Archived: Chesterholm Lodge

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.

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. Chesterholm Lodge is registered to provide care for up to 15 people, including people living with dementia and mental health needs. At the time of the inspection, there were 15 people living at the service.

People’s experience of using this service:

• Medicines were not always managed safely. People received support to take their oral medicines safely and as prescribed. However, processes in place to manage other medicines were not always robust.

• There were sufficient numbers of staff available to keep people safe and meet their personal care needs. However, staff were not always available to meet people’s social needs.

• People told us they felt that they received safe care.

• The environment was clean and homely.

• Individual and environmental risks were managed appropriately. People had access to appropriate equipment where needed, which meant people were safe from harm.

• Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

• People's rights to make their own decisions were respected. Staff recognised people’s individual needs and supported them to make choices in line with legislation.

• People were supported to access health and social care professionals if needed.

• People received enough to eat and drink and were happy with the food provided.

• Staff were kind, patient and responsive to people's needs. People were treated with dignity and staff respected their privacy.

• Staff knew the people they supported well and had a good understanding of their needs which enabled them to provide person centred care.

• People knew how to complain and were confident that if they raised concerns, the registered manager would act promptly to address these.

• People and staff were fully engaged in the running of the service.

• The management team were open and transparent. They understood their regulatory responsibilities.

• The management team had effective quality assurance systems in place and there was an emphasis on continuous improvement.

The service met the characteristics of Good overall. More information is in the full report.

Rating at last inspection:

The service was rated as Good at the last full comprehensive inspection, the report for which was published on 14 September 2018.

Why we inspected:

This inspection was a responsive inspection. We inspected following concerns raised to us by whistle blowers and members of the public.

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.

People were safe. There were sufficient staff to meet people's needs and staff had time to spend with people. People’s nutritional needs were met and staff supported people to maintain a healthy diet. Where people had specific dietary needs, these were met.

Risk assessments were carried out and promoted positive risk taking, which enabled people to live their lives as they chose. People received their medicines safely. Records relating to risks and medicines were accurate and up to date.

The service provided support in a caring way. Staff supported people with kindness and compassion and went the extra mile to provide support at a personal level. Staff knew people well, respected them as individuals and treated them with dignity whilst providing emotional support. People and their relatives, were fully involved in decisions about their care needs and the support they required to meet those individual needs.

There was a positive culture at the service that valued people, relatives and staff and promoted a caring ethos that put people at the forefront of everything they did.

People received effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People had access to information about their care and staff supported people in their preferred method of communication.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care and support and promote a positive culture that was person-centred, open, inclusive and empowering which achieved good outcomes for people.