkind manner.

People’s dignity during mealtimes was not respected as people who were unable to wipe food away from their mouth did not have it removed promptly or gently.

During activities such as nail painting some staff were observed to spend time speaking to people in a very kind manner and were helping to relax people.

Staff supported people to maintain contact with their loved ones and took people to visit their relatives in hospital.

Support plans were personalised and contained detailed information on how to support people and how to communicate with them but this was not always followed. Information in support plans was out of date in some cases and referred to old guidance which was no longer applicable.

People took part in activities within the service or out in the community with the support of their key worker. We observed a music session but observations showed that not everyone was engaged in this activity. People also attended the day centre, went shopping at the local centre and did baking at the service.

People relied on the sensitive support of others to be able to make complaints and express their views. Staff supported people to make complaints.

Staff at the service felt they could easily approach the scheme manager for help or with any concern but felt the scheme manager was kept in the office due to the amount of paperwork to complete. Staff and people met regularly and staff stated that learning from incidents took place.

Records of care were not accurate and were missing information. Daily log information did not contain an accurate reflection of how a person had been during the shift. What people had eaten was generalised or had not been completed at all. Checks completed for handovers and daily logs had been signed as completed when information was missing.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used 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 we spoke with told us they felt safe living at the home. One person nodded when we asked them if they felt safe living at the home. Staff had undertaken training in areas that promoted people's safety including training about safeguarding vulnerable adults. Risk assessments had been carried out to help reduce the risks people faced.

Is the service effective?

People told us they were satisfied with the care and support provided by the service. One person told us "I like the staff.' We observed staff supporting people in line with their stated wished and assessed needs. Staff were aware of people's needs and preferences and the support each person using the service required.

Is the service caring?

We observed that staff supported people in a way that promoted people's dignity. For example we saw people were provided with choices about what to eat and daily activities. Staff told us how they promoted dignity by respecting the wishes of people who used the service. One person told us "I choose what I want for dinner or lunch."

Is the service responsive?

The service carried out assessments of people's needs before they began to provide support. Assessments included information on people's likes and preferences. The service involved others such as district nurses, psychologists and other health professionals where there was a need.

Is the service well-led?

The service had a registered manager in place and a clear management structure. Staff we spoke with said they found management staff to be approachable. Clear records were maintained which were stored securely. Quality assurance and monitoring processes were in place. These included seeking the views of people who used the service.

People seemed happy and at ease with the staff. People participated in a variety of activities and regularly attended day centres, the theatre, swimming and craft courses. Care plans were comprehensive and person centred: they contained information on people's care needs, likes/dislikes, activity plan and risk assessments.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

People were cared for in a clean, hygienic environment. The home appeared to be clean and was free from offensive odours. Staff were knowledgeable about infection control and food hygiene procedures.

The premises were suitably designed and safe. They were generally well-maintained, however some repairs were outstanding: handrails in the corridor, kitchen worksurfaces and an area of tiling in one of the bathrooms required refurbishment.

People were made aware of the complaints system. This was provided in a format that met their needs. There were no formal records of complaints since 2010.