Chase Park Neuro Centre

Chase Park Neuro Centre is a care home providing personal care to up to 60 people. The service provides support to people aged 18 and over, some of whom were living with a neurological condition. At the time of our inspection there were 41 people using the service.

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

Medicines were not managed safely. Improvements were needed in the records and guidance for topical and when required medicines. Further information was also needed for how people should take their medicines.

We found a dirty and ripped shower chair and a lack of shower chairs within the home to meet people's bathing preferences. Following our inspection, 5 additional shower chairs were purchased.

Bathrooms were not big enough to allow them to get dressed in there. This did not uphold people's dignity.

The general environment was tired in relation to decor. The manager shared with us a refurbishment plan which was due to commence in 2024 throughout the two buildings.

We found window restrictors in one corridor of the building opened further than the legal requirement. We made a recommendation about window restrictors and risk assessments relating to this. This was addressed by the provider immediately following our inspection visit.

The manager and staff were open and honest. Whilst we did receive a lot of positive feedback, some staff shared negative feedback regarding the management and culture of the service. We discussed this with the manager who said they would undertake meetings to listen to all views. Staff were keen to learn and drive improvement to ensure people received the best possible care.

The provider did not have a policy relating to duty of candour on the first day of our inspection visit and we made a recommendation about this. This was in place by the second day of our inspection.

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.

Systems were in place to safeguard people from the risk of abuse. Risks to people were managed by staff following appropriate risk assessments. We saw staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and staff were recruited safely. Relatives and friends were encouraged to visit the home and spend time with their loved ones.

People’s preferences and choices were being upheld. People were offered choices during mealtimes and enjoyed the food provided in the service. The home ensured people had access to health care professionals when required and worked in a multi-disciplinary way with therapists employed by the service.

People and relatives told us staff were kind and caring. We observed positive interactions between staff and people living in the home.

People told us they enjoyed the activities provided within the service and feedback about the therapies provided was excellent.

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 good (published 19 March 2020 )

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being provided to people. 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.

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.

You can see what action we have asked the provider to take at the end of this full report.

The provider acknowledged the shortfalls found during this inspection. They took action following the first day of inspection to begin to address some of the shortfalls found regarding medicines, records and the environment.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chase Park Neuro Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicine management, safe care and treatment, person centred care, records and provider oversight and monitoring 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Chase Park Neuro Centre is a residential care home providing personal and nursing care to up to 60 people. The service provides support to people aged 18 and over, some of whom were living with a neurological condition. At the time of our inspection there were 35 people using the service.

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

The premises were safe. Previous health and safety concerns had been fully rectified and were safe for people living at the home. Regular checks of the environment were in place to make sure any concerns were identified and addressed immediately by the registered manager and deputy manager.

One area of the home had been refurbished and decorated to provide a positive environment for people living with a dementia. The building had been adapted to allow for accessible access throughout.

Safe infection control and prevention processes were being followed by staff. The home was clean with a homely environment.

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 18 March 2020).

Why we inspected

We undertook this targeted inspection to check the previous health and safety concerns identified in 1 area of the home had been addressed. This was at the request of the Local Authority to ensure people aged 65 or over who needed short term placements, had a diagnosis of dementia or required long term nursing support would be safe in the refurbished area of the home.

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.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chase Park Neuro Centre 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.

We found the following examples of good practice.

¿ The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors.

¿ The registered manager had an effective monitoring system in place to check that the service was following government guidance and the provider's own policies.

¿ Staff were confident and knowledgeable about government guidance and what visitors were required to do prior to entering the service. Professional visitors and relatives were tested for COVID-19 at the service or provided a negative lateral flow test result from that day. Visiting professionals and staff provided evidence of their vaccination status to the registered manager before entering the service.

¿ Staff and people received regular testing for COVID-19 and emergency care givers were included in this testing programme. Visitors were supported to carry out a lateral flow test prior to visiting their relative.

¿ People were encouraged and supported to leave the service to visit relatives or access the local community. Relatives were able to visit their family members either in their rooms or communal lounge areas.

¿ Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control from the provider. The registered manager had appointed two nurses to be infection prevention and control (IPC) champions at the home who attended regular forums and training sessions, and who had shared their knowledge with all staff.

We found the following examples of good practice:

¿ All visitors had their temperature checked upon arrival at the service. Protocols were in place to carry out lateral flow testing for any visitors to the service. All visitors had access to the relevant PPE.

¿ Systems were in place to support people to maintain contact with their family. Families were kept up-to-date with what was happening in the service regarding visits. Some relatives had purchased a portal device which allowed relatives to video chat with people any time they wished. People were also supported to maintain contact with relatives via Zoom calls.

¿ Staff had access to adequate amounts of PPE. The registered manager and clinical lead had received training from the infection prevention and control (IPC) nurse. The registered manager and clinical lead then cascaded this training to staff. The majority of staff were up-to-date with their on-line IPC training. Feedback from the IPC nurse following a visit to the service had been positive.

¿ The registered manager told us both people and staff underwent regular COVID-19 testing in line with government guidelines.

¿ Adjustments had been made to the environment and this was to support with social distancing. Staff were seen to adhere to social distancing guidance during the inspection. Appropriate signage was displayed throughout the service to support social distancing.

¿ Robust cleaning protocols were in place for both daily and more in-depth cleaning. The registered manager completed monthly cleaning audits of the home.

¿ The registered manager worked well with external professionals including a local GP and the infection control nurse.

Chase Park Neuro Centre is a residential care home providing personal and nursing care to 32 people aged from 18 and over at the time of the inspection, some of whom were living with a neurological condition. The service can support up to 60 people in two large adapted buildings.

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

People and relatives were happy and content living at the service. People told us that they were supported with their rehabilitation by accessing the occupational therapist, the neuropsychologist and visiting the swimming pool, which were based within the home.

People were supported to access the local community and maintain social relationships. People could join in activities at the service, but staff told us this still required further development to make sure there were a choice of meaningful activities available every day.

People had an initial assessment of their needs which were used to create specific care plans. Not everyone had personalised and individual care plans in place.

We have made a recommendation that the provider reviews all records relating to people’s care to make sure they are person-centred and accurate.

The premises were safe. Some areas of the home were in need of refurbishment and the provider had an action plan in place for these repairs. We found there were some areas of the home where infection control procedures were not being fully followed by staff, but the registered manager took action during our inspection to resolve this.

Since our last inspection, the registered manager and director of quality and nursing had developed the quality and assurance systems in place to make sure they effectively identified any areas for improvement and monitored the quality of care provided. The provider visited the service regularly to carry out their own audits of the service. People, relatives and staff were engaged with the service and were asked for feedback ideas to improve the service further.

Medicines were managed safely. Staff knew people very well and could tell us the level of support each person required. People were supported to maintain a healthy balanced diet and were provided with a range of options for meals. Staff worked with other agencies positively to make sure people received a continuous level of care.

Relatives and visitors were welcomed into the service. People and their relatives were part of their care planning. People were provided with choices with their care and staff worked with relatives to make sure people’s views were included. There was enough staff to safely support people and the registered manager had greatly decreased the usage of agency staff since our last inspection.

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.

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 16 April 2019) and there was a breach of the regulations in relation to the safety of the premises and medicines management. 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 the safety and quality of care provided to people. We asked the provided to complete an improvement plan to address the concerns we had received, and this inspection was carried out to follow up on these.

We have found evidence that the provider needs to make improvements. Please see the responsive section of this full report.

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.

People’s experience of using this service: People received person-centred care which promoted positive outcomes to their well-being and independence. Care records detailed how people liked to be supported and were individual to the person. The service worked in partnership with other health and social care agencies to support people’s rehabilitation.

There were regular reviews of people’s needs to make sure they received the support they required. People had regular input other health care professionals and external agencies, for example GPs and therapists.

Environmental risks had not always been identified and assessed. Individual risks to people had been fully assessed and mitigated to help keep people safe. Medicines were not always managed safely; there were gaps in people’s medicine administration records. This meant people may not have had their medicine administered.

There was a governance framework, designed to assess the quality and safety of care, which was not always effective. The management team completed audits of the service and created action plans to improve the quality and safety of the service. However, these did not include actions to mitigate the risks we found.

Staff were kind and caring with people; they respected their privacy and dignity. People received safe care from a competent staff team. Some staff had not completed the required training.

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

People were supported to attend activities in the local community and within the service. People were encouraged to maintain social relationships.

Following the last inspection, we asked the service to complete an action plan detailing what they would do and by when to improve the key questions of safe and well-led to at least good. At this inspection we found the service had addressed the initial safety issues identified at the last inspection. However, we identified new risks and safety issues during this inspection.

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

We identified a continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safety of the service. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires Improvement (report published August 2018). This is the second time the service has been rated as requires improvement.

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

Follow up: We will continue to monitor the service through information we receive from the service, provider, the public and partnership agencies. As part of our process we will be meeting with the provider and requesting an action plan to be completed to address the issues identified. We will re-visit the service in-line with our inspection programme . If we receive any concerning information we may inspect sooner.

Chase Park Neuro Centre is ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Chase Park can accommodate 60 people in two adapted buildings and on the date of this inspection there were 39 people living at the service and 15 people receiving respite complex care. Most of the people living at Chase Park Neuro Centre had fluctuating capacity due to an underlying medical condition or injury. There is also a coffee shop and swimming pool area, accessed by members of the public that are attached to the care home building.

There was a registered manager in post who has been registered with the Care Quality Commission (CQC) to provide the regulated activity since November 2016, this was one of the requirements of the home’s registration with the CQC. 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.

During this inspection we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations: Safe care and treatment, and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations: Good governance. This was because the provider had not adequately assessed the risks to the health and safety of people using the service and the management of medicines was not safe. You can see the action that we have asked the provider to take at the back of the full version of this report.

We found the premises were not always safe. Designated fire escape routes were used as storage areas for staff belongings, the sluice and clinical waste storage areas were not locked and oxygen was not safely stored. This practice increased the risks of injury to people using the service.

Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. However, we found medication administration records (MARs) had not been completed correctly and the medicines trolley was left unattended in front of the main entrance to the building. People's care records were left in the main corridors of the home which were easily accessible to other people and visitors.

People told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe which were being followed by staff. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were able to tell us basic safeguarding practices, what to do if they needed to raise a safeguarding concern and what they did to keep people safe. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required.

Infection control procedures were in place at the home and during the inspection we saw regular cleaning of the home. There was a business continuity plan in place to ensure the service could still provide care to people in the case of an emergency. There was enough staff to support people but we found that the deployment of staff during the first morning of the inspection was an issue.

There was a fire risk assessment in place, personal emergency evacuation plans (PEEPs) in place and we saw regular testing of equipment. A PEEP is an individual escape plan for a person who may not be able to reach an area of safety unaided or in a safe amount of time in an emergency situation. PEEPs included how many staff would be required to support people and what action should be taken. There was a clear evacuation route throughout the service and the lights, doors sensors and alarms were tested regularly.

There was a newly created governance framework in place at the service. The registered manager carried out regular checks and audits of the service and worked with the provider to achieve positive outcomes for people who used the service. The provider and registered manager had a clear vision to care for people living at the home. The management team created an open and honest culture with staff and had an ‘open door’ policy for all people, relatives and staff.

The registered manager was a visible presence at the home and also supported people by carrying out nursing duties. Staff told us they felt supported by the registered manager and were able to seek advice and guidance when needed. Staff were able to describe their role in supporting people and championed the work they did.

We saw regular involvement from GPs, local authority, clinical commissioning group (CCG) and other partnership agencies documented in people’s care files. Care files contained daily recordings of the support people received and we also saw referrals to other health care services within these. For example, one person had a referral to the speech and language therapist. Records were audited as part of the governance framework and we saw evidence of monthly reviews of people’s needs.

Chase Park Neuro Centre is registered to provide care to 60 people aged 18 years or over. At the time of this inspection there were 47 people living at the home, three of these were respite admissions. The home provides rehabilitation and nursing care to people with a neurological condition as well as older people. The service is provided across two buildings.

The home had a registered manager. 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 provider’s approach to gathering feedback about the service from people and relatives lacked structure. Regular meetings did not take place. People had not been included in previous consultation. We have made a recommendation about this.

People told us they were well cared for. They said staff were kind and caring and they were treated with respect. Staff supported people with developing and maintaining their independence. People and staff told us the home was safe.

Staff had a good understanding of safeguarding and the provider’s whistleblowing procedure. Although they had no concerns about people’s safety, they knew how to raise concerns if needed.

Previous safeguarding concerns had been dealt with in line with the provider’s safeguarding procedure and referrals made to the local authority safeguarding team.

The provider had taken measures to ensure there was enough staff on duty to meet people’s needs. Most people said staffing levels had improved. Staff confirmed there was sufficient staff to meet people’s needs. Staffing levels were monitored periodically to check they were still appropriate to meet people’s needs.

There were effective recruitment procedures in place to check new care workers were suitable to work with people living at the home.

Records confirmed medicines were managed safely. People received their medicines from trained and competent staff.

Regular health and safety checks and risk assessments were carried out to help keep the home safe. For example checks of electrical safety, gas safety, fire-fighting equipment, emergency lighting and specialist moving and handling equipment. Procedures were in place to help ensure people continued to receive care in emergency situations.

Accidents and incidents were logged, investigated and monitored.

Staff confirmed they received the support and training they needed. Records we viewed confirmed this.

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

People’s cultural and religious needs had been assessed and adaptations made to their care. For example, offering an adapted diet to meet religious requirements.

People were supported to have enough to eat and drink. Where people required specific support or specialist advice and guidance this was provided.

People had access to external health care services in line with their assessed needs. This included GPs, community nurses, speech and language therapists, physiotherapists and occupational therapists.

People had the opportunity to be involved in planning their care. People’s needs had been assessed including identifying their preferences and the information was used to develop individualised support plans. These had been reviewed to keep them up to date with people’s changing needs.

Activities were provided and people could choose to participate. These included activities both inside the home and in the local community, such as shopping, going to discos, outings, themed activities and a cookery club.

People knew how to raise any concerns they had. Previous complaints had been investigated and where required action taken to resolve the complaint.

The provider had invested in improving the environment and providing the facilities and equipment people needed. The registered manager told us about plans for continuous improvement of the home. However, these were not documented within a service development or improvement plan. Staff were enthusiastic and optimistic about how the future of the home.

Staff had opportunities to give their views and suggestions about the home.

The provider carried out regular quality assurance checks, such as checks of medicines, accidents, complaints, safeguarding concerns, staff files and care records. Where required action had been taken to deal with any issues identified through quality assurance checks.

Feedback from relatives during the last consultation was mostly positive. Regular staff meetings were held.