Archived: Chesswood Care

Our inspection team comprised an inspection manager and an inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people who used the service, four members of staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

Whilst people's care needs had been assessed at the time of their admission to the service, we found that they had not been adequately reviewed or monitored since. This meant that people's most up-to-date care needs were not identified and catered for appropriately. We found that risk assessments had not been undertaken in sufficient detail to prevent accidents or incidents from happening.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. As far as we could ascertain, no applications have needed to be submitted and Chesswood Care was unable to provide us with their policies and procedures relating to DoLS. We were unable to establish whether staff had received appropriate training or not as the provider did not provide us with any evidence to confirm this.

This is being followed up and we will report on any action when it is complete.

We found that the environment was in a clean and tidy state and that appropriate measures were in place to prevent the risk of infection. Improvements to the premises had been undertaken since our last inspection and maintenance issues had been rectified.

Is the service effective?

We saw that people's care records lacked detail and that daily records did not provide a clear picture of how people had spent their day or how they were feeling. Some members of staff had left recently and new staff that had been recruited were in the process of getting to know people, although they did not have updated care records to refer to. This is being followed up and we will report on any action when it is complete.

We found that the staff did not provide care in line with people's needs and that protected their safety and welfare.

Is the service caring?

Three people we spoke with told us that they were happy and well. We observed that staff were patient with people and treated them warmly. However, people's views and wishes were not always sought in relation to their care, nor were the views of their representatives. We found that little improvement had been made with regard to people's autonomy or community involvement. There was a lack of activities for people who used the service.

This is being followed up and we will report on any action when it is complete.

Is the service responsive?

We saw that people were weighed and their weights recorded on a chart, although we observed that no-one had been weighed recently. Two people had lost weight, but there was no information in their care records to show whether any action had been taken to manage this weight loss. All the people who used the service had been diagnosed with dementia or other type of cognitive impairment. We found that people had not been assessed consistently in a way that allowed them to be involved in decisions about their care.

Some activities were available, but a Bingo game that had been organised on the day of our visit was beyond most people's capabilities or understanding. There was a lack of mental stimulation available for people who used the service, taking into account people's varied levels of cognitive ability.

This is being followed up and we will report on any action when it is complete.

Is the service well led?

Previous inspections found that the provider did not have effective systems in place to manage the risks to the health, safety and welfare of people who used the service and others. The quality of the service that people received had not been monitored nor had their views been obtained. A Warning Notice was issued in March 2014. At this inspection we found that little change had taken place and the Warning Notice was not met.

The provider had still not issued quality assurance questionnaires to people's relatives. Complaints were not routinely documented and addressed and none had been recorded since 2008. The accident book showed a lack of detail and did not identify what lessons had been learned as a result of accidents or incidents that had occurred.

The registered manager left the service in May 2014 and has not been replaced.

Enforcement action will be pursued with regard to the provider and their failure to achieve and sustain compliance.

We found that the home respected people and protected their privacy and dignity. However, people's independence, views and abilities to make decisions was not always taken into account in the way the service was provided and delivered in relation to their care.

We found that the premises were in a poor state of repair and that cleaning was not undertaken to a high standard or on a regular basis. One relative told us that the curtains in her family member's room had never been washed. The relative added that, 'Carpets do need a thorough cleaning.' They also said that, 'The outside of the building is a mess.' Another relative told us that [the building], 'Is a bit old' and needed updates.

There were no records in place to evidence that quality assurance audits had taken place. None of the relatives we spoke to had been asked what they thought about the quality of the service. One relative told us that they had concerns about cleanliness, premises, staffing levels and overall management. One person who used the service told us that they felt, 'Safe as anywhere in the world'. Another person told us that their room was 'peaceful' and that they enjoyed the view of the garden. They also said, 'I can't think of anything I'm not getting'.

We found that the provider had appropriately reported deaths of service users to the Care Quality Commission.

We saw that additional staff had been employed at the service and there were additional staff on each shift. We saw this had a positive impact on the safety of the service and staff told us it had.

We observed that several improvements had been made to the premises including new furniture and the lighting had been replaced. In addition, checks and documentation related to the environment were being done to ensure on-going maintenance and safety of the premises.

Some of the people and relatives we spoke with felt that they weren't included in the planning and review of their care. We found that there was limited documentation of people and their representatives being involved in care decisions. There was no information about how decisions should be made in the event of a person lacking capacity. We observed that staff did not consistently meet people's needs for dignity, independence and social stimulation.

People who used the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises. The home did not have a system for checking and addressing routine maintenance issues. There were risks related to fire safety procedures which had not been resolved.

We found that there were not enough qualified, skilled and experienced staff to meet people's needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. The feedback and input from people who lived at the home and their relatives was not routinely sought or recorded.

We spoke with two people who used the service and two relatives. People told us they were happy living at the home. They said staff were kind to them and treated them with respect. People said they had choice in how they spent their days and access to the activities they enjoyed such as cards, games, reading, films and outings. They told us they had choices in their food as well. Relatives told us they were included in decisions about people's care and informed promptly of significant changes or problems. We found that people's choices and preferences were respected. People using the service and their relatives were consulted in care decisions.

People and their relatives told us there were enough staff in the home to meet people's needs. We spoke with staff who also felt the current staffing levels were manageable and safe. We found that there were enough staff on duty to safely support people and to engage them in stimulating activities.