Chandos Road

Chandos Road is a care home for people with acquired brain injuries. At the time of our inspection there were six people using the service who received personal care. The home is a terraced house in a residential area. The accommodation comprises of a communal lounge, kitchen diner, downstairs toilet, shower room, bathroom and seven bedrooms. There is a garden area to the rear of the property.

People's experience of using this service and what we found. People were safeguarded from the risk of harm and abuse. Staff were recruited safely. People were protected from the risks associated from the spread of

infection. Medicines were managed safely. People had risk assessments to protect them from the risks they might face.

People's needs were assessed before they moved to the service. The service worked together with healthcare professionals to ensure people's needs could be met. People were supported with nutrition and hydration. Staff were supported with training and supervision.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems were in place that supported this practice.

Staff demonstrated they knew people well and understood the way people wanted to be cared for. Staff obtained people's consent before delivering care. People and relatives were able to express their views about the care that was provided. People's privacy, dignity and independence were promoted. Staff understood how to provide personalised care. Care records were personalised and contained information about people's preferred method of communication. People and relatives knew how to complain, and the provider had a system to record concerns.

Relatives and staff spoke positively about the management of the service. Staff and management understood their roles and responsibilities. The provider had a system to obtain feedback from people and to audit the quality of the service in order to make improvements.

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 23 February 2021).

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

The inspection was prompted in part due to concerns received about a provider level concerns raised by the local authority in relation to the care and support people received. A decision was made for us to inspect and examine those risks. We also followed up on the action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from required improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chandos Road 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.

About the service

Chandos Road is a residential care home providing personal and nursing care to six people with acquired brain injury, aged 50 and over. The service can support up to seven people.

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

Most relatives told us they felt the service was safe. Risks related to behaviours that challenge did not always ensure staff and people were safe. People were not always protected from the risk of acquiring an infection because we were not assured that infection prevention practices were always followed.

People took part in various activities to improve their wellbeing. Most people were supported to maintain relationships with their family member.

Systems were in place to audit and monitor the quality of the service. However, we received mixed feedback from relatives about the management of the service and staff did not always feel supported in their role.

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 24 October 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safe care and treatment, staff support and management of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection prevention and control and management of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 changed from Good to Requires Improvement. This is based on the findings at this inspection.

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 have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of this full report.

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 have identified breaches in relation to risk management, infection control and management of the service at this 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.

Chandos Road is a ‘care home’ for people with acquired brain injuries, the service only supports men. 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 this inspection. Chandos Road accommodates seven people in one adapted building. Each person has their own bedroom with en-suite bathroom facilities and free access to shared living, kitchen and dining spaces as well as a large garden.

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.

The registered manager provided excellent leadership to the home, demonstrating person-centred values in his approach to people, relatives and staff. They had taken on board feedback and worked with the provider and external agencies to achieve significant improvements in the quality of people’s experience of care. They took a flexible approach to engagement which ensured people, relatives and staff were involved in developing and improving the service. There were effective audit and quality assurance systems in place which ensured the safety of people living in the home.

People felt safe and staff were knowledgeable about how to safeguard people from abuse and avoidable harm. The service took a positive approach to risk taking, ensuring people were facilitated to take risks where they had capacity to do so. Staff had clear, up to date information about how to mitigate risks people faced. There were enough staff who had been recruited in a way that ensured they were suitable to work in a care setting. People were supported to take their medicines and systems ensured this was managed safely. The home was clean and free from malodour. When incidents occurred the service completed thorough, transparent investigations and took action to ensure the risk of recurrence was mitigated.

People’s needs were assessed in a holistic and person centred way. This led to care plans which focussed on people’s goals and aspirations. Staff were well supported by the registered manager and received the training they needed to perform their roles. People were involved in planning and preparing meals and records showed people were supported to maintain nutritious and balanced diets. Staff worked with other professionals and healthcare services to ensure people received the support they needed and had their healthcare needs met. The home environment reflected the preferences of people living in the home. Staff were working within the principles of the Mental Capacity Act 2005 and there was clear information about how to support people to make their own decisions.

People told us the staff were friendly and caring. Staff told us they had time to develop meaningful relationships with people. Staff spoke about the people they supported with kindness and respect. The service considered people’s religious beliefs and cultural background and supported people to attend places of worship and maintain their cultural identity. The service provided an environment where people could disclose their sexual and gender identity.

People met with their keyworkers each week where their care was reviewed and updated as needed. People were supported with a range of activities of their choosing. People knew how to make complaints and complaints were responded to appropriately with changes made to how the service operated when needed. There were systems in place to ensure people received appropriate support if they reached the last stages of their life.

Chandos Road is a care home for people with acquired brain injuries. At the time of our inspection 7 people were living in the home. This was the home’s first inspection under this provider.

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.

The service completed thorough needs assessments with people and their relatives. However, the care plans and risk assessments that were developed failed to reflect people’s preferences or address risks. Care plans lacked detail and records showed staff meetings were used to plan people’s care rather than individual reviews or meetings. People’s needs with regard to their understanding of English were not met.

Records of incidents showed staff did not always follow guidance in how they responded to people in crisis. Staff were knowledgeable about the different types of abuse people might be vulnerable to and records showed the service escalated concerns in an appropriate way.

People and staff told us there were enough staff on duty. The service had not followed best practice in how it recruited staff.

People were supported to take medicines by staff. Medicines were managed in a safe way that ensured people took their medicines as prescribed. People were supported to be as independent as possible with their medicines.

People living in the home had a range of complex needs. Their support was not based on best practice. Staff had not received the training they needed to meet people’s needs.

People indicated their consent to their care by signing their care plans. Where people lacked capacity to consent to their care appropriate Deprivation of Liberty Safeguard authorisations had been obtained. Care plans contained information about how to facilitate people’s ability to make their own decisions.

People told us they liked the food. People were able to choose their meals and dietary preferences were known and respected by staff.

People told us staff supported them to attend healthcare appointments when they needed. Staff maintained clear records relating to people’s health appointments so information was shared appropriately with staff.

People and staff had developed strong, caring relationships with each other. People told us staff respected their privacy. People were supported to maintain links with their past and relationships with family members and friends were supported.

The home had a robust complaints policy and records showed complaints were responded to appropriately and in a timely manner.

People and staff spoke highly of the registered manager. Observations showed people and staff interacted with each other and the registered manager easily throughout the inspection. The person centred values of the organisation were reflected in staff meeting records.

The quality assurance systems had failed to identify and address issues with the quality and the safety of the service.

We found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in respect of safe care and treatment, good governance, person-centred care and staffing. We have made a recommendation about recruitment practice. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.