Archived: Chalcraft Hall Care Home

Chalcraft Hall Care Home is a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 20 people.

Chalcraft Hall Care Home accommodates people in one building, there are two wings to the service and the home is on two floors. People at the home have access to a shared dining room, lounge and garden. The home provides specialist care for people with dementia.

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

At the previous inspection documentation to ensure people were kept safe was sometimes incorrect or incomplete, at this inspection this documentation had been corrected. The provider had reviewed procedures and audits at the service and had plans to carry out more frequent audits to reduce risk to people.

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 best practice.

People were offered activities which were hosted by a dedicated activities coordinator. People were able to choose their entertainment and we saw people colouring, reading, knitting and playing team games involving throwing beanbags and rolling balls. There were enough staff to support people, and when staff had time between tasks we saw them sit and interact with people.

New electronic care plans had been introduced enabling staff to access detailed person centred information easily during the day via handheld devices. During the transfer, the care plans were reviewed, and the ease of access meant staff could update them in real time. Most staff knew people well, and new or agency staff were able to read the care plans during their initial shadowing shifts.

People were happy and active. We saw friendly interaction with staff. People told us they liked the food at the home. We saw people enjoying well presented meals and being assisted by staff in polite and dignified ways.

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 November 2020) 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.

Why we inspected

We carried out an announced focused inspection of this service on 17 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Need for Consent and Good Governance.

We undertook this focused inspection to check they had followed their action plan to improve Need for Consent and Good Governance, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

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

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 coronavirus and other infection outbreaks effectively.

Follow up.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chalcraft Hall Care Home is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service can support up to 20 people.

Chalcraft Hall Care Home accommodates people in one building, there are two wings to the service and the home is on two floors. All people at the home share a dining room and lounge. The home provides specialist care for people with dementia.

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

People were offered few activities, and no separate spaces to take part in their interests. There were not always enough staff to support people to remain active, for example to take a walk in the garden. People were restricted from leaving the home to keep them safe, these decisions were not always documented. There was a lack of evidence that people's choices were respected.

The manager had recently left the service and the provider was acting as manager at the time of the inspection. Neither senior staff nor the provider had identified past issues with documentation or understood the impact this could have on people. The lack of clear oversight and correct documentation left people at the risk of harm. The provider was preparing an action plan to address this. The provider was taking time to speak to all staff and reviewing working patterns to create a more cohesive team. Staff said they had been nervous when the manager left but the provider had implemented positive changes. Policies, procedures and audits at the service needed review.

While we did not see any evidence of harm to people at the home, care plans were not always kept up to date. This meant staff were acting on old instructions and may not have been taking recent changes in a person’s choice of care into account. While some staff knew people well, new or agency staff would not be acting on people’s current care needs. People at the home were happy. We saw friendly interaction with staff. People told us they liked the staff at the home. Staff understood the importance of safeguarding and the provider worked closely with the local authority. Issues regarding safety and risk continued to be overseen by the local safeguarding team.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible or in their best interests; the policies and systems in the service did not support best practice.

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 22 February 2019).

Why we inspected

We received concerns in relation to people’s care needs, staffing, and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions before the inspection. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.

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

Enforcement :

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s freedom and consent to care and of good oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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.

People’s experience of using this service: Quality assurance systems did not always identify issues in practice. Accidents and incidents were recorded. However, these records did not always show management oversight and action taken when trends in incidents were identified. This did not provide assurance that the registered manager had full oversight of accidents and incidents. This is an area of practice that needs to improve.

People were safe from the risk of abuse. One relative told us, “Mum is very safe here. She is very unsteady on her feet and has a frame to walk with. The staff seem to have eyes in the backs of their heads because they don’t miss a trick.” Specific risks to people had been assessed and were known by staff. The home was clean and people were protected from infection risks. Staffing levels met people’s needs and staff were suitable to work with people.

People received effective care from skilled, supported and knowledgeable staff. Staff had access to a range of training and development opportunities and worked well as a team and with other professionals to meet people’s needs. People were supported to maintain a balanced diet. People were given choice and control over their lives which promoted their independence.

People received kind and compassionate care. A relative told us, “They’re lovely. They’re just so caring and lovely with everybody.” People’s privacy and dignity were respected and their views listened to.

People received person centred care that was specific to their needs. People had access to a range of activities which enhanced their lives. There was a complaints procedure in place which was accessible to people. People were supported with compassionate end of life care.

People, staff and relatives spoke positively of the registered manager and their leadership. One person told us, “The manager is very nice. She is very kind and is always around.” There were a range of audits in place with the aim of driving the quality of the home and most were effective in this. People were supported to be engaged in the running of the home and their opinions were listened to.

Rating at last inspection: Requires Improvement. (The last inspection report was published on 16 January 2018). The overall rating has improved since the last inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our reinspection schedule for those services rated Good.

There was a lack of effective leadership at the service. A registered manager was not 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 and associated Regulations about how the service is run.

People's individual needs were not routinely met by the adaptation of the premises.

There was a range of quality assurance systems to help ensure a good level of quality of care was maintained. However, these systems had not fully ensured that people received a consistent and good quality service that met individual need. Robust day to day management support was not available for staff.

Risks associated with the safety of the environment and equipment were not always identified and managed appropriately.

Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of support and a negative culture in the service.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. People were cared for in a clean, hygienic environment and infection control protocols were followed.

People were being supported to make decisions in their best interests. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and managing behaviour that may challenge others. Staff had received supervision meetings with their manager.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included singing, films, exercises and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after, supported and empowered to make their own decisions. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. Accidents and incidents were monitored to help prevent them happening again.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of the report.