Chantry House Residential and Nursing Home

Chantry House Residential and Nursing Home provides accommodation and personal care for up to 24 people. At the time of our inspection there were 22 people living in the home. The majority were being supported with their mental health needs and some were also living with varying levels of dementia.

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

We found concerns at our last inspection and rated the home requires improvement in four key questions and overall. We also found several breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that progress had been made and the provider was no longer in breach of regulations. However, further improvements were still needed to fully embed a person centred approach in the home.

The culture in the home was task led and not always person centred. Emphasis was placed on meeting people's medical needs and associated risks and at times there were missed opportunities for meaningful engagement.

We were encouraged by the actions the provider was taking to address this but these had not been fully implemented. Therefore, we were unable to assess there effectiveness. We have made a recommendation that the provider considers current guidance and best practice to ensure care records are detailed, accurate and person centred.

People told us they felt safe and we observed they were at ease in the company of the staff that cared for them. Visitors could freely visit the service and were welcomed.

People were protected from the risk of potential harm; safeguarding policies and processes were in place and staff had received appropriate training.

Staff were recruited safely. There was mixed feedback about staffing levels and the use of agency staff. On the day of our visit there were sufficient staff to meet people’s needs. However, we have made a recommendation about staffing arrangement in the home.

Risks to people were regularly assessed with measures in place to mitigate them. This included timely referrals to healthcare services.

Staff were kind, caring and treated people well. They supported people in a discreet and dignified way which maintained people's privacy and independence. 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

The home was clean and hygienic with good infection control procedures carried out. Staff wore appropriate personal protective equipment (PPE). Safe management of medicines was in place.

There was clear leadership in the home. Governance systems supported the provider and management team to identify shortfalls in the home and address them. Processes were in place to learn lessons when things had gone wrong with actions taken to reduce future incidents happening.

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 5 May 2019) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at 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.

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

Follow up

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

Chantry House Residential and Nursing Home 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 the inspection.

Chantry House Residential and Nursing Home is registered to provide care and support for up to 24 people. There were 22 people living in the service on the day of our inspection visit.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the five key questions to good.

People’s experience of using this service:

¿ Since our previous inspection the management of the service has changed. Some staff had left and there was a new manager in place. They were working to improve the culture in the service.

¿ Concerns from our previous inspection regarding the management of risk continued. Care plans did not always contain appropriate risk assessments. Where risk assessments had been carried out they were not always accurate.

¿ Care plans did not always show what care a person required. In one case we found that the person was receiving the appropriate care, but this was not reflected in the care plan.

¿ People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. This was demonstrated in the lack of appropriate authorisation for the administration of covert medicines.

¿ People were not involved in their care planning. Their choices and preferences were not always recorded. The manager told us how they were planning to improve this with meetings with people and their relatives and the introduction of ‘resident of the day’ process.

¿ People were not supported to follow their interests and take part in activities. There were no meaningful activities taking place in the service on the day of our inspection.

¿ The provider, manager and senior staff completed a range of audits and checks on the quality of the service. The manager had developed a home improvement plan, but this was still to be fully implemented. Staff we spoke with were positive about the impact of the new manager and the changes being made.

¿ We found further improvements were required to the provider's systems and processes to ensure compliance with all regulations.

Rating at last inspection: Requires Improvement. The report was published on 25 October 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

Enforcement We have required the provider to send us an action plan setting out how they will address the concerns. Full details can be found at the end of the report.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule.

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

Chantry House accommodates 24 people in one adapted building. At the time of our inspection they were supporting 22 people. The service is divided into three units with a secure garden.

The service did not have a registered manager. 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.

Risks were not managed effectively. For some risks, such as the use of bed rails, risk assessments had not taken place. Where risk assessments had been carried out, actions identified to mitigate the risk were in not always followed.

Staff training was not up to date. Some staff training had not been refreshed since 2015 despite the service policy being that it should be updated yearly. We are aware that the provider has now planned training dates for staff to catch up.

Environmental checks did not ensure that the service was safe. On the day of our inspection a fire exit was obstructed. We also found areas that needed repair and additional cleaning.

Oral medicines were managed safely and people received these as prescribed. However, due to a lack of adequate recording we could not be sure that people were receiving topical medicine as prescribed.

The manager used a dependency assessment tool to assess the number of staff required. People and staff had mixed views as to whether there were sufficient staff.

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. Applications for authorisation to deprive people of their liberty under the Mental Capacity Act 2005 were not always made when necessary. Where authorisations had been received, conditions on the authorisation were not met.

Decoration within the service was tired and worn. The provider had obtained a quote for the service to be re-decorated. However, this was not supported by an action plan which showed how the new decoration would meet people’s needs and be carried out in way to cause least disruption to those living in the service.

People gave us mixed views about the quality of the food. People were offered a choice of food to meet their individual taste and dietary requirements.

People’s dignity was not always respected. Linen was worn and shabby and personal items were stored and on display in people’s bedrooms. People's confidential information was not being stored in a way which ensured it was secure.

People were not involved in their care planning. Sufficient regard had not been given to ensuring that people with fluctuating capacity were able to take part in planning their care and support. There were minimal activities. People were not supported to follow their hobbies and interests.

Audits by the manger and provider had not identified all of the concerns identified at our inspection. Where concerns had been identified actions had not been taken to remedy concerns. Feedback from staff was not always acted upon to ensure people received high quality care. A recent survey of relatives and residents had provided individual feedback to people but not been analysed to identify any trends.

Some of these issues constituted breaches in the legal requirements of the law. There were four breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.