Chaseview Care Home

Chaseview Care Home is a residential care home providing personal and nursing care to up to 120 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 60 people using the services. The accommodation was arranged across 3 separate units. One of the units specialises in providing care to people living with dementia. Most bedrooms have en-suite facilities. There is a large communal lounge, a dining room, and a garden.

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

Since our last inspection, the provider had taken action to improve staffing level. The service had enough appropriately skilled staff to meet people's needs and keep them safe. People and relatives were happy with staffing levels. The provider had a safe staff recruitment process in place. Staff received appropriate training, support and development which enabled them to meet people's needs.

Systems were in place to protect people from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. Steps had been taken to help ensure the physical environment was safe.

People received their prescribed medicines in a safe way. The service uses electronic Medicines Administration Records (MAR) to record all administrations. Regular medicine audits were taking place. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

Assessments were carried out of people's needs prior to the provision of care to determine if their needs could be met at the service. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. The premises were clean and well maintained. People had access to health care professionals.

People were supported with their nutritional needs. Specialist diets were in place when required and people were monitored to help them retain a healthy weight. Their health care needs were monitored, and staff ensured when support from external health professionals was required this was sought in a timely manner.

Staff engagement with the people they support was good and people were treated in a caring and respectful way. People and their relatives had the opportunity to express their views on their care. Staff worked in a way which supported people's dignity and privacy.

There were activities provided seven days a week. People had asked for some activities to be provided later in the afternoon/early evening so that their visitors were not rushed. During our inspection, the provider arranged one persons’ 100th birthday party. The provider bought a present, cake, and a birthday card, and also arranged a birthday celebration with friends, families and staff at Chaseview Care Home.

People and relatives told us staff were caring and that they treated people with respect. Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.

Care plans were in place for people which set out how to meet their needs in a person-centred way. Information was provided to people in a way that was accessible to them. Systems were in place for dealing with complaints, and complaints had been dealt with accordingly.

The service had a complaints policy in place and staff were aware of how to support people should they wish to complain. The manager of the service was approachable and open, staff and people in their care felt supported.

We received positive feedback on the service. One person said, ''there’s nothing wrong with the home. I’m happy, carers are kind and they listen to me.''

Quality assurance and monitoring systems were in place to help drive improvements at the service. People and staff told us there was an open and positive culture at the service. People were supported to express their views. The provider was aware of their legal obligations and worked with other agencies to develop best practice and share knowledge.

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 inadequate, published 16 November 2022 and there were breaches of Regulation 12 (safe care and treatment), Regulation 18 (staffing), Regulation 17 (good governance), Regulation 9 (person-centred care), Regulation 10 (dignity and respect), Regulation 11 (need for consent), Regulation 14 (meeting nutritional and hydration needs), and Regulation 15 (premises and equipment).

This service has been in Special Measures since 16 November 2022. This meant we kept the service under review and, we re-inspected the service within 6 months to check for significant improvements. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chaseview Care Home on our website at www.cqc.org.uk

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection in September 2022. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chaseview Care Home is a residential care home providing personal and nursing care to up to 120 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 103 people using the services. The accommodation was arranged across four separate units. One of the units specialises in providing care to people living with dementia. Most bedrooms have en-suite facilities. There is a large communal lounge, a dining room, and a garden.

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

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. People were at risk because the provider had not acted to ensure they had sufficient oversight of the service. Records were an area of concern across the service; records were not complete and accurate.

People were not always supported in a way that was safe. Risk assessments contained inaccurate, out of date and contradictory information, especially in relation to food and fluid, risks of falls, and, bladder and bowel assessment. In some cases, risk assessment were missing altogether, for example, in relation to epilepsy and diabetes, and care was not always provided in line with risk assessments.

The service had systems in place to safely store, administer and record the use of medicines. However, these were not always followed. Medicines were not always being given at their prescribed times. Staff were not following correct infection control procedures when administering medicines. Medicines were not always being stored appropriately.

Agency staff were not always being given appropriate training and handover to understand people’s care needs. Audit processes were not identifying areas for improvement and where they did, actions were not being taken.

People's care plans contained conflicting and confusing information about their mental capacity. It was not always clear when a person lacked capacity and when a best interest's decision had been made, who had been involved in the decision making process. Covert medication was not recorded in Deprivation of Liberty Safeguards (DoLS).

Care plans did not contain any information to guide staff as to how to support people to manage specific medical conditions, such as diabetes and Parkinson’s disease safely.

We were not assured there were enough staff to meet people's needs. We observed call bells were not always answered quickly. We also observed that call bells were muted or switched off without staff attending to people to find out what they wanted or needed. Staff were recruited safely.

Supervisions meetings with staff were inconsistent, staff were not always given opportunities to discuss their progress or discuss issues. Most staff had completed training in the areas the service identified as mandatory, such as safeguarding and moving and handling. However, the service had not identified that staff required training around individual health needs and conditions, such as diabetes or epilepsy.

People were not always treated with dignity and respect. People's cultural needs were not always respected. Most people told us the staff were nice and kind.

Some people told us their personal care needs were not always met. People's care records did not always evidence people had received personal care. Care and support plans for people with long term conditions lacked detail. There were very little activities taking place in the service.

There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor risk management, lack of oversight of medicines and limited oversight of people mental capacity had not been identified prior to our inspection. The provider had failed to sustain and make improvements to the service following previous inspections.

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 15 October 2019 and there were no breaches. At this inspection not enough improvement had been made, the provider was in breach of regulations 18 for the third time and regulation 17 for the second time. Further breaches of regulations have been identified in this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the staffing levels, infection control, the environment and the overall safety of the service. 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.

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

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

You can read the report from our last inspection report, by selecting the ‘all reports’ link for Chaseview Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, staffing, need for consent, person-centred care, privacy and dignity, premises and equipment, and, meeting nutritional and hydration needs.

Please see the action we have told the provider to take at the end of this report.

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.

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.

Special Measures

The overall rating for this service is Inadequate and the service is therefore remains in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Chaseview Care Home is a residential care home providing personal and nursing care to 85 people at the time of the inspection. Most people living at the service were older people some of whom had dementia. The service can support up to 120 people across four units in an adapted building.

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

Since our last inspection, improvements had been made with risk assessments for people at risk of skin complications. This included control measures, referral to professionals and monitoring the risks. People’s nutrition and hydration risks were recorded appropriately, and staff followed care plans and health professional’s advice. However, risk assessments were not completed for people that had breathing problems to minimise associated with breathing. The management team told us that these risk assessments would be completed.

Infection control procedures had been enhanced due to the risk of COVID19 and we observed the service was clean and a cleaning schedule was in place. Systems were in place to ensure visits were made safely. Personal protective equipment [PPE] was readily available and people and staff were tested regularly.

There was sufficient staff available to support people safely. Staffing levels were reviewed regularly and call bells were answered promptly.

Quality assurance processes at the service monitored the safety and wellbeing of people at the service. These processes were completed regularly and when actions were identified to improve elements of care, these were followed up on.

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 requires improvement (published 24 October 2019) and was a focused inspection to follow up on the warning notice we served for staffing and requirement notice for good governance at our last comprehensive inspection on 18 March 2019.

Why we inspected

We undertook this targeted inspection to follow up on recommendations we made at the last inspection on call bell monitoring and good governance and to check if improvements had been made on skin integrity risk assessments. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on specific 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.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chaseview Care Home on our website at www.cqc.org.uk.

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.

Chaseview Care Home is a residential care home for up to 120 older people, primarily with dementia. At the time of the inspection, the home was supporting 87 people with personal and nursing care.

People’s experience of using this service

Improvements had been made with staffing. Staff rotas showed that there were enough staff across units to support people safely. Call bells were being answered promptly. However, we found instances whereby call bells were not within easy reach of people. We made a recommendation in this area.

There were inconsistencies with risk assessments. Some assessments included mitigation to minimise risks, which were not being carried out. Unexplained bruising was not being analysed to identify cause to minimise risk of skin complications.

Audits had identified shortfalls with risk assessments and an action plan was in place. However, prompt action was required to ensure people received safe high-quality care.

Pre-employment checks were carried out to ensure staff were suitable to care for people safely. Safeguarding procedures were in place and staff were aware of these procedures. Medicines were being managed safely.

Systems were in place for quality monitoring to ensure people’s feedback was sought to improve the service. Staff were positive about the management of the service.

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 home was requires improvement (published 26 April 2019) and there were breaches of regulation in relation to staffing and good governance.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 March 2019. Breaches of legal requirements were found. As a result, we served a warning notice to ensure the home was compliant with staffing. The provider also completed an action plan after the last inspection to show what they would do and by when, to improve with Good Governance and Staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led, which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions were looked at on this occasion and were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chaseview Care Home on our website at www.cqc.org.uk.

Follow up:

We will speak with the management team prior to this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Chaseview Care Home is a residential care home providing accommodation and personal care to 97 people, at the time of the inspection.

People’s experience of using this service:

• Some people, relatives and staff raised concerns with staffing levels. We found a number of issues with staffing, which included delay in call bell response and ineffective staff deployment in units.

• Some staff raised concerns with lack of support given by the management team. Supervisions were not regular to ensure staff were supported at all times. This was being addressed. We made a recommendation in this area.

• Care plans were inconsistent especially in the area of skin integrity to ensure people were in the best of health and received person centred care. We made a recommendation in this area.

• Audits had not identified the shortfalls we found during the inspection especially with staffing.

• People received their medicines as prescribed and medicines records were completed accurately. However, there was lack of robust systems in place to review people’s medicine’s annually. We made a recommendation in this area.

• Risks associated with people’s needs had been assessed.

• Staff had completed essential training to perform their roles effectively.

• People were supported with their nutritional needs and had choices with meals. However, people and relatives expressed concerns with meals and the timing of meals. We made a recommendation in this area.

• The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required.

• People continued to receive care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy.

• Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

• People’s independence was promoted.

• We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

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

Rating at last inspection:

• At the last inspection on 5 and 6 February 2019 the service was rated ‘Requires Improvement’. At this inspection, the rating for the service continuous to be ‘Requires Improvement’.

• At our last inspection, the service was in breach of three Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, risk management and restricting people’s liberty lawfully. At this inspection, breaches relating to risk management and restricting people’s liberty lawfully had been addressed. However, concerns remained with staffing.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The home had recently changed providers and this was the first inspection since the new provider took over.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Risk assessments for most people who lived in the home included information on how to mitigate identified risks. However, risks were not always robustly managed for some people to ensure they were safe at all times.

Some people, relatives and staff raised concerns about staffing levels. The way staff were deployed across the home meant there were sometimes delays in providing support to people who required it.

Some people who lived at the home were deprived of their liberty under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty applications had not been made for four people when their initial DoLS authorisation had expired. Staff were aware of the principles of the MCA and assessments had been carried out to determine people’s ability to make decisions in certain areas.

Quality assurance systems were in place but were not always effective. The audits which the home carried out had not identified the shortfalls we found during the inspection to ensure people were safe at all times. Accurate and complete records had not been kept to ensure people received high quality care and support.

Medicines were managed safely. In general, we found that people’s Medicine Administration Records (MAR) had been completed accurately. Medicines was being administered as instructed on people’s MAR, or in accordance with the provider’s policy.

Pre-employment checks had been carried out for new staff to ensure they were suitable to provide care and support to people safely. Staff we spoke to were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Incident records were reviewed and these showed the provider took appropriate action following incidents that had been recorded. Systems were in place to analyse incidents for patterns and trends to ensure lessons were learnt and incidents were minimised.

Systems were in place to reduce the risk and spread of infection. Staff had access to personal protective equipment and used this when needed.

Staff had the skill and knowledge to provide support effectively. Records showed that some staff needed refresher training in some areas. This was being addressed by the management team. Staff were knowledgeable on how to support people. Supervisions were carried out regularly and staff told us that they were supported by the manager.

People had access to healthcare services and staff knew what to do if people felt unwell.

People in general told us that they enjoyed the food at the home and were given choices. However, people in one unit raised concerns with meals. People’s weight and food intake was monitored when required and if there were concerns, action was taken, which resulted in people’s health improving.

Care plans were inconsistent. Some people’s current circumstances were not being reviewed effectively to achieve effective outcomes as although reviews were being undertaken, we found that they did not accurately reflect some people’s current circumstances. Care plans contained information on how to communicate with people. Pre-assessment forms had been completed in full to assess people’s needs and their background.

People’s privacy and dignity were respected by staff. People told us that staff were caring and they had positive relationships with staff.

Complaints were being investigated and staff were aware of how to manage complaints.

Regular activities were being carried out. This involved group activities and individual activities. There was an activities lead for each unit.

We identified three breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of this report.