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Reports


Inspection carried out on 14 September 2018

During a routine inspection

Chaseview Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Chaseview Nursing Home accommodates 60 older people some of whom were living with dementia. The provider also provided nursing care. On the days of our inspection 56 people were living in the home. The home is situated on two floors and was accessible to wheelchair users.

This inspection was unannounced and took place on 14 and 18 September 2018.

We completed a previous inspection of this home in May 2017 which we published in July 2017. The provider was rated Requires Improvement overall and was in breach of Regulation 12, Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At that inspection we issued a Warning Notice to the provider. In response the provider sent us an action plan to tell us what they would do to improve the service and to comply with this regulation.

A focused inspection was carried out in September 2017, to find out if the provider had addressed the concerns identified at the previous inspection and that they had met the legal requirements. We looked at the key question ‘Safe’ because we had received concerns from members of the public about people’s safety. At this inspection we found that the provider had not taken sufficient action to comply with the breach of Regulation 12. The provider was also in breach of Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 17, Good governance.

Following the inspection in September 2017, the registered provider was issued a Notice of Decision to apply conditions to their registration. The registered person was required to ensure that they supervised the management of Chaseview Nursing Home and monitor compliance against the regulations. This included their duty to ensure that people received safe care and treatment and that they were protected from abuse and improper treatment. The registered person was required to ensure that quality improvements were implemented and sustained.

At this inspection we found that improvements had been made and that the provider was no longer in breach of the regulations.

Chaseview Nursing Home had a registered manager in place who was present throughout this inspection. 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.

People were safely supported with their medicines by competent staff members. People were confident that they would receive their medicines as prescribed and on time. There was guidance available to staff when supporting people with “when required” medicines.

People were safe from the risk of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the registered manager were acted on appropriately. There were enough staff to support people to meet their needs in a timely manner.

New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff members had access to on-going training to maintain their skills and to keep up to date with changes in adult social care. The provider followed safe recruitment procedures when employing new staff members.

People received care that was effective and personalised to their individual needs and preferences. 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.

Inspection carried out on 7 September 2017

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 11 May 2017. At this inspection a breach of legal requirements was found of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment around the safe management of medicines. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We had also received information from members of the public who were concerned about the safety of people who lived at the home. This report only covers our findings in relation to those requirements and the safe question. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chaseview Nursing Home on our website at www.cqc.org.uk.

Chaseview Nursing Home provides nursing and residential care for up to sixty people. At the time of our inspection there were forty nine people living at the home. At the last comprehensive inspection we issued the provider with a warning notice to improve the way they managed medicines to ensure that people’s needs were met safely. At this inspection we saw that some improvements had been made but that further improvements were needed. We saw that the provider had implemented systems which meant that staff recorded when people did not receive their medicines as prescribed. However, these were not always followed fully to ensure that further errors were avoided. They also did not always take action to ensure that people had not been harmed when they had not taken their medicines. Similarly, when incidents were recorded which could mean that people were at risk of abuse these were not always reported to the relevant agencies to protect people.

Other risks to people’s health and wellbeing were assessed and managed. People were supported to move safely and any equipment that they used was regularly checked to ensure it was safe. There were enough staff to meet people’s needs and to keep them safe in communal areas. The provider continued to try to recruit new permanent staff because they recognised that people did not always feel as confident with agency staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection carried out on 11 May 2017

During a routine inspection

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60 people. There were 45 people living in the home at the time of our inspection.

This unannounced inspection took place on 11 May 2017. At our last unannounced inspection on 9 February 2017, multiple regulatory breaches were identified and the service was judged to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment from a sufficient number of staff that was responsive to their changing needs. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and drive improvements.

This 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.

At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the management of medicines was safe and their internal monitoring was effective in identifying when errors had occurred.

There was no registered manager in post. 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 that medicine administration was not always safe and some people were not protected from the harm associated with their prescribed medicines. Staff did not understand the legal requirements for depriving people of their liberty to keep them safe and temporary restrictions on people waiting for assessment did not provide staff with guidance.

Risks associated with people’s care had been assessed but their management plans did not always reflect recent changes in their support needs. People’s level of support had been re-assessed and amendments had been made to the staffing levels to ensure people’s needs were met by a sufficient number of suitable recruited staff.

Staff understood how to protect people from abuse and poor care and how to assist them to leave the building in an emergency.

Staff training update had improved and there were arrangements in place to support staff with their development. Mealtime arrangements had improved and people with specialist nutritional needs were supported safely by staff with the training and competency to do so. People were provided with choices from a varied menu and regularly offered drinks. The advice and expertise of healthcare professionals was sought and followed by staff.

People were supported by kind staff who engaged with them and promoted their dignity whilst respecting their dignity. Relatives were able to visit whenever they wanted and were acknowledged warmly by staff. Staff knew people well and provided care which met

Inspection carried out on 9 February 2017

During a routine inspection

This inspection took place on 9 February 2017 and was unannounced. Following our last inspection on 26 October 2016 we issued the provider with warning notices to improve the level of staffing and meet the legal requirements regarding consent. The provider sent us an action plan which detailed the improvements they would make within the timescale we had specified. At our inspection we found that the level of staffing was still not adequate to protect people from harm and poor care. The provider had made improvements in gaining consent and supporting people who were unable to make decisions for themselves.

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60, some of whom may be living with dementia.

There was no registered manager. A new manager had been appointed and was completing the process to register with us. This manager has since left the service. 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 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.

People were not protected for harm because there were an insufficient number of staff to meet their needs and keep them safe. We had to alert the provider on three occasions because of our concerns for people’s safety relating to specialist nutritional care, a fall and the failure by staff to respond to a call bell which had been activated for 45 minutes. Staffing levels were based on an assessment of people’s individual needs but we saw this had not been completed correctly to reflect their requirements. Staff who should only have been shadowing experienced staff were left alone with people, including a person who presented with behaviours that challenged their safety and that of others, particularly staff. The way people’s medicines were managed required improvement. Some medicines had been refused but staff had not taken action to ensure the person’s wellbeing was not affected.

When people were seen by healthcare professionals their requests for investigation were not always done. People’s dignity was not supported because staff were delayed in providing personal care in a timely manner. The provider was using agency (temporary) staff but they did not know people or show an active interest in them or their welfare. Communication arrangements for agency staff were insufficient as they did not know about people’s long term conditions and behaviours.

People’s access to activities was limi

Inspection carried out on 26 October 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 24 March 2016. Breaches of legal requirements were found including After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 26 October 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chaseview Nursing Home on our website at www.cqc.org.

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60 people. At the time of our inspection there were 56 people living in the home.

There was a registered manager in post. 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.

Staffing levels were at times insufficient to keep people safe and meet their needs. This was an ongoing concern following our last inspection. Relatives and staff did not feel their views about the number of staff available were listened to. People’s medicines were not always provided at the times they were prescribed and staff were not provided with guidance about some ‘as and when required’ medicines to ensure they were administered safely.

Some incidents where people had been at risk of abuse or poor care had not been reported or discussed externally as required. Some people’s freedom of movement was being restricted and causing them distress without the necessary legal permissions in place. Information about recent accidents was not readily available which demonstrated that communication within the home was not effective.

People’s risks had been assessed but the management plans did not always reflect the care they received to keep them safe.

People who lacked capacity to make decisions for themselves were supported by staff however the reasoning behind decisions made in their best interest was not always demonstrated. The provider had not met their own action plan in respect of mental capacity assessments and deprivation of liberty applications.

It was not clear what actions had been taken in response to shortfalls identified during the provider’s quality monitoring audits.

Staff were suitably recruited and received training to provide them with the skills they required to care for people. People were provided with a choice of food and drinks were offered regularly. People’s wellbeing was supported by healthcare professionals whenever addition guidance was required. People were asked for their views on plans for their future entertainment.

We found breaches of 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 report.

Inspection carried out on 24 March 2016

During a routine inspection

Chaseview Nursing Home provides accommodation, personal and nursing care for up to 60 people. There were 50 people living in the home on the day of our inspection. We inspected the service on 24 March 2016. The inspection was unannounced and undertaken by three inspectors. At our last inspection on 23 October 2014 the provider was meeting the legal requirements and was rated as good overall.

At this inspection we found there were insufficient staff available to protect people from harm. Some relatives were unhappy about the registered manager’s response to their concerns regarding how staffing levels were managed. We also found that people’s ability to make choices had not been assessed and staff had not demonstrated why they had made decisions in their best interest, on their behalf.

There was a registered manager in post. 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.

Staff were aware how they should protect people from the risk of abuse but some incidents of potential abuse had not been reported, as required, to the local authority and ourselves. People’s medicines were managed safely but guidance on the use of ‘as and when required’ medicines had not always been provided to staff.

People’s risk of harm associated with their care had been assessed and there were plans in place to ensure the risks were managed appropriately. Staff received training and support to provide them with the skills and knowledge to care for people effectively. People had a choice of nutritious food and plentiful drinks which met their individual requirements. Staff ensured that people who needed specialist care and treatments were referred appropriately.

Staff were kind and polite to people. Staff recognised people’s individual needs and provided care which met their preferences. Care was reviewed regularly to ensure it met people’s current needs. People’s dignity and privacy was promoted. People were supported to maintain the relationships which were important to them.

People were supported to take part in activities which interested them and had opportunities to socialise with members of the local community. There was a complaints procedure in place and people received verbal or written responses depending on their preference.

There were meetings provided for people, their relatives and staff to discuss changes in the home which might affect them. Staff felt well supported by the registered manager and were happy to approach them to discuss any issues. There was an audit programme in place to continually monitor the quality of the service and drive improvements for people.

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

Inspection carried out on 23 October 2014

During a routine inspection

This inspection took place on the 23 October and was unannounced. At our previous inspection in August 2013 there were no breaches in the regulations of the Health and Social Care Act 2008.

Chaseview Nursing Home provides accommodation, personal and nursing care for up to 60 people. The home had a registered manager in post. 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.

People who used the service and their relatives told us that they were happy with the care and support being delivered at Chaseview Nursing Home.

People were protected from the risk of harm through risk assessments. Safeguarding referrals were made to the local authority when they suspected a person had been abused.

Staffing levels were sufficient to meet the needs of people who used the service. People did not have to wait to have their care needs met.

The provider managed people’s medicines safely. Safe systems were in place which minimised the risk of medicine errors occurring.

People received health and social care support when they needed it. When people’s needs changed or they became unwell the relevant professional advice was gained in a timely manner.

Care plans and risk assessments were followed which ensured that people received the care and support they required. We saw that these were regularly reviewed to ensure the care was current and relevant to people’s needs.

People told us and we saw that people who used the service were treated with dignity and respect and their privacy was ensured at all times.

Hobbies and interests were on offer dependent on people’s individual preferences. People had been able to access the community. A variety of  trips out were arranged with the use of the home’s minibus.

Training was available to all staff dependent on their role. Staff felt supported and competent to fulfil their roles.

People who used the service and their relatives were kept informed and involved in the running of the home. There was a complaints procedure and we saw that formal complaints had been managed appropriately.

During a check to make sure that the improvements required had been made

During the inspection in June 2013 we found that there were omissions of information and recording in regard to assessing the mental capacity of people, the robustness of the do not resuscitate procedures and obtaining the consent of people for their care and treatment. We issued a compliance action to ensure improvements would be made.

The provider had sent us with a written report which recorded the actions they had taken to ensure improvements had been made. We have spoken with the registered manager, who confirmed that the actions needed had been taken and implemented.

Staff had received further training in the Mental Capacity Act 2005 and the implications of the Act. Formal assessments had been completed for people who were deemed as lacking the capacity to make informed decisions about their care. This ensured that where people were unable to make decisions for themselves, action would be taken in their best interests.

Where decisions have been made for the action needed in the case of a medical emergency or for end of life care, do not resuscitate (DNAR) documents had been completed correctly and fully. This ensured people's personal preferences were upheld.

Consent had been obtained for the use of photographs for identity or monitoring purposes. This ensured that people were fully aware of and agreed to their photographs being taken and used.

Inspection carried out on 3 June 2013

During a routine inspection

This was a scheduled unannounced inspection.The service did not know we were visiting.

At the time of our inspection 38 people lived at the home. We spoke with staff, visitors and people that used the service who were able to tell us about their experiences. One person told us: "The staff are very attentive to our needs". Another person told us: "It’s nice here, staff are nice to me, they are patient if I don’t understand what they are asking me.The food is good, I like it it’s nice to chat with staff but they are busy".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people.

We looked at the care and support records of five people who were accommodated in the two units within the home. We spoke with staff, they told us how they provided care for people each day.The information recorded in the plans corresponded with what staff had told us. We did not see any formal process for assessing a person's capacity to make decisions or how decisions were made in the person's best interest.

We saw that staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care. The manager told us that additional training was being arranged.

We saw that records included the care and support needs for the people who used the service.

During a check to make sure that the improvements required had been made

At the inspection in May 2012 we found some inconsistencies in the way people's views and experiences were recorded. Not all staff had received training in the protection of vulnerable adults. Staff told us they were aware of the Mental Capacity Act (2005) but had not received any training in this. Staff told us that there was not enough equipment available to meet the needs of people who used the service. We issued a compliance action to ensure improvements would be made.

The provider has provided us with a written report which records the actions they have taken to ensure improvements have been made.

Arrangements have been made to ensure the views of people are sought and the information recorded in the care plans.

Staff have received training in the protection of vulnerable adults. Training in the Mental Capacity Act 2005 has been arranged.

Equipment is in working order and in sufficient quantities to meet the needs of people who used the service.

Inspection carried out on 29 May 2012

During a routine inspection

We spoke with the majority of the people who used the service, some people were able to speak with us, and some people were unwilling or unable due to frailty. We spoke with two visitors, the unit managers and other members of staff.

We spent time in the communal areas and observed how staff and people got on with one another. We observed staff to be very busy but we did not see or hear anyone waited for assistance when they needed help. We saw staff being very patient with people, offering choices of activity and offering reassurance when this was needed.

Some people stayed in their own rooms either due to their own preferences or ill health. Staff told us and we saw that regular checks were made to people in their own rooms to ensure their comfort and safety.

Some people told us that they were able to make decisions and choices for themselves. Other people were unable to do so; staff told us the ways they help people with decision making. We did not see any record for assessing a person’s capacity to consent to the care and treatment in any of the care plans we looked at.

We saw that each person had a recorded plan of their care which is reviewed at regular intervals. People we spoke with expressed a satisfaction with the care they received and said the staff were very good to them.

Many people told us they enjoyed the food that was provided, one person did not.

We saw the system for the storage of medication was safe and secure.

Staff told us and we saw records that indicated the majority of the staff had received training in safeguarding vulnerable adults. Staff told us the way they would deal with any allegations of abuse.

We saw that equipment was provided to meet the needs of some people. Some essential items of equipment for ensuring the safety of people was not available. Some equipment for transferring people from area to area was not in working order.

People told us the staff were very helpful and kind. Staff told us that due to the ever changing needs of people more staff would be beneficial.

We saw the many way the service monitors the quality of the service.