Chapel Lodge

Chapel Lodge is a care home service with nursing. It is registered to provide service to 63 older people. At the time of our inspection there were 47 people living at the service.

People’s experience of using this service:

Since the last inspection considerable improvements had been made in the way risks and medicines were managed. People were receiving their medicines safely. People’s care plans were up to date and accurately detailed the care and support people wanted and needed. Risk to people were properly assessed and safeguards put in place to mitigate any risks which had been identified. It was also clear that effective processes had been put in place to make sure these improvements were sustained

There was better management oversight and the checks and audits of the quality and safety of the service had been strengthened, and this helped to drive continuous improvement. People’s feedback was regularly sought, so that they could contribute to improvements within the service.

People received care and support which was tailored to their needs, delivered by staff who treated them with respect and understood their needs and preferences. Staff were caring, and people and relatives complimented the service and said they would recommend it to others.

People were protected against the risk of abuse and received care from staff who were well trained to meet people’s needs. . Staff were recruited safely and there were enough of them to keep people safe.

People received care in an environment that was safe, clean and tidy. There had been improvements made, to make the home more conducive to people’s wellbeing, homelier and more welcoming.

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 dietary and healthcare needs were met. There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People’s feedback was used to make improvements to the service.

Rating at last inspection:

The service was last inspected on 23 August 2018 (report published 23 October 2018). At that time the overall rating for the service was ‘Inadequate’. The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected:

This was a planned, comprehensive inspection based on the rating at the last inspection.

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

At our last comprehensive inspection in November 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches of Regulation 18, Staffing and a continued breach of Regulation 12, Safe care and treatment. We took enforcement action and a warning notice was issued for Regulation 12. The service’s overall rating was ‘Requires Improvement’.

The registered provider sent us a report saying what action they were going to take to meet the requirements of the regulations. We carried out this comprehensive inspection to check whether the service had completed these actions.

At this inspection we found sufficient improvement had been made to meet the requirements of Regulation 18, Staffing. However, we found a continued breach of Regulation 12, Safe care and treatment in relation to the management of medicines and of the management of risk and a new breach of Regulation 17, Good governance. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The registered manager had started managing the service at the end of April 2018. 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.

At our last inspection we found some concerns about the management of some peoples medicines. We saw improvements had been made to address these concerns. However, at this inspection we found some new shortfalls regarding the management and administration of medicines.

There were planned and regular checks completed at the service to check the quality and safety of the service provided. However, our findings during the inspection showed some of the checks needed to be completed more robustly. These checks need to be done well so they identify any concerns so appropriate action can be taken to improve the quality of support provided.

At our last inspection people, their relatives and the staff told us there were not enough staff on duty to safely meet people’s care and support needs in a timely way. At this inspection we concluded there was sufficient staff scheduled to be on duty. We found the registered provider had made sufficient improvement to meet the requirements of Regulation 18, Staffing.

During the inspection we found concerns in some people’s individual risk assessments. The registered manager assured us that action would be taken to review these people's risk assessments.

We found concerns across a range of records relating to people’s care. We shared this information with the registered manager. During the inspection, the registered manager took action to address any omissions or inaccuracies in the records we reviewed.

People we spoke with told us they felt ‘safe’. Staff were aware of their responsibility to protect people from harm or abuse.

There were robust recruitment procedures in place so people were cared for by suitably qualified staff who had been assessed as safe to work with people.

People and relatives made positive comments about the staff and told us they were treated with dignity and respect.

During the inspection we observed staff giving care and assistance to people. They were respectful and treated people in a caring and supportive way.

Staff underwent an induction and shadowing period prior to commencing work and had regular updates to their training to ensure they had the skills and knowledge to carry out their roles.

Staff received appropriate support to enable them to carry out their duties.

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.

There were end of life care arrangements in place to help ensure people had a comfortable and dignified death

We saw the service promoted people’s wellbeing by taking account of their needs including activities within the service and in the community.

Complaints were recorded and dealt with in line with organisational policy.

We saw the registered provider actively sought out the views of people to continuously improve the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We checked progress the registered provider had made following our inspection on 7 September 2016 when we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 12, Safeguarding service users from abuse and improper treatment; Regulation 18, Staffing; Regulation 9, Person-centred care; and Regulation 17 Good Governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. We found improvements had been made in some areas, however the service continued to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 12, safe care and treatment and Regulation 18, Staffing.

Chapel Lodge is a ‘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. Chapel Lodge provides accommodation for up to 63 people over two floors, accessed by a lift. All bedrooms are single with en-suite toilets. There are lounges and dining areas on each floor of the home. The service has a garden and a car park. On the day of our inspection there were 58 people living in the home.

The manager had worked at the service since June 2017 and was in the process of registration with 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.

We found effective systems were still not in place to ensure medicines were stored, managed and administered in a safe way.

People, their relatives and staff told us there were not always enough staff employed to safely meet people’s care and support needs in a timely way. We were told this was particularly evident at night.

Staff were suitably trained, and received supervisions and appraisals. However, the frequency of supervision was not consistent across the service. We saw plans had recently been implemented by the manager for all staff to receive regular supervision in line with the service’s own policy.

Staff spoke passionately about the people they supported. They knew people’s preferences and were keen to support people to be as independent as possible. Staff told us they knew what it meant to treat people with dignity and respect. However, we saw this didn’t always happen in practice as some doors were left open when people were being supported with personal care.

We saw people received appropriate care and support to meet their needs, however some care records needed updating to reflect recent changes.

Quality assurance systems had been introduced to monitor and improve the quality of the service provided. However, these need to be sustained to ensure continued compliance with regulations.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

People and their relatives told us they enjoyed the food served at Chapel Lodge, which we saw took into account their dietary needs and preferences. This meant their health was promoted and their choices were respected.

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.

There was a range of activities on offer to people living at Chapel Lodge. People told us they enjoyed taking part in the activities. Some people and their relatives told us they would like more activities and of a wider variety.

There was a complaints policy and procedure. This was clearly displayed in the reception area.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 12, Safe Care and Treatment and Regulation 18, Staffing.

You can see what action we told the provider to take at the back of the full version of the report.

Chapel Lodge provides accommodation for up to 63 people who require nursing and/or personal care. Accommodation is provided over two floors, accessed by a lift. All bedrooms are single with en-suite toilets. There are lounges and dining areas on each floor of the home. The service has a garden and a car park. At the time of the inspection there were 60 people living at the service.

There was 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 registered manager was on annual leave at the time of this inspection. The provider’s regional operations manager was present at this inspection.

There was a friendly atmosphere in the service and staff were very welcoming. Our observations during the inspection told us people’s needs were being met in a timely manner by staff. We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a caring and supportive way.

People told us they felt safe and were treated with dignity and respect. Relatives spoken with felt their family member was in a safe place.

The service did not have appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Some people had personalised their rooms and they reflected their personalities and interests. We saw the signage in the service to help people navigate around the building could be improved. People living with dementia may need such signs to aid them to move around a building.

People spoken with told us they were satisfied with the quality of care they had received and made positive comments about the staff. Relatives spoken with also made positive comments about the care their family members had received and about the staff working at the service.

We saw people’s care plans had been personalised but were not yet person centred. We found some people’s care plans had not been updated to reflect changes in their needs and we also found examples of conflicting information.

There was evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners.

People’s nutritional needs were monitored and actions taken where required. People made positive comments about the food.

Staff told us that there was a good team working at the service and that they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, likes and dislikes.

Although staff told us they felt supported by the registered manager and senior members of staff we found staff did not receive regular supervisions.

We saw the service promoted people’s wellbeing by taking account of their needs including daytime activities. There was a range of activities available which included: arts and crafts, baking, pamper mornings and gentle exercises.

The provider had a complaint’s process in place. We found the service had a robust process in place to enable them to respond to people and/or their representative’s concerns, investigate them and take action to address their concerns.

Regular residents and relatives meeting were held at the service. The service had completed a survey with people living at the service and relatives in 2015.

Accidents and untoward occurrences were monitored by the registered manager to ensure any trends were identified. We found the systems in place to monitor and improve the quality of the service were ineffective in some areas.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 9, Person Centred Care, Regulation 12, Safe Care and Treatment, Regulation 17, Good Governance and Regulation 18, Staffing.

You can see what action we told the provider to take at the back of the full version of the report.

The provider wrote to us and told us that they had prepared an action plan to address all of the areas highlighted in the report. They told us that by end of October 2013 they would complete the actions.

The provider used 'Residents and Relatives' meetings to find out about people's preferences in food and drinks to meet their needs. We were informed by staff that food and drinks served at the home took into account people's preferences including their cultural and religious needs. This was supported by the records we reviewed.

We spoke with the support workers about how they organised meal times for people who lived at home. They told us that during each shift they were allocated duties that they were responsible for at meal times and this was helpful.

The chief said that they visited each dining room regularly during mealtimes and spoke with the people and staff to get feedback. They said they also monitored the food returned to the kitchen following meal times to assess if people had enjoyed the meals.

We noted that staff had ensured that people with artificial (PEG) feeds were in receipt of regular mouth care to avoid the discomfort from a dry, sore mouth.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Most people said they liked the home. We observed the activities person interacting with people and suggesting different activities.

People said the quality of meals served was not consistent. They commented on the quality and the presentation of food. The manager said they were aware of this and were taking action.

Staff said they worked with health and social care agencies to ensure people received appropriate care. A visiting professional said staff were knowledgeable about the people's conditions and they were always open to suggestions.

The home environment protected people's rights, dignity, choice and autonomy. Following the recent Fire Safety inspection, improvement actions have been required to ensure fire safety at the home.

There was enough equipment to promote the independence and comfort of people who used the service.

People had their comments listened to without fear of being discriminated against. None of the people who spoke with us were afraid of voicing their opinions.

Records were kept securely and they were able to be located promptly when needed.