29 July & 1 August 2014
During a routine inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission which looks at the overall quality of the service.
This inspection was unannounced and was undertaken on 29 July and 1 August 2014.
Chatsworth Grange Nursing Home was last inspected in February 2014 and was meeting the requirement of the regulations we inspected at that time.
Chatsworth Grange Nursing Home Nursing Home provides accommodation and nursing care for up to 66 people living with dementia. There are four different units which support people with differing levels of need. There were 62 people living at Chatsworth Grange Nursing Home at the time of this inspection.
A registered manager was in place. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
We found that people were not appropriately supported to make decisions in accordance with the Mental Capacity Act, 2005 (MCA). Whilst the manager had an understanding of the MCA and Deprivation of Liberty Safeguards (DoLS); care staff had not received training and were unable to describe how these pieces of legislation applied to their practice.
Our review of records also demonstrated a lack of knowledge about the MCA and provided further evidence that staff were not following the MCA Code of Practice. This meant that the service was not meeting the requirements of the regulation in relation to consent to care and treatment. The action we have asked the provider to take can be found at the end of the full version of this report.
We reviewed the care plan for a person who was subject to the Deprivation of Liberty Safeguards (DoLS). The correct procedure had been followed in order to meet the DoLS and ensure that this persons rights had been protected.
On three of the four units, people had care plans in place which reflected their assessed needs. On one unit it was difficult to establish if some records were current and accurately reflected people’s needs. The care plans on this unit were not as comprehensive as those reviewed on the other units and contained some inconsistencies, as well as poorly ordered and illegible information. On the second day of our inspection we saw that the registered manager had taken swift action and had begun to address some of our findings.
We found that there were policies and procedures in place to make sure people were safe. Staff knew about safeguarding adults and we saw that any concerns had been reported and appropriately dealt with.
People’s nutritional needs were met. Our observations of mealtimes and our review of nutritional records evidenced that people received a choice of suitable healthy food and drink. People’s physical health needs were monitored and referrals were made when needed to health professionals.
Equipment within the home was clean, well maintained and was fit for purpose. Some dementia friendly signs were in place to support and orientate people living with dementia. The manager informed us of their intention to make the environment more dementia friendly.
We found that there were enough staff to meet people’s needs. The staff team was well established, with many members of staff working at the home for ten or more years. Our conversations with the manager, staff and our review of records evidenced that the home had an effective process to ensure that employees were of good character and held the necessary checks and qualifications to work at the home. Staff were provided with a range of training to help them carry out their roles and some staff had also undertaken further training courses. Staff received regular supervision and an annual appraisal.
Staff across the home had a good understanding of people’s individual needs and preferences and people told us that they were treated with kindness and compassion. Staff knew how to respect people’s privacy and dignity.
A range of activities were provided and seen during the course of our inspection. Some people commented that they were bored and that there was not enough to do. The manager told us of their intention to provide more one to one engagement on individual units. People accessed the local community for meals out and shopping trips.
Regular audits were undertaken to monitor the quality of the service. People, relatives and staff were encouraged to give feedback about the service. People and relatives did not raise any complaints about the home. There were no complaints at the time of our inspection.