6 January 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 14 and 15 November 2017 and was unannounced.
On the first day, the inspection was carried out by one inspector, a specialist advisor whose area of expertise was nursing care and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second day the inspection was carried out by one inspector.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed notifications and any other information we had received since the last inspection. A notification is information about important events which the service is required to send us by law.
We contacted community professionals, for example, the local authority and health service commissioners of the service and the safeguarding team, to seek their views about people’s care.
We spoke with the registered manager and ten staff members. This included nurses, care workers, housekeeping staff, the chef and activities staff. We met with the regional manager for the service on the second day, to provide feedback on the inspection visit.
We checked some of the required records. These included ten people’s care plans, medicines records in two parts of the home, four staff recruitment files, four staff development files and the training matrix for all staff. We looked at a range of other records which included accident and incident reports, monitoring records and records of checks such as gas, electrical and water safety.
We spoke with twelve people who live at the home and two visitors. Some people were unable to tell us about their experiences of living at Chesham Leys because of their dementia. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
6 January 2018
This inspection took place on 14 and 15 November 2017. It was an unannounced visit to the service.
We previously inspected the service on 31 October, 01 November and 09 November 2016. The service was not meeting all of the requirements of the regulations at that time. We had concerns about fire safety measures and support given to staff. We asked the provider to take action to address this. They sent us an improvement plan which told us about the changes they would make. On this occasion we found improvements had been made to ensure people received safe care that was appropriate to their needs.
Chesham Leys provides nursing care for up to 62 people. Fifty four people were living at the service at the time of our inspection. The service provides nursing care to older people and people with dementia.
The service had a registered manager in post. 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.
We received positive feedback about the service. Comments from people included “They’re a wonderful group of staff here,” “I have been living here for two years and I am well cared for” and “The people are brilliant; the standard is high, I can't fault it. The staff and management are excellent.” A community professional’s feedback included “I can say that Chesham Leys have worked really hard to improve standards.”
The service had received many compliments. One included “I would like to take this opportunity to thank everyone at Chesham Leys for all their help in making mum’s time in Chesham as comfortable and welcoming as they did. My personal dealings with yourself and your colleagues were always incredibly easy, nothing was ever a bother and any queries dealt with promptly. I loved the relaxed and openness of the home. More importantly was the carers and nursing staff themselves; they treated mum with care and respect.”
People were kept safe at the service. This included use of thorough recruitment practices before staff were appointed. Staff knew about safeguarding people from abuse and had undertaken training in this area. Medicines were handled safely to make sure people received them in line with the prescriber’s instructions. Equipment had been serviced and was safe to use. The premises were well maintained and fire safety checks were carried out.
People’s needs were assessed before they moved to the service. Care plans documented any support needs people had. These had been kept up to date. People received the medical support they required. We did not have any concerns about how people were cared for at end of life but have made a recommendation for best practice to be followed.
The building was clean and tidy; there were no unpleasant odours. Staff wore disposable protective items when they carried out personal care to prevent the spread of infection. We have made a recommendation for the service to follow best practice with workflow in the laundry to reduce the risk of contamination.
Staff received appropriate support to help them develop as professional workers. This included an induction, training and supervision. Staff meetings were held to discuss practice and share ideas.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service had started to look at ways of making information accessible to people who had communication needs. We have made a recommendation for more work to be done in this area to comply with the Accessible Information Standard.
Activities were provided for people to provide stimulation. The service took part in events held between some of the provider’s other homes such as baking and gardening competitions.
Management was open and transparent. The registered manager was aware of their responsibilities. They were assisted by a senior team; a new clinical lead had been appointed to manage nursing practice. There were clear visions and values for how the service should operate and staff promoted these. Monitoring and audits took place to assess the quality of people’s care. We have made a recommendation about recording any actions from audits and signing these off when completed.