Archived: Chapel View Care Home

Chapel View Care Home is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can accommodate up to 37 people in one adapted building. Accommodation is spread over two floors. At the time of this inspection there were 31 people living at Chapel View Care Home.

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

People told us they felt safe living at Chapel View Care Home. Comments from people included, “The staff always check I’m alright. They are all very good” and “The staff are excellent. There’s enough of them.”

Staff had received training in protecting vulnerable adults from abuse. There were systems in place to manage risks to people. There were enough staff employed to meet people’s care and support needs in a timely manner. Safe procedures were in place to make sure people received their medicines as prescribed.

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.

The service was well-led. Comments about the managers were positive. There were effective systems in place to monitor and improve the quality of the service provided. The provider had a comprehensive set of policies and procedures covering all aspects of service delivery.

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 (published 25 March 2020).

Why we inspected

We received concerns in relation to staff conduct and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from the concerns. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chapel View Care Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The premises were clean and well-maintained. Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned, including high touch areas such as door handles and light switches.

The service had a specific unit to be used as a designated setting for people with a positive COVID-19 result. The registered manager had identified routes for movement on and off the unit and designated staff for the unit who would not move between units to reduce the risk of transmission.

All rooms had an en-suite toilet and wash basin. Staff understood the need and frequency for enhanced cleaning schedules for all communal areas and bedrooms in the unit to prevent the transmission of infection.

Staff had received training and understood their responsibilities in relation to infection prevention and control.

Risk assessments for people who used the service, staff, visitors and professionals had been undertaken. Staff had the necessary PPE and the management team undertook spot checks and observations to ensure staff used it correctly.

The management team were on call out of hours to support staff. They understood their responsibilities to monitor the quality and safety of the service to ensure people who used the service and staff were safe during the pandemic.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Chapel View is a care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can accommodate up to 39 people in one adapted building. Accommodation is spread over two floors. At the time of this inspection there were 32 people living at Chapel View.

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

People and their relatives spoke positively about all the staff. A relative told us, “The best thing [about Chapel View] is I have the confidence [my relative] is well looked after and cared for.”

There were systems in place to recognise and respond to any allegations of abuse. Staff had received training and understood what it meant to protect people from abuse. Safe recruitment procedures made sure staff were of suitable character and background. There were enough staff deployed to meet people’s care and support needs in a timely way. Medicines were stored safely and securely. There were effective systems in place to ensure people received their medicines as prescribed.

Staff were provided with an effective induction and relevant training to make sure they had the right skills and knowledge for their role. Staff were supported in their jobs through regular supervisions and an annual appraisal.

People enjoyed the food served at Chapel View. People were supported to eat and drink to maintain a balanced diet. People were supported to maintain good health and have access to health and social care services as required. There was a range of activities and social opportunities available to people living at Chapel View. Strong links had been developed with the local community.

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.

People were supported by kind and caring staff who knew them well. People’s right to privacy was respected and staff ensured peoples dignity was maintained. Care records provided person-centred information to enable staff to meet people’s needs and wishes.

The service was well-led. Comments about the registered manager were positive. People, their relatives and staff were asked for their opinion of the quality of the service via regular meetings and annual surveys. The service had up to date policies and procedures which reflected current legislation and good practice guidance. There were effective systems in place to monitor and improve the quality of the service provided.

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 requires improvement (published 13 February 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 10 January 2019 and was unannounced. On the day of the inspection there were 28 people living in the home.

At the last inspection in October 2017 we rated the service requires improvement overall and in each domain area. We found five breaches of regulation relating to; failure to provide safe care and treatment, good governance, consent, failure to notify CQC of incidents and dignity and respect. Following the last inspection, the provider sent us an action plan to show what they would do to improve the service.

At this inspection we found the service had improved in a number of areas. However, there were further areas that needed further development before the service would consistently be providing good care and support. A new manager had come into post in September 2018 and we found they were committed to continuous improvement of the service and responded positively to addressing the shortfalls we found on this inspection.

A registered manager was not in place. The previous registered manager deregistered in March 2018. 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 new manager told us it was their intention to apply to become the registered manager for the service.

People and relatives provided good feedback about the service. They said that care needs were met, staff were friendly and the service was responsive to their individual needs.

People said they felt safe using the service. Safeguarding procedures were in place and followed to help keep people safe. However, some risks to people’s health and safety were not appropriately assessed and mitigated. Some people were not provided with appropriate food in line with their assessed needs. This demonstrated the service had failed to provide safe care and treatment.

There were enough staff to ensure people received prompt care and support. Staff were visible and keen to attend to people’s individual needs. Robust recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

Staff received a range of training and support in order to undertake their role. People spoke positively about the skills and knowledge of the staff who supported them.

People had access to a choice and variety of food. We found some aspects of the mealtime experience could have been improved to ensure a consistently pleasant mealtime atmosphere.

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.

People’s healthcare needs were assessed and the service worked with a range of professionals to help meet their needs.

Medicines were managed in a safe and appropriate way and people received their medicines as prescribed.

Staff treated people with kindness and compassion. People were listened to and their views used to help shape their care and support.

People’s care needs were assessed. Some care plans required more detail adding to provide evidence their needs had been fully assessed, for example in the provision of end of life care. There was a good range of activities available to people based on their likes and preferences.

A system was in place to log complaints. However, it was not always clear that complaints had been responded to in a timely manner.

People, relatives and staff all provided positive feedback about the service and how it was managed. People’s feedback was sought and influenced how the service run.

Systems were in place to assess, monitor and improve the service. However, these were not sufficiently robust in ensuring a consistently high performing service. However, we had confidence the new manager would continue to develop and improve the service.

We found two breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Chapel View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Chapel View is registered to provide nursing and residential care for up to 39 people. On the first day of inspection 32 people were using the service. None of the people were receiving nursing care and the registered provider was in the process of deregistering the home as a provider of nursing care. The building has two floors. There are communal lounges and a dining area on the ground floor, and shared bathrooms and toilets on both floors. The home has 37 ensuite bedrooms, two of which can be used as double bedrooms.

Chapel View was last inspected in August 2016. At that time we rated the home as ‘Requires Improvement’ overall, as it was deemed to be ‘Requires Improvement’ in the key questions of Safe, Effective and Well-led, and ‘Good’ in the key questions of Caring and Responsive.

The home had a registered manager. A registered manager is a person who has registered with 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.

Most checks on the building, its equipment and utilities had been completed appropriately. However, we identified aspects of the building and facilities which posed a risk to people.

People’s care plans did not always contain sufficient detail to inform staff how to support them safely. Care staff we spoke with could describe the support people required which evidenced this was an issue with record-keeping.

We identified some accidents and incidents which the registered manager was not aware of, because they had not been recorded on accident and incident forms. Records showed the registered manager had oversight of those accidents and incidents which were recorded properly.

Some parts of the home were not clean. In places the home’s décor and fittings were tired, which made them more difficult to keep hygienically clean, although a programme of improvement was underway. We recommended the registered manager update infection control procedures in accordance with nationally recognised good practice.

Sufficient staff were deployed to meet people’s needs.

Most aspects of medicines management were undertaken safely, although the application of people’s topical creams was not always recorded.

Records showed the registered provider and registered manager had not ensured the principles of the Mental Capacity Act 2005 were consistently followed for those people who may lack mental capacity. This was a finding at the last inspection in August 2016.

Most feedback about the food and drinks served at Chapel View was positive. We observed staff focused on tasks at mealtimes and chatted amongst themselves, rather than interacting with people. Food and fluid documentation did not always reflect people’s needs; this was an issue at the last inspection.

Staff received the induction, supervision and training they needed to meet people’s needs.

Records showed people had seen a wide range of healthcare professionals, such as GPs, community nurses and dieticians, in order meet their wider health needs.

Good practice on dementia-friendly environments had been used when updating and improving the building.

People and their relatives told us staff were kind and caring. We observed some positive and caring interactions during this inspection; however, we also had serious concerns about the lack of respect some staff showed for people’s privacy and dignity. From our observations we concluded this was due to a lack of awareness rather than any intention to cause upset to people.

People were supported to remain independent. They also had access to advocacy services if they needed help to make decisions.

People and their relatives (if applicable) were not always involved in writing and reviewing people’s care plans. The registered manager planned to review all people’s care plans with them, including those for end of life care, and document people’s involvement going forward.

The quality of people’s care plans varied; some were person-centred, whereas others lacked detail. Daily records evidenced people received the support they needed, however, some record-keeping required improvement.

People told us they had enough to do at Chapel View; we observed people had access to a wide range of activities both inside and outside the home.

People and their relatives felt confident to complain if they needed to. Records showed complaints had been investigated and responded to appropriately.

The efficacy of audits at the home was mixed. Records showed some audits had led to improvements and others had missed the issues we identified at this inspection. There had been gaps in audits for some months in 2017 when the registered manager was also acting manager of another home.

The registered provider and registered manager had failed to notify CQC of incidents of abuse between people at Chapel View.

People and their relatives had opportunities to provide feedback about the service. Staff meetings had been sporadic in 2017; minutes showed these meetings focused on issues and problems.

The registered provider was keen to use information technology to drive improvement at the service.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

This inspection took place on 31 August 2016 and was unannounced.

Chapel View is registered to provide nursing and personal care for up to 39 older people. The home is purpose built and has accommodation and communal areas across two floors. At the time of our inspection there were 35 people using the service. The home was not providing support to anyone with nursing care needs.

The service is required to have a registered manager, and at the time of our inspection there was no registered manager in place. There was a manager in post and their application to the Care Quality Commission (CQC) to become the registered manager was being processed. A registered manager is a person who has registered with the 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.

There had been a planned increase in the number of new people admitted to the home in the month prior to our inspection. Some concerns were raised about the availability of sufficient staffing to meet people’s needs safely. The registered provider had taken action to review and increase staffing levels to reflect the increased numbers of people supported, but rotas for the previous month and feedback we received showed that there were occasions where sufficient staffing had not been promptly deployed to cover gaps in the rota. We have made a recommendation about this in our report.

Cleaning schedules were in place, but we noted a number of areas of the home that required greater attention with cleaning and maintenance, in order to ensure standards of hygiene were consistently maintained. We have made a recommendation about this in our report.

Staff had completed Mental Capacity Act (MCA) training and where people had a condition on their Deprivation of Liberty Safeguards (DoLS) authorisation, we saw that the registered provider was ensuring this condition was met. However, care files lacked information about people’s capacity to consent to their care and demonstrated a lack of staff understanding about who could sign to give consent to decisions if the person lacked capacity. The registered manager was taking action to address this. We have made a recommendation about this in our report.

The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse and staff had received safeguarding training.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. Regular maintenance and equipment checks were also completed.

Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for administration of medication had received training and the registered provider completed medication audits. This showed that there were systems in place to ensure people received their medication safely.

Most people told us they were satisfied with the quality and variety of food available and the home was taking action to increase the variety of food available. People were supported to ensure they got sufficient to eat and drink and their weight was monitored. However, record keeping in relation to food and fluid intake was poor and could not always clearly evidence the action staff had taken in relation to dehydration risk and weight loss. We have made a recommendation about this in our report.

Staff completed an induction and a range of training to help them carry out their roles. Training considered essential by the provider was refreshed annually.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare services, such as GPs, speech and language therapists, and dieticians. Visiting healthcare professionals we spoke with told us that staff acted on the advice they gave in relation to people's healthcare needs.

People who used the service, and visitors, told us that staff were caring and we observed positive and friendly interactions between staff and people who used the service. People's independence was promoted and their privacy was respected.

Care plans were reviewed monthly and contained information about people’s needs and preferences. Staff were also able to demonstrate a good understanding of people’s needs.

There was a complaints, suggestions and compliments procedure in place and records showed that complaints had been appropriately investigated and responded to.

There was a quality assurance system in place, which included a range of audits conducted by the registered manager and deputy manager, as well as an external audit of the home. The quality audits had not, however, been fully effective in addressing some of the concerns we identified in our inspection.