The Chantry

About the service

The Chantry is a residential care home providing accommodation and personal care to up to 16 adults with learning disabilities. At the time of our inspection there were 9 people using the service.

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

Right support: Model of care and setting maximises people’s choice, control and Independence;

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. People were not able to comment on their safety. However, their body language while interacting with staff was relaxed and positive, which indicated they felt safe. A relative commented, “The management team have been very supportive, will always reach out to me if we need to discuss any issues. I have no concerns whatsoever.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. There were comprehensive risk assessments in place covering all aspects of the service and support provided.

Medicines were managed as necessary. Infection control measures were in place. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

The number and skills of staff matched the needs of people using the service. There were effective staff recruitment and selection processes in place.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. A person commented, “I love it here, the staff are lovely and look after me.” A relative commented, “[Person’s name] has been at The Chantry for a number of years now and is extremely happy there. [Person’s name] is in the right place, is loved and his personal level of care is first class.”

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives;

Staff put people’s needs and wishes at the heart of everything they did. The provider’s action/improvement plan identified that an area of work was to explore new activities to increase people’s access to meaningful occupations. Two health professionals we spoke with as part of the inspection agreed to contact the service and share best practice ideas and suggestions to support this action to increase person-centred care and support.

The service worked hard to instil a culture of care in which staff truly valued and promoted people’s individuality, protected their rights and enabled them to develop and flourish.

Staff felt respected, supported, and valued by the management team which supported a positive and improvement-driven culture.

Systems were in place to monitor the quality and safety of the service. Our inspection found that these systems needed to be reorganised to ensure they remained effective. As a result, following our inspection the management team contacted the Quality Assurance and Improvement Team (QAIT). Local authority QAIT support services to implement robust systems and processes to ensure people receive appropriate person-centred care and support. A QAIT visit was scheduled for 13 July 2023.

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 Good (published 5 March 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service and length of time since the last 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.

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

Follow up

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

We found the following examples of good practice:

The staff were following up to date infection prevention and control guidance to help people to stay safe. There were suitable risk assessments and an up to date infection control policy and procedure in place. The registered manager ensured staff understood why every measure was in place.

Facilities were in place to wash hands or use hand sanitiser on entering and leaving the home. Visitors were supported to wear a face covering when visiting, and wash hands before/after mask use. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home and other signs of Covid-19. There was prominent signage and instructions to explain what people should do to ensure safety. Information was easily accessible on arrival or before visits to ensure visitors followed guidance, procedures or protocols to ensure compliance with infection prevention control.

The provider provided training to ensure staff knew how to keep people safe during the Covid-19 pandemic.

Staff supported people to occupy themselves whilst maintaining their safety. Activities had been improvised as people were unable to go out during ‘lockdown’, which is what they liked to do. For example, a cinema club had been introduced and there had been an increase in in-house activities due to outside entertainers being unable to visit the home.

Staff helped people to stay in touch with their families. Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

Further information is in the detailed findings below.

The Chantry is a 'care home' registered to provide accommodation and personal care support for up to sixteen people living with a learning disability and/or autistic spectrum disorder. At the time of this inspection 10 people were living there and one person came for regular overnight respite care each week.

Services for people with learning disabilities and or autism were supported. The service was larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and other domestic homes of a similar size. There was a separate annexe where some people had bedrooms. This allowed them to develop their independence. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People, their relatives and professionals were very positive about the care and support delivered at the Chantry. Comments about the staff included, “Whenever I arrive they are polite, caring and happy to engage.”; “…confident in and happy with the support provided and how any risk factors were managed.”; “empower the residents to participate in all aspects of the local community wherever possible and seems to have very positive relationships with them.”

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were kept safe by staff who had been trained to meet each person’s needs. Staff knew people well spent time supporting them to do activities they enjoyed. This included following interests and hobbies both in the community and in the service. Staff also supported people to develop skills to promote their independence. Staff understood how to communicate with each person using a variety of communication methods, both verbal and non-verbal.

People received their medicines safely and on time. Medicines were stored safely. Risks to each person had been assessed and care plans described how people were supported to minimise these risks while supporting people to live life as fully as possible.

The registered manager understood their role to promote a positive culture which was person-centred and empowering. Staff commented that the registered manager was supportive and open. There was positive feedback from health and social care professionals about the registered manager and the way they worked with them to ensure risks to people were reduced and helped to achieve good outcomes for people. Checks and audits were undertaken to ensure the quality of care and the safety of the service. Where issues were identified, action was taken to make improvements

Rating at last inspection

The last rating for this service was Good (published 15 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

At the last inspection in November 2014, the service was rated good, although the well-led domain was rated as requiring improvement. This was primarily because there was no registered manager in post.

This comprehensive inspection took place on 9 May 2017 and was unannounced. At this inspection we rated all the domains as good and therefore the service remained Good.

The home had a manager who had registered with the Care Quality Commission in March 2015. 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.

There were quality assurance systems to monitor the running of the home. Records showed that where issues were identified these were addressed.

People risks, needs and preferences were assessed when they came to live at the Chantry. Care plans were developed to address these with the involvement of the person. The plans described what staff needed to do in order to support people to be as independent as possible and lead fulfilled lives to their maximum potential. Plans were reviewed regularly and if the person’s requirements altered.

Staff knew people well and showed kindness and compassion when working with them. Staff respected people’s right to privacy and ensured they maintained people’s dignity.

People were encouraged to do activities of their choice both inside and outside the home. Some people attended local clubs which they said they enjoyed doing. People were able to do some activities on a one to one basis. Staff also encouraged people to develop skills related to daily life, such as cooking, cleaning and laundry.

People were provided with a healthy and varied menu to meet their nutritional needs. People said they liked the food and were given choices of what to eat and drink.

Staff had been trained in the requirements of the Mental Capacity Act (2005) and knew the implications of this when providing care for people.

There were sufficient staff on duty to support people with their assessed needs. The registered manager ensured staffing levels were monitored and adapted to support people both in groups and on a one to one basis.

People received care that met their needs from staff who were recruited safely and trained in their role. Staff received regular supervision and appraisals to ensure they had the support they needed including consideration of their personal development. New staff received induction training which met national guidelines. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns.

Policies and procedures were in place for staff to support people take their medicines safely.

The home was well maintained. People were able to personalise their bedrooms. Friends and family were encouraged to visit without unreasonable restrictions.

We spoke with six staff, the manager and the nominated individual and looked at training and supervision records for staff. We spoke with ten health and social care and obtained feedback from them about the home. They included a learning disability community nurse, speech and language therapist, physiotherapist and occupational therapist.

We spoke with three relatives about people's care. They confirmed they were very satisfied with the care provided. One relative we spoke with said, "I have confidence in the staff team'. Another relative told us they had seen 'significant improvement' and said, 'They have got a new manager and everybody seems positive, it's calmed down a lot and clients are more of a family'.

Is the service safe?

Improvements in staffing meant people were safer and that staff were better able to support and interact with people. Staff told us they were able to give people more time and support. We saw how staff spent more one to one time with each person doing things that interested them. At night, we saw that staffing levels enable people to have additional support and supervision. Hourly night welfare checks had been introduced for two people to ensure they were safe and were offered assistance promptly. An additional member of staff on duty early each morning meant people who liked to get up early were supported to have their breakfast and have assistance with personal care.

Since our last visit, a number of people had been reviewed by a speech and language therapist. The therapist had undertaken training with staff about how to support people to eat and drink safely. We saw the support offered to the person at lunch time was in accordance with their care plan. Staff we spoke with demonstrated they understood people's risks and we observed they sat with people during lunch and supervised them. For example, by prompting one person to slow down and reminding another person to chew their food properly and swallow it before having the next mouthful. This meant people's choking risks were reduced.

Further repairs and improvements had been undertaken since we last visited such as the repair of an uneven slope and the installation of new grab rails. However, further repairs and improvements required. For example, a radiator cover still had not been fitted in the refurbished upstairs shower room, a cracked cistern lid needed to be replaced and loose slates on the top of the boundary wall needed to be fixed. The manager told us they had spoken with the provider and agreed funding and a timescale for all the remaining works, which they said would be completed by the end of June 2014.

Is the service effective?

We saw the range of sensory activities available for people had been expanded. For example, sensory cooking, the use of more communication tools such as photographs, symbols and an iPad for one person. Generally, we found care plans included more detailed information about people's medical history, medical conditions and what support people needed. People's needs were assessed and care and treatment was in line with their individual care plan. However, not all care plans developed to address people's needs were being reviewed, evaluated and updated regularly to monitor if the actions being taken were successful. This made it difficult to track people' progress over time or see whether the care given was effective.

We followed up concerns raised at our previous visit about 'My everyday living capacity assessment' documents in care records. These detailed people's capacity to make day to day decisions such as about eating and drinking, activities, personal care and about the time people wished to get up and go to bed. At this visit, we found these assessments had not been updated or improved. For example, one person's assessment contained contradictory information about whether or not a person could give their consent to participate or be included in planned activities. This meant some people's mental capacity assessments did not take account of the requirements of the Mental Capacity Act 2005.

Is the service caring?

People we spoke with seemed happy most of the time and staff treated people with caring and compassion During the morning, we saw staff having much more interaction with people than we had seen on previous visits. For example, staff spent more time with people and people were given opportunities to take part in individual activities such as drawing and colouring, playing dominoes. In the lounge, two people watched a film with a member of staff and another two people went into town to do some shopping. In the afternoon, most people enjoyed a group art activity with an art therapist. Throughout the day we heard staff prompt people and offer praise and encouragement to them for their achievements.

Is the service responsive to people's needs?

We saw that people's care plans had been updated and had much more up to date information particularly about people's health care needs. We looked at the care of one person who was prone to falls because of their reduced mobility and frailty. Since our last visit, this person had been moved to a larger room much more suited to their mobility needs. We followed up what action had been taken about developing a care plan for a person with diabetes. We found a detailed care plan had been made to inform staff about how to support this person with their diabetes. We saw this included information about a low sugar diet and about the need for regular skin care and observation of their feet to check for circulation problems. We saw that diabetic specific foods had been purchased for this person and there was evidence of daily skin care and regular monitoring for known complications of diabetes, as required by their care plan.

Is the service well led?

A new manager had started a few weeks before our inspection and planned to register with the Care Quality Commission. The manager told us they had re-introduced a key worker system at the Chantry so that each person had a small core of staff who were responsible for ensuring their needs were met and for reviewing their care monthly. We saw that a residents' meeting had recently been held and that people had contributed their ideas to develop the garden and that these ideas were being incorporated into the plans being made. This demonstrated people's views were being sought and acted on.

The manager told us how a recent audit of care records had highlighted some poor record keeping. They told us how this had been addressed with those staff and objectives agreed about improvements needed. This demonstrated performance issues were being addressed so that all staff were expected to work to a required standard. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We looked at the incident reports completed since our last visit. We saw that detailed records of each incident were documented with measures identified to reduce the risks of recurrence. We also saw how incidents were monitored regularly by the provider to identify trends. This demonstrated that the quality of incident reporting had improved and was being used proactively to reduce risks.

We met with all ten people who lived at The Chantry over the two days that we visited. A specialist advisor with expertise in caring for people with learning disabilities accompanied us on the inspection. Several people who lived at The Chantry had limited verbal communication skills so we observed staff interactions with people over a two day period and looked in detail at eight people's care records. We spoke with nine staff including the nominated individual and we looked at training and supervision records for six staff. We also received feedback from eight health and social care professionals who had visited the home.

We found some improvements in care had been made but that risks remained. The quality monitoring and risk management systems in place were not sufficiently robust. We found the provider was still not compliant with eight of the nine standards we inspected.

People we spoke with seemed happy most of the time. We saw how much people enjoyed singing Christmas carols and making gifts at their arts and crafts class and helping look after the animals. People went out regularly for walks, shopping and enjoyed playing skittles and swimming. We spoke with two relatives about people's care and both were very satisfied with the care provided. One said, 'Personally, I am quite happy. The staff have a lot of patience, they are firm but kind'.

People were treated with caring and compassion by staff at the home. People's care had improved because most staff had undertaken additional training to meet people's needs. Care records had been updated and provided much more person centred information. However, care plans needed further improvement, particularly in relation to people health care needs.

Some people who lived at the home had very complex care needs and needed intensive staff support at times. We remained concerned about staffing levels, particularly at night. This was because our observations and care records showed that staff struggled to meet some people's needs. This meant people were at increased risk when several people needed support at the same time. We found improvements had been made to the environment of care and to the reporting of risks. However, we were not assured that risks were always recognised and responded to.

We will take further action and report on this when it is completed.

Following our last visit we raised a whole home safeguarding alert to the local authority about our concerns. A multiagency safeguarding process was convened and is on-going. As a result, a detailed review of each person's care needs was undertaken. Since then, two people have moved to other homes more suited to meeting their needs. A number of health and social care professionals have continued to visit the home and worked with individuals and staff to support further improvements.

This visit was to follow up whether improvements had been made in relation to the warning notices served. These related to people's care and welfare, the safety of the premises, staffing levels and systems for managing risks. At the time of our visit there were 10 people living at the home. We met everyone who lived at the home, and spoke to four people's relatives. A specialist advisor with expertise in caring for people with learning disabilities accompanied us on the inspection. We observed staff interactions with people over a two day period and looked in detail at six people's care records. We spoke with seven staff who worked at the home, an agency care worker as well as the nominated individual and the provider. We also spoke with five health and social care professionals who visited the home. They reported that staff were working well with them to support improvements in people's care.

One relative we spoke with said, 'generally X is cared for in a kind and respectful manner'. They told us how pleased they were to receive a picture from the home of the person enjoying themselves on their recent holiday. Another relative said, 'I've no qualms about the Chantry whatsoever, I am very happy, x is doing a wonderful job, and keeping us well informed'. A third relative said they thought staff were able to manage people's behaviours quite well and supervised other people at risk of harm.

We found people's care had improved because staff were better informed about people's needs and staff were able to spend more time interacting with people. However, we identified some gaps in the assessments of people's care needs, particularly related to their health and a lack of care plans for people's identified needs.

We found some improvements in staffing levels which meant staff were able to respond to people's individual needs in a timely way. This included the appointment of a new manager who started the previous week. However, we found that staffing levels in the evening were still not sufficient and staff worked long hours and were often disturbed in the Coach House during their sleep in shift. This meant people were at risk of being cared for by staff that were overtired and the working patterns placed some staff at risk.

We saw that some risks remained in relation to the safety of the environment, particularly for people with more limited mobility. This was because some of the improvements planned had not taken place and others did not fully address the needs of people with reduced mobility. This meant some people continued to be at higher risk of slips, trips and falls and increased risks of injury for staff.

The home had improved systems in place for seeking feedback from people. We saw people's views about their care had been sought and were incorporated in their care records. However, the risk assessment and incident reporting systems, and health and safety monitoring were inadequate. For example, in relation to environmental risk assessments and lack of moving and handling risk assessments. There was no incident reporting policy. The staff were unclear about the incident reporting system. This meant under reporting of incidents and opportunities to take actions to reduce risks were being missed. Further improvements were needed for people's safety and welfare and those of staff.

We have met with the provider and outlined the further improvements needed. We have received an updated action plan of further improvements planned. We concluded the provider had not complied in full with the warning notices. We will take further action and report on this when it is completed.

The provider took over running this home in April 2012. At our last inspection in November 2012, we found some improvements had been made to the premises. However, more improvements were needed to improve safe access to all areas of the home, particularly for people with limited mobility. After that inspection, the provider sent us an action plan outlining additional improvements planned. This was a planned follow up inspection to check that those required improvements to the premises had been completed.

We met with all 12 people who lived at the home over the two days we visited. We were unable to communicate effectively with some of the people who lived there. A specialist advisor supported us with this aspect of the inspection. We reviewed four people's care in detail. We observed how care and support was provided for people. We looked at the environment of the home to see whether it met the needs of the people who lived there. We spoke with seven staff who worked at the home and with the nominated individual for the provider. We also spoke with three health and social care professionals who work with the home about people's care needs.

One person we spoke with told us they were able to tell staff if they were unhappy or had any concerns or worries. They said, 'I speak to X and they sort it'. Other people told us about activities they enjoyed such as swimming, going out on trips and attending local community groups.

We found that mostly care staff were kind and caring towards people. However, staff were not always able to communicate effectively with people who had limited verbal communication skills. This was because most staff had not been trained to use alternative communication methods.

We identified a number of concerns and risks related to people who lived at the home. We found the improvements required to provide disabled access to all areas of the home had not been completed. There were no risk assessments relating to the environment or in relation to moving and handling risks for staff. This meant actions were not identified to reduce some of those risks and people were at increased risk of slips, trips and falls. Staff were also at risk in relation to moving and handling.

We found previous improvements made in people's care records had not been maintained. People's changing care needs were not being assessed. This was because care plans were not reviewed and updated regularly as people's care needs changed. This meant staff did not have all the appropriate information they needed to meet people's care needs. Although some staff training had taken place, the training provided was inadequate to meet the specialist needs of people who lived at the home. This meant staff did not have all the knowledge and skills they needed to meet people's needs.

We also identified concerns about staffing levels, particularly at night and for people who remained at the home whilst staff accompanied other people on trips into the community. This was because staffing levels were not being maintained at appropriate levels. We found the incident reporting system was not effective. This was because incidents that happened were not always reported via the incident reporting system. Also that incidents reported were not reviewed. This meant opportunities to review and change people's care to reduce risks in response to incidents were being missed.

We have raised our concerns about the care of people at the home with the local authority safeguarding team and with commissioners. A whole home safeguarding process is underway to agree next steps to improve people's care.

We found the home was not compliant with any of the nine standards we inspected.

One person told us about plans to have a vegetable garden next year and said, 'I want to grow carrots and turnips'. Staff told us how sensory stimulation was being used to improve the quality of life for a frail elderly person. We were told they loved their aromatherapy bath and how they had been making and tasting smoothies. A relative told us how a person helped with the shopping and laundry and how they enjoyed taking some responsibility.

People's care had improved and more person centred documentation had been introduced. We found communication between staff had improved and staffing levels had increased. A new bathroom with disabled access had been installed in The Coach House. Further improvements to the environment were still needed to ensure all areas of the home were safe and accessible. Regular checks on cleanliness, record keeping as well as health and safety were made.