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Chelmunds Court Requires improvement

We are carrying out a review of quality at Chelmunds Court. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 23 January 2020

During a routine inspection

Chelmunds Court is a care home providing personal and nursing care to a maximum of 73 people aged 65 and over. Some of those people lived with dementia. The home is purpose built and has two floors. During our visit 48 people lived at the home and one person was in hospital.

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

The management of people's medicine was not consistently safe because people did not always receive their medicines as prescribed. Medicines were ordered, received, stored and disposed of safely. Risk management continued to require improvement because the provider could not demonstrate all risks were being well managed. This placed people at risk of potential harm.

People did not always receive personalised and responsive care. People’s care records continued to lack up to date and correct information to help staff provide individualised care.

Management and leadership at the home was not consistent. Management changes had occurred since our last inspection and further changes took place immediately after our visit. Staff provided mixed feedback when we asked them if they felt valued and listened to by their managers.

The management team welcomed our feedback and responded immediately when we shared the concerns we had identified and begun to take reactive action to make improvements. Some areas requiring improvement had been identified prior to our visit but remedial action had not been taken in line with set timescales. Some previously demonstrated standards had not been maintained to ensure compliance with regulations. This showed lessons had not been learnt.

Quality assurance systems continued to be ineffective because the management team did not have sufficient oversight of the service provided. Relatives felt the management team were approachable, but some lacked confidence in their ability to make changes to improve outcomes for people. Overall, people and relatives had confidence in the ability of staff to provide effective care and we observed staff helped people to move safely during our visit.

Staff were recruited safely. They received an induction when they started work and completed ongoing training to help them to be effective in the roles. Enough staff were on duty during our visit to respond to people’s needs in a timely way. However, we received mixed responses when we asked people, their relatives and staff about staffing levels. The nominated individual had begun to explore the feedback we shared with them.

Whilst the mealtime experience in dining rooms was positive for people the provider was unable to demonstrate people had consumed sufficient amounts of food and fluids to maintain their health. Staff knew what people liked to eat and drink and people's dietary preferences were known and catered for.

People felt safe and told us they liked living at the home. Safeguarding procedures were in place to protect people and staff received training to help them understand the different types of abuse people might experience.

People said staff had a caring attitude and they felt involved in planning their care. However, some relatives did not share this view point. Staff enjoyed their jobs and spoke fondly about people. People engaged in meaningful activities and continued to be supported to maintain relationships with those that mattered to them. People had opportunities practice their chosen religions and some people’s suggestions to improve the service had been acted upon.

People were supported to be independent. Whilst staff understood the importance of maintaining people’s dignity, it was not consistently upheld. Some relatives felt people's personal belongings were not treated with respect.

The process used to assess people's mental capacity and to ensure their rights were upheld required improvement. However, people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interes

Inspection carried out on 16 January 2019

During a routine inspection

This inspection visit took place on 16 January 2019 and was unannounced.

Chelmunds Court 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.

Chelmunds Court accommodates up to 73 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. During our visit 31 people lived at the home and one person was in hospital. The home is located in Solihull, West Midlands.

At our inspection in June 2018 we identified the need for improvement in all the key questions. We found six breaches of the regulations. The service was rated 'Inadequate' overall. Due to the seriousness of our concerns we imposed a condition on the provider's registration. The condition required the provider to complete regular quality and safety checks and provide us with monthly reports to demonstrate improvements were being made.

The service was placed into '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.

In August 2018 in response to information of further concern we carried out a focused inspection looking at the key questions of Safe and Well Led. Despite some improvements being made the rating remained ‘Inadequate.’

At this inspection improvements have been made in all areas. The service is no longer rated as 'inadequate' overall or in any of the key questions. We have removed the condition we had imposed on the provider’s registration and the service is no longer in Special Measures.

The service is required to have 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 and associated Regulations about how the service is run. A manager had been in post since August 2018. Their application to apply to register with us is under consideration.

The management team had worked hard in the previous six months to make changes. The quality of care had improved and changes made needed to be sustained over a longer period of time as more people came to live at the home in order to be fully embedded.

People and relatives were happy with the service provided and the way the home was managed. Staff received on-going support and training to be effective in their roles. Staff morale and job satisfaction was now good. Staff respected people’s rights to privacy, maintained their dignity and independence. Staff were described as caring and kind; they knew people well and were responsive to their needs. Care plans supported staff to provide personalised care. Work was on-going to improve care records and compile new care plans. Relatives were encouraged to be involved in their family member's care and there were no restrictions on visiting times.

Quality monitoring within the service had strengthened. Action had been taken in response to the feedback gathered from people. However, further action was needed to ensure all audits and checks were effective. The management team continued to work in partnership with the local authority and the CCG to drive this forward.

People felt safe and staff understood their responsibilities to protect people. Some risk management plans required improvement to ensure people were kept as safe as possible. Accidents and incidents were monitored, and action had been taken to prevent reoccurrence.

People received their medicines when they needed them, and medicines were in stock. Further improvement was needed to ensure medicine protocols were detailed and medicines were always stored

Inspection carried out on 15 August 2018

During an inspection looking at part of the service

This inspection took place on 15 August 2018 and was unannounced.

Chelmunds Court 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.

Chelmunds Court accommodates 73 people in one adapted building over two floors. There were 40 people living at the home on the day of our visit, most of whom lived with dementia

At our previous inspection on 26 June 2018 we rated the overall service as 'Inadequate' and it was placed into special measures.

At that inspection we identified six breaches in the legal requirements and regulation associated with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were breaches in Regulations 9, 10, 12, 14, 17 and 18. This was because there were not enough staff available with the knowledge needed to support people in the right way which meant people did not receive personalised care. Risks associated with people’s care were inconsistently managed. Medicines were not managed safely and people were not assisted to external healthcare appointments when required. The provider failed to demonstrate people had received sufficient amounts of food and fluids to keep them healthy. Effective systems were not in place to ensure the service was delivering good quality care to people.

The significant concerns we identified during that inspection resulted in us imposing a condition on the provider’s registration. This meant they had to complete regular checks of the quality and safety of the service and provide us with monthly reports of their findings to demonstrate the required improvements were being made.

The provider sent us an action plan which informed us of the improvements they planned to make to would be completed by 30 September 2018.

Since that inspection no further people had been admitted to the home. We received further information of concern in relation to the service. These concerns related to people not being given their medicines when they needed them, further management changes and the risks associated with people’s care were not managed safely which had placed people at risk. As a result, on 15 August 2018 we undertook this unannounced focused inspection to check whether people were safe and whether the service was well-led. This report only covers our findings in relation to these two key areas.

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

As a result of this inspection the overall rating for this service remains 'Inadequate' and the service therefore remains 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.

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.

Further management changes had taken place at the home since our last inspection and the provider had recruited their fourth manager sinc

Inspection carried out on 26 June 2018

During a routine inspection

This inspection took place on 26 June 2018, and was unannounced. The inspection was brought forward earlier than planned due to concerns we had received from relatives, staff and external agencies. This was our first inspection of the care home since it registered with us in November 2017.

At this inspection we found the service was inadequate overall, and in all of the key questions. The inspection identified six breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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 and 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.

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.

Chelmunds Court 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.

Chelmunds Court accommodates 73 people in one adapted building over two floors. There were 58 people living at the home on the day of our visit, most of whom lived with dementia.

The provider had recruited their third manager into the home since it opened in November 2017. The home manager advised that they would be registering with the CQC so they could be the 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.

The management of people’s medicine was unsafe and put people at risk of significant harm. People had missed their medicines due to ineffective stock control. People had been placed at risk of harm and in some cases had sustained harm because of this. There were not enough staff with the knowledge of people’s care needs to keep people safe. Staff felt people were neglected as there was insufficient staff to meet people’s needs. People raised concerns about the safety of people who lived with a dementia related illness and relatives felt their family members were not always safe. Where potential risks to people had been identified the plans to reduce the risk where not consistently followed. Staff understood what abuse was and how to report it. Staff understood the importance of reducing the risk of infection to keep people safe.

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