Archived: Chaucer House

Chaucer House is a residential care home providing personal and nursing care to up to 60 people. There were 36 people at the time of the inspection,

The care home accommodates people across two separate floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

People told us since the last inspection, their experience at the service had improved. Risks to people had been assessed and mitigated, and there had been improvements to medicine management, but further improvement and embedding of this practice was needed.

Audits and quality reviews of the service were being completed regularly by the manager and provider, and action was taken when areas for improvements were identified, however these systems had only been in place for a short period of time, and therefore we could not assess the effectiveness of them.

Staffing levels had increased, and there were more permanent staff who knew people better. People and their relatives told us they felt safe living at Chaucer House as a result of the staffing levels.

Staff were now receiving more regular training and supervision to enable them to support people effectively. Assessments had been carried out when people’s needs changed to ensure the person received the relevant support needed.

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 told us they were supported by a kind caring staff team who knew them well and understood their needs. People had been supported to review and be involved in the updating of their care plans.

People were supported by a consistent staff team who knew them well and supported them to maintain their interests.

The number of complaints received by Chaucer House had decreased since our last inspection.

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 1 March 2019) and there were multiple 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.

This service has been in Special Measures since 1 March 2019. During this inspection the provider demonstrated that improvements had 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.

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.

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.

Chaucer House 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.

Chaucer House is a purpose-built care home, registered to accommodate up to 60 people. At the time of the inspection there were 41 people living at the service.

We last inspected the service on 23 and 24 November 2017. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the service was rated Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good.

At this inspection we found there had been a deterioration in the quality of service people received: leadership and management was poor, and people had not received safe care. We have rated the service Inadequate overall.

At the time of our inspection, there was 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.

There was not sufficient staffing to meet people’s needs. The service continued to rely heavily on agency staff, which meant people did not receive care from a consistent staff team. Risks to people had not been assessed and minimised in all cases. For example, one person did not have adequate information to for staff to support them with their catheter care. Medicines were not managed consistently safely. There were issues with medicines ordering, which lead to potential harm for one person. Staff did not always follow best practice around the labelling of opened medicines.

Accidents and incidents were documented by staff, and action had been taken to try to avoid the risk of the incident reoccurring. However, action taken did not always reduce the number of accidents, and no further follow up had been made.

Staff continued to not receive regular supervision to support them to carry out their roles. Staff had received some training, however had not received training in supporting people with behaviours that could challenge. New staff completed the providers induction process. Staff recruitment files showed the provider followed safe recruitment processes.

Some people had recently had DoLS applications authorised by the local authority. We found the conditions on people’s DoLS were not consistently being met. People were supported to have choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Quality monitoring systems had identified the shortfalls but the registered manager and provider failed to make improvements for issues identified during this inspection. This included care planning, risk assessments, staffing and the management of medicines.

Care plans we reviewed lacked person-centred details on how best to support people as individuals. One person had lived at the service for a number of weeks, and yet did not have a detailed care plan in place.

Staff we spoke with understood their responsibilities to safeguard people from potential harm and abuse. People were protected by the prevention and control of infection. The service was clean, well maintained and without odour. The service was purpose built, and since our last inspection there had been some improvements to the dementia friendly signage.

People’s needs were mostly assessed before moving into the service and support was given in line with nationally recognised tools to monitor things like people's weight and skin condition. People received enough food and drink to maintain good health and told us that they liked the food. Staff worked in partnership to provide consistent support when people moved to or from the service. Staff worked alongside healthcare professionals when people’s needs changed to ensure they received the appropriate care and treatment.

Staff treated people with kindness and compassion and people told us they liked their staff. Permanent staff knew people's needs well and people told us they valued their staff. However, staff did not have sufficient time to spend with people. People and their relatives were consulted around their care and support. People's privacy was respected, and staff encouraged people to be as independent as safely possible.

There was a complaints policy in place and available to people. Complaints were being recorded and acted upon. People received a pain free and dignified death at the end of their lives.

Staff told us they felt supported by the registered manager, and people told us they had confidence in them to make improvements however we found sufficient improvements had not been made since our last inspection.

People who lived in the service and members of staff told us they felt engaged in developing the service due to monthly meetings introduced by the registered manager.

At this inspection four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Chaucer House 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.

Chaucer House is registered to accommodate up to 60 people. At the time of the inspection there were 41 people living at the service.

We carried out a comprehensive inspection on 19 and 21 September 2016 and the service was rated Outstanding. This inspection was prompted by information from the local authority, other healthcare professionals and relatives that there were increased risks to people’s safety, health and welfare following the registered manager leaving. This inspection examined those risks.

There had been a change in the management of the service since our last inspection. There was a registered manager leading the service. 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 registered manager had started working at the service in August 2017.

There were not sufficient staff on duty to provide consistently safe, effective and person centred care. There had been a reliance on high levels of agency nursing and care staff; however, at the time of the inspection, the amount of agency staff had reduced. Staff did not always have the skills to provide the care and support people needed. Staff had not received consistent supervision and appraisal. The registered manager had increased the number of staff on duty, following the inspection; they told us that another member of staff would be on duty during the day. We will check this at our next inspection. Staff were recruited safely. New staff completed an induction when they started work at the service.

Potential risks to people’s health and safety had not been consistently assessed and there was not always detailed guidance for staff to following to mitigate risk. The high use of agency staff meant that people were at risk of not receiving safe care. During the inspection, we observed staff and staff told us how they supported people safely.

Checks to the environment and equipment were completed to ensure they were safe. Shortfalls were identified, however, action to mitigate risk to people’s safety was not always taken quickly.

Before the inspection, concerns were raised about unsafe management of medicines. The registered manager had taken action to reduce medicines incidents, these had been effective. During the inspection, medicines were being managed safely.

Each person had a care plan. The care plans contained information about people’s lives before they came to live at Chaucer House. However, the care plans did not consistently contain details about people’s care and support that was unique to them. During the inspection, we observed and staff told us about people’s preferences and how they provided person centred care. People were assessed before coming to Chaucer House. The registered manager assessed the person’s mental health, physical and social needs, including equality and diversity but this had not always been reflect in the person’s care plan.

Some people were receiving end of life care. There were not always enough staff to provide the skilled care and support to the person and their family. There were not detailed care plans in place to guide staff about the person’s wishes and the support required.

People and relatives told us, that staff were kind and caring. However, they told us that staff did not always maintain their dignity and treat them with respect, they felt this was due to not having sufficient numbers of staff on duty.

Audits had been completed, shortfalls had been identified but sufficient action had not been taken to rectify the issues and the same shortfalls were found at this inspection. There were systems in place to receive feedback from people, relatives and staff. Complaints had been received from relatives, but action had not always been taken to improve the service. There was an action plan in place, the registered manager, had started to complete actions required.

The building was purpose built, meeting people’s physical needs. However, in the dementia unit the signs to direct people to places such as the bathroom, were not clear and were not pictorial. There was a risk that people would not be able to find their way around the unit. This was an area for improvement.

People and staff had the opportunity to attend meetings. Staff meetings had not been held regularly, the registered manager had identified this and meetings were held regularly, to keep staff up to date and receive their feedback. . A relatives meeting had been held in May 2017, but there were no minutes available. There were activities available each day.

Staff knew how to recognise signs of discrimination and abuse. They were confident that any concerns would be dealt with appropriately. The registered manager had reported incidents to the local safeguarding team when appropriate and was working with healthcare professionals to reduce the risks of the incidents happening again.

People were supported to eat and drink enough to maintain a balanced diet. Staff referred people to specialist healthcare professionals such as dieticians when required and followed the advice given. People had access to opticians and chiropodists as needed. People were protected by the prevention and control of infection procedures.

People were supported to have maximum choice and control of their lives and staff supported them in least restrictive way; policies and systems in the service supported this practice. Staff were kind and compassionate when spending time with people, they supported people to make choices about their care and support where possible.

Staff told us that they felt supported by the registered manager and felt that the service had started to improve. The registered manager promoted an open culture within the service, they were visible around the service. There were mixed views from people and relatives, some people knew the registered manager and others stated they had not met them. The registered manager told us that they were trying to meet as many people as possible.

The registered manager was aware of the shortfalls in the service and was working through an action plan to rectify these. They had worked with other agencies and healthcare professionals to build relationships to reduce the risk of incidents in the future.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.

Providers are required by law, to display their CQC rating to inform the public on how they are performing. We found that the provider had conspicuously displayed their rating at the service and on their website.

At this inspection five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

Chaucer House provides accommodation with personal and nursing care for up to 60 adults. The service is divided into two separate units for people with nursing needs and people living with dementia. There were 28 people living at the service at the time of the inspection. In each unit people had access to a number of seating areas and a dining room. There is a separate hairdressing room, shop, cinema room, family room and a bar on the top floor. There is a garden to the rear of the home.

A registered manager was 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.

People’s care needs and the staffing levels available were regularly reviewed to assess if there were sufficient staff on duty at all times. Some people said there were enough staff and others that staff did not always have time to talk to them. During the inspection staff took time to talk to people, support them when they required and did so in an individual manner.

Relatives said their family member was cared for in a safe place. Staff knew how to recognise any potential sign of abuse and report them in order to help keep people safe.

Assessments of risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and had been used as learning events to improve the standard of the service.

Medicines were stored safely and administered by qualified nurses. A clear record was kept of the medicines given to each person to ensure they received their medicines as prescribed by their GP.

A schedule of cleaning was in place to ensure the service was clean and a lead nurse was responsible for ensuring practices minimised the spread of any infection.

People’s health care was effectively monitored and professional advice was sought as appropriate. The service understood the importance of ensuring people were offered regular drinks and snacks and a hostess had been employed to facilitate this. Mealtimes were important social occasions. People were offered a choice, support was provided and people were not rushed.

New staff received an induction which included shadowing new staff and spending time with people. Staff were provided with training in the areas necessary for their role, and this was refreshed on a regular basis. This included specialist training in supporting people living with dementia and end of life care. All staff had received training in the Mental Capacity Act 2005 and staff understood the principles of the Act and how to apply them. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unlawfully. .

The environment had been adapted for people living with dementia and a disability. There was specialist equipment to aid people with mobility needs and visual aids to help direct people to where they wanted to go.

Staff were consistently kind, caring and compassionate, and treated people with dignity and respect. Care was personalised and had been adapted to meet the individual needs of people. Staff had positive relationships with people and their family members who they knew well. People were actively involved in making decisions that affected their daily lives and their wishes were respected when receiving end of life care.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person which included their individual choses and preferences. Guidance was in place for staff to follow to meet people’s needs. Staff knew people well which enabled them to support people in a personalised way.

The service prioritised ensuring people were provided with stimulating and meaningful activities. Activities reflected people’s interests and abilities and included group and one to one activities to ensure that each person was reached.

Information was given to people about how to raise any concerns they may have. Relatives said that when they had raised a concern, they had been listened to and the issue resolved to their satisfaction.

The views of people and their relatives about the quality of care provided at the service were regularly sought and acted on. People and relatives felt able to approach the registered manager and said they would recommend the service to others. The service had received a number of compliments.

The registered manager was a visible presence in the service and led a staff team who were clear about the aims and values of the service in providing personalised care.

Effective quality assurance systems were in place to ensure the service continuously improved for the benefit of people.