Archived: Chiltingtons Residential Home

There was a registered manager on the first day of our inspection however on the second day of our inspection we were told that there was no longer a registered manager in place. Following the inspection the provider confirmed that there was no registered manager in place. 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. However the provider was in the process of appointing a new manager.

The previous comprehensive inspection was undertaken on 24 and 26 November 2015 and the service was rated Requires Improvement. As a result of this inspection, we found the provider in beach of regulations relating to safe care and treatment as the provider had not ensured that the premises were safe. Action had not been taken following visits by the Fire and Rescue Service. We saw that fire doors had not been wedged open, fire exits had fallen off the walls and emergency lighting had failed testing. At this inspection we saw that the provider and registered manager had actioned the recommendations from the Fire and Rescue Service. However, we saw a further breach of this regulation. We identified issues with the assessment of risk for people who smoked. Some systems were in place to identify risk and protect people from harm, however, not all necessary assessments had been carried out. We saw that there were three people living within the home who smoked, but the risk to these people and others had not been assessed and steps had not been taken to reduce this risk. These three people used flammable emollient creams and this risk had not been considered.

This was the first inspection of Chiltingtons Residential Home since a change to the provider’s legal entity. At the previous inspection we also identified concerns with the maintenance of the premises and the provider was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. Several areas were in need of improvement, the building was not well maintained or decorated to a good standard. While some improvements had been made, we identified concerns with other areas relating to the maintenance of the premises. The provider did not have a legionella tesing certificate in place and following the inspection confirmed that legionella testing had not been carried out. We saw that areas within the home were not well maintained, carpets were ripped and radiator covers were hanging loose from the wall. We spoke to the registered manager about the premises and they told us “family tolerate the environment due to the good care their relative gets”.

At the previous inspection the provider was in breach of Regulation 17 relating to good governance as the home did not have a system to monitor the quality of the service which people received. There were no quality assurance systems in place and the registered manager did not receive any formal feedback. At this inspection we saw that some action had been taken to improve this area and quality assurance systems were now in place. However, we saw that while areas for improvement were identified the provider did not respond to these concerns or at other times did not respond in a timely way.

People told us they felt safe living at the service and able to raise concerns with staff. Staff knew what action to take if they suspected abuse and had received training in keeping people safe.

There were sufficient numbers of staff on duty to keep people safe and meet their needs. We observed that people were not left waiting for assistance and people were responded to in a timely way. However, we saw that there were not enough safe on duty to meet people’s social needs and ensure that people were supported to take part in meaningful activities. New members of staff were checked to ensure they were safe to work at the service.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, given to people as prescribed and disposed of safely.

While mental capacity assessments were completed we could not check if applications for Deprivation of Liberty Safeguards had been made appropriately as the registered manager was not at the service on the second day of our inspection. We spoke with the deputy manager and the provider, however, they were not sure whether applications had been made and could not locate records which may confirm applications had been made. The provider and deputy manager where unsure how they would check where applications had been made or how they would follow this up in the absence of the registered manager.

There was a supervision and appraisal process in place for care staff. Staff received supervision every two or three months, they also received a yearly appraisal. They received supervision and appraisal minutes which detailed what had been discussed. However, the registered manager did not receive supervision or support to ensure that they had opportunities to reflect on their practice or discuss concerns.

People had enough to eat and drink. The chef had details of people’s dietary needs, including soft food diets kept within the kitchen and ensured that they were aware of any changes to people’s diet.

People were supported to maintain good health and had access to health professionals. Staff worked with professionals such as doctors and dieticians to ensure advice was taken when needed and people’s needs were met.

People’s care plans included information on people’s relationships, mobility, nutrition and communication needs. However they did not contain information relating to people’s life history.

People told us there was not enough to do and they often felt bored and lonely. We were told, “I ask to go out for a walk and I always get the same answer.. no”. The information within care plans on people’s interests and hobbies was limited and the activities offered did not always reflect people’s personal preferences.

At this inspection we identified areas that required improvement. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the report.