Archived: Chesterholm Lodge

Updated 22 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was conducted by three inspectors.

Service and service type

Chesterholm 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.

At the time of the inspection the service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager left the service on the 27 September 2019. On day three of the inspection a new manager was in place who commenced working at the service on the 25 November 2019.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed information, we had received about the service, including previous inspection reports and notifications. Notifications are information about specific important events the service is legally required to send to us. We also considered information the provider sent us in the provider information return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we had received from the local authority, safeguarding team, healthcare professionals and whistle-blowers. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service about their experience of the care provided. We spoke with 12 members of staff including, the nominated individual, two directors of the providers company, the manager, the activities coordinator, the cook, the housekeeper and five members of the care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed the care being provided and reviewed a range of records, included seven people's care records and multiple medication records. We looked at staff files in relation to recruitment and training and a variety of records relating to the management of the service including, audits and policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found and reviewed training data, quality assurance records and additional supporting information provided by the service.

Updated 22 April 2020

About the service

Chesterholm Lodge is a residential care home that provides accommodation for older people and adults living with a mental health condition. The service is registered to accommodate up to 15 people. At the time of our inspection, there were 15 people living at the service.

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

People did not receive a service that provided them with safe, effective, compassionate and high-quality care. The staffing levels were not sufficient to keep people safe and provide them with effective care to meet their needs. Risks to people's safety and well-being were not managed effectively, placing people at risk of harm and environmental risks had not always been considered or acted upon.

People were not always safeguarded from abuse and incidents and accidents were not managed safely to prevent a reoccurrence. The management of medicines was unsafe, and people did not always receive medicines as required.

The environment was not well maintained and did not promote people's emotional wellbeing or physical safety. Staff did not complete training in meeting people's needs and this meant people were at risk of inappropriate care and treatment.

People were not always provided with a varied and nutritious diet based on their individual preferences and could not always access food as required.

The principles of the Mental Capacity Act 2005 were not understood and applied. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Staff were described as kind and caring, and we observed people were spoken to in a respectful way. However due to the environment people did not always receive care that promoted their privacy and dignity.

Leadership was poor and the service was not well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

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

Rating at last inspection

The service was rated as Good at the last full comprehensive inspection, the report was published in April 2019.

Why we inspected

The inspection was prompted in part due to concerns received about insufficient staffing levels to meet peoples needs, the safety of the environment and the overall management of the service. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement.

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

Enforcement

We have identified the following breaches at this inspection.

Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure sufficient staff were deployed to meet people's needs at all times.

Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure risks relating to the safety and welfare of people using the service were assessed and managed.

Regulation 13 (Safeguarding) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to safeguard people from abuse and improper treatment.

Regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure the environment was properly maintained.

Regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure people's rights were upheld within the basic principles of the Mental Capacity Act 2005.

Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to operate effective systems to assess, monitor and improve the service.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 6 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.

Following our inspection, we raised our concerns about people's safety with the local authority safeguarding team.