Archived: Cheybassa Lodge Rest Home

Cheybassa Lodge is a residential care home providing personal care to up to 18 people. The service provides support to older people who live with dementia and physical frailty. At the time of our inspection there were 14 people using the service.

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

The provider’s quality assurance systems were not fully effective in identifying all concerns in the service. Some policies needed improvement, so they provided effective guidance to staff. We have made a recommendation about this. When the provider was made aware of any issues, they acted to address them and told us of their plans to further improve.

Although no restrictions were imposed on people and they were supported to have choice and control over their lives, the policies and procedures in place did not support this practice. We have made a recommendation about this.

People felt safe at Cheybassa Lodge and were protected from the risk of abuse. Risks associated with people’s health and support needs were safely managed. There were enough staff to meet people's needs in a timely manner. Safe procedures were in place to ensure people received their medicines as prescribed.

Staff received enough training to support people effectively and staff felt supported in their roles. People enjoyed their meals and had a choice about what they ate and drank. People's healthcare needs were met, and staff supported people to achieve good outcomes.

People spoke positively about the support they received and the staff team who cared for them. Staff were described as kind and caring. People were happy living at Cheybassa Lodge and relatives also provided us with positive feedback about the support people received. People’s privacy and dignity were respected.

People's care plans contained sufficient information to support staff to provide person-centred, responsive care to people. Staff recognised people's individual communication needs and provided meaningful activities for them.

The service had a positive person-centred culture. People, relatives and staff were positive about the registered manager. Everyone we asked said they would either recommend the service as a place to live or a place to work.

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 11 April 2019). 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.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

The inspection was prompted in part due to concerns received about the application of Mental Capacity Act 2005. A decision was made for us to inspect and examine those risks.

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.

Recommendations

We have made recommendations for the provider to improve their practice into the application of the Mental Capacity Act 2005 and governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cheybassa Lodge Rest Home is a 'care home'. Cheybassa Lodge Rest Home accommodates up to 18 people living with dementia and physical frailty in one building. At the time of our inspection 14 people were living at the home.

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

Quality assurance systems had not always been effective in identifying the concerns we found at this inspection or fully addressed concerns from our last inspection.

The provider had not always notified CQC about important events that happened in the service which meant these could not be monitored.

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 and in their best interests; the policies and systems in the service did not support this practice.

The lack of robust infection control practices placed people at risk of being exposed to infections. This included known risks associated with the current Covid-19 pandemic. We made a recommendation about this. Some risks to people’s safety had not been safely managed and the registered manager had plans in place to address this.

We made a recommendation that the provider reviews their safeguarding systems and processes to ensure people are fully protected from the risk of harm and abuse.

People, staff and relatives felt there was enough staff for people to be safely supported. However, some staff and people felt there was not always enough staff to undertake other tasks such as cleaning and supporting people with social engagement. The registered manager told us of their plans to improve this by recruiting activities and cleaning staff. Recruitment processes were safe.

The management of medicines was mostly safe although further work was required to ensure people received their ‘as required’ medicines in the most effective way.

Staff felt well supported through training and supervision. Staff in the service worked well with each other and external professionals to ensure good health outcomes for people. People were provided with a nutritious and balanced diet that met their needs and preferences.

Care plans were not consistently detailed, or person centred, however, there was a consistent staff team in place, and they had got to know people well which meant they understood people’s needs and preferences. People were well supported at the end of their lives.

The provider had made some effort since our last inspection to improve social engagement for people, but this was not enough to ensure people’s social needs were always met. The registered manager had plans in place to improve this.

The provider had not always worked in line with the duty of candour requirements and we have made a recommendation about this.

People and their relatives knew the registered manager and felt able to speak to them if they had any concerns. Staff felt well supported by the registered manager and felt they provided them with good leadership. Relatives and staff told us they would recommend the home to others.

The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

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 10 April 2019). There was one breach of regulation in relation to regulation 17 Good Governance. We met with the provider and they completed an action plan after the last inspection to show what they would do and by when to improve.

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

At this inspection enough improvement had not been made and the provider was still in breach of regulation 17. We also found two new breaches of regulations in relation to consent and submitting notifications to CQC as required. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 remained as 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, Responsive 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 Cheybassa Lodge Rest 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 monitor the service 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 consent, governance and notifying CQC where required.

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 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.

Cheybassa Lodge Rest Home is a ‘care home’. Cheybassa Lodge Rest Home accommodates up to 18 people living with dementia and physical frailty in one building. At the time of our inspection 14 people were living at the home.

People’s experience of using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times there was a lack of clear and accurate records regarding people’s medicines and support needs.

•Accidents and incidents were not analysed at a service level which meant overarching trends and patterns could not be identified. We have made a recommendation about this.

•The provider was not meeting the requirements of the Accessible Information Standard (AIS), we recommended that the provider seeks reputable guidance to ensure this was met.

•We found that activities were not always reflective of people’s preference and we made a recommendation that the provider seeks reputable guidance in order to provide personalised support for people

•Despite this, people were happy living at Cheybassa Lodge Rest Home and people told us they felt safe. People were supported by staff who were kind, caring and who understood their support needs, likes and dislikes. Where they needed external health input they were supported to receive this.

•Staff were not always supported with regular supervision or appraisal but staff told us they felt well supported by the registered manager and had enough training to undertake their roles effectively.

•People and their relatives knew the registered manager and felt able to speak to her if they had any concerns. Staff felt the registered manager had improved the culture of the service. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection: Requires Improvement (Report published 13 February 2018)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Requires Improvement.

Follow up: The overall rating of the service remains Requires Improvement. At the last inspection, the provider was found to be in breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection, we found the provider had met the requirements of Regulation 12 but remained in breach of Regulation 17. This is the second consecutive time the service has been rated as Requires Improvement and we will request a clear action plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 8 and 12 December 2017 and was unannounced.

There was a registered manager in post at 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 and associated Regulations about how the service is run.

People who use the service and one person's relative were positive about the care they received and praised the approach of the staff and how the service was managed. Comments from people included, “Staff are good as gold, not a bad egg”, “Staff are kind” and “The staff are very nice, all of them”. One person’s relative told us, “Staff are brilliant". We observed staff interacting with people in a friendly and respectful way.

People told us they felt safe living at Cheybassa Lodge Rest Home. However risks to people were not consistently monitored and managed to ensure they received safe care. The provider did not have effective systems in place to learn from safety incidents and concerns. The provider told us they took action following our inspection to manage these risks.

Staff knew how to identify abuse and they told us they would raise any concerns with the registered manager. Not all concerns had been shared with the local authority. The provider took action to report these concerns during our inspection. We have made a recommendation about the reporting of safeguarding concerns in line with safeguarding protocols.

People did not receive all of their medicines when required and some improvements were required to the recording of prescribed creams. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

The home was clean and staff understood their responsibilities for infection control.

Care plans lacked detailed information about people's needs and preferences. The registered manager had identified improvements required to ensure all care plans were detailed and relevant. We have made a recommendation about involving people and their representatives in care planning.

People’s preferences and choices for their end of life care were not discussed with them or recorded in their care plans.

People received support to ensure they had enough food and drink.

The provider had identified improvements to the systems to monitor the quality of the service provided however these improvements had not been implemented. Improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received. The provider did not had systems in place to learn from safety incidents and concerns.

People told us they felt the service was well managed.

People were supported by staff who had been through checks on their suitability to work in the home but improvements were required to ensure staff's full employment history was checked.

Staff required additional training to ensure they had the necessary knowledge and skills to meet people's needs. We have made a recommendation about staff training on the subject of dementia.

People had access to health care professionals and were supported to maintain their health by staff.

The provider had arrangements in place to respond to complaints and a complaints procedure. Improvements were required to how complaints were responded to.

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