Cheney House

We found the following examples of good practice

Staff, people and visitors followed robust testing in line with current government COVID-19 guidance. People were supported to pursue activities and go out whilst staying as safe as possible. People were supported to visit friends and family and receive visitors in their home. Visitors were supported to follow testing and safe infection prevention and control procedures during their visits.

Staff understood and followed robust infection prevention and control procedures. This included wearing personal protective equipment (PPE) and washing and sanitising hands regularly. PPE stations were available throughout the service and we saw there were sufficient stocks of PPE available.

The environment was clean and hygienic, staff followed cleaning schedules which included regular cleaning of high contact areas, such as door handles and grab rails. The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

We have also signposted the provider to resources to develop their approach.

Cheney house provides residential care for up to 34 older people, including people living with dementia. There were 21 people receiving care at the time of the inspection. Cheney house is set out over 2 floors with a communal lounge and dining room.

We found the following examples of good practice.

¿ Sufficient stocks of Personal Protective Equipment (PPE) were in place including masks, gloves, aprons, hand sanitiser and visors.

¿ Infection control polices reflected the current national guidance and had been reviewed regularly. Cleaning schedules had been increased to ensure high touch surfaces were cleaned regularly and additional cleaning to maintain good hygiene standards. The provider was in the process of recruiting additional domestic support staff.

¿ People living in the service and staff were being tested regularly. This was to ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

¿ The provider had a plan to ensure the environment for visitors was COVID-19 secure and followed national guidance for visitors to care homes in preparation for visitors once the COVID-19 outbreak was over. A new visiting pod had been purchased to enable this.

¿ The staff team had received additional training in the putting on and taking off of PPE following a visit from Public Health Community Infection Prevention Control Team. We saw staff wearing PPE appropriately on the day of the inspection.

¿ There was a clear procedure in place, in line with national guidance to ensure people were admitted to the service safely.

Cheney house provides residential care for up to 34 older people, including people living with dementia. There were 24 people receiving care at the time of the inspection.

Cheney house is set out over 2 floors with a communal lounge and dining room.

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

People were not always safeguarded from the risk of abuse. Unexplained bruises had not always been investigated and checks to ensure people’s safety had not been recorded.

Risks to people had not been consistently assessed. Not all known risks had appropriate strategies in place to mitigate them. Staff had not recorded the actions taken to reduce the risks to people’s skin integrity.

Records required improvement. We found gaps in the recording of peoples care needs, handover information and behaviour charts.

Staffing levels required reassessing. The tool used by the provider to calculate staffing levels showed that on average the service was running 41% of staff hours below the assessed amount.

The provider and registered manager lacked oversight of the service. Audits completed did not identify the issues found on inspection, and audits had not been completed regarding the recording of people's care needs.

People and relatives told us they felt the staff team worked well and that staff knew people and interacted well with them. The registered manager and staff supported communication between people and their families throughout the pandemic.

People received their medicines as prescribed by staff who had received the appropriate training and support.

People were protected against infection. Staff wore appropriate personal protective equipment [PPE] and the home appeared clean.

People, staff and relatives were encouraged to feedback on the service and make suggestions to improve. Staff felt supported by the registered manager and felt their views were valued.

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 05 December 2018).

Why we inspected

We received concerns in relation to people’s dignity not being respected, staffing concerns, medicine administration and the safety of people living at Cheney House. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cheney House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to staffing, safe care and treatment, protecting people from abuse and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cheney House 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.

Cheney House accommodates up to 34 people in one adapted building. The service provides residential care for older people including people living with dementia. At the time of this inspection 29 people were using the service.

At the last inspection in September 2017, the service was rated ‘Requires Improvement’. At this inspection, we found the evidence supported an improvement in rating of the service to Good.

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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place and provided detailed information and guidance for staff about the potential risks people faced. The service learnt from incidents and accidents and acted to mitigate the risks of them occurring again.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People were supported by sufficient numbers of staff to meet their needs.

People were supported to take their medicines as prescribed. Infection control procedures were in place and followed by staff to protect people from the risk of infection.

Staff were supported and supervised and completed induction and development training. This helped to ensure they had the skills, knowledge and expertise they needed to perform their roles. Suitable training was provided to ensure people's needs were met.

People's needs were assessed, and people were supported to maintain good nutrition and access healthcare to maintain their health and wellbeing.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff had received training and information which enabled them to provide care in line with the guidance of the Mental Capacity Act 2005.

The provider made the necessary improvements to the premises, which included redecoration and building upkeep to upgrade the service.

People received care from staff that knew them well and consistently treated people with dignity and respect. People were supported to maintain their independence and staff protected people's right to privacy.

People and their representatives were involved in developing their care plans, which enabled them to receive care and support in line with their preferences. People and relatives were involved in reviews of people's care to ensure the care provided met people's current needs.

A process was in place which supported people to raise concerns and complaints. People felt confident their concerns would be listened to and acted on.

People, relatives and staff had confidence in the leadership and governance of the service. The provider had effective systems in place to monitor the quality of all aspects of the service to ensure people received good care. Actions were taken, and improvements were made where required.

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.

At the last comprehensive inspection on the 22 and 23 February 2017 the provider was in breach of legal requirements. This was because suitable arrangements were not in place to effectively monitor the quality and safety of the care people received at the service. The provider sent us an action plan telling us how they planned to make the necessary improvements and at this inspection we found the legal requirements were met.

Improvements had been made to the systems and processes to monitor the care people received and the staffing arrangements. Closer monitoring of the environment and repairs and refurbishment works would ensure people lived in a home that was always safe and well maintained.

We found that a fire exit door was awaiting a break glass cover to be fitted and in the interim a combination padlock had been fitted. However not all staff were aware of combination number to open the door in the event of an emergency requiring people to be evacuated from the building. Following the inspection the provider informed a new break glass cover had been fitted and the padlock was no longer in use. Having spare stocks of break glass covers would ensure the fire exit doors were always fully operational.

People were treated with dignity and respect. However due to not having personal toiletries available to meet their personal hygiene needs, their dignity could have been compromised. During the inspection the provider took immediate action to arrange for all people using the service to have personal toiletries made available.

The registered manager and staff understood their responsibilities to safeguard people from abuse. The staff recruitment systems were sufficiently robust to make sure the right staff were employed to keep people safe. In addition sufficient numbers of staff were available to meet the needs of people using the service.

Individual risks were identified and effectively managed. People’s medicines were appropriately managed to ensure they received their medicines safely.

Staff had a good understanding of people's needs and preferences and worked with people to enable them to communicate these. There were positive interactions between people and staff.

Staff received training that was relevant to their roles and responsibilities, ensuring they had the skills and knowledge required to support people effectively. Staff were supported in their roles, and had supervision meetings to discuss their performance, development and training needs.

Mental Capacity Assessments (MCA) had been carried out for all people using the service, the assessments identified where people required help to make specific decisions. Where people lacked capacity to make specific decisions, relatives and / or other health professionals had been involved in making best interests’ decisions on their behalf.

People were supported to maintain a healthy diet and to have access to healthcare services. Healthcare professionals were contacted in response to any deterioration or sudden changes in people's health and the staff acted on the instructions of the health professionals.

Cheney House is registered to provide residential care for up to 34 people, including people who may be living with dementia. At the time of this inspection there were 32 people living in the home.

The service did not have a registered manager in post at the time of our inspection. 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 location had been without a registered manager since October 2016. The provider had appointed a new manager who had applied to the Care Quality Commission (CQC) to become the registered manager for the service.

Appropriate systems and processes were not in place to assess, monitor and improve the quality and safety of the service. Quality assurances processes were not always effective at identifying shortfalls and where shortfalls were identified these were not always addressed in a sufficiently timely manner to minimise the impact on people.

Staff recruitment procedures needed to be strengthened to ensure that all necessary risk assessments had been completed as part of staff selection process. Although there were enough staff on duty the way in which they were deployed meant that they were not always able to meet the needs and choices of people living in the home.

Staff had an in-depth understanding of peoples care and support needs and understood how to care for them safely. However individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people's needs. This was discussed with the provider and they began an immediate review of all care plans and risk assessments in place.

People were supported to take their medicines as prescribed, however staff did not always follow the provider’s policies and procedures when administering medicines. Records showed that medicines were obtained, administered and disposed of safely.

People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care. Staff supported people to have sufficient amounts to eat and drink to help maintain their health and well-being.

People felt safe in the home and relatives had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staff received an induction to their role and training in areas that enabled them to understand and meet the care needs of each person. People received care from staff that were friendly, kind and thoughtful and their right to privacy and dignity were respected.

People's consent was sought prior to care and support being delivered by staff. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were opportunities for people and their families to share their experience of the home and the provider and manager actively sought feedback from people. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

We found that people’s care and treatment needs were recorded within the care plans and specified the daily support people required. We also saw that people’s preferred daily routines, likes and dislikes were recorded.

We saw the staff worked at a relaxed pace and the people we spoke with commented that the staff were “nice, friendly and helpful". A visitor told us the staff were approachable and always made them feel welcome when they visited the home.

We saw that people using the service, relatives and staff were regularly asked to provide feedback on the quality of service delivery. This meant that people had the opportunity to say where they thought improvements were needed.

The provider may wish to note that people with dementia have particular needs in terms of the environment and we found the environment fell short of providing a dementia friendly environment. The large communal lounge, which was used by the majority of people using the service, lacked the provision of magazines, books, newspapers and other materials to provide stimulation and engagement. We also found there was also a lack of features around the building such as appropriate signage to aid people’s orientation and support their remaining capacities. There was no evidence of any risk to people; however the environment did not promote the wellbeing of all people using the service.

We looked at the care plans and assessment records for three people who had experienced weight loss and had been identified nutritionally at risk.

We found the care plans and assessments relating to people’s nutrition and hydration were regularly reviewed and updated to reflect changes in their health status. We also found the provider had involved other healthcare professionals in meeting people’s nutrition and hydration needs.

During our visit we spoke with the manager, care workers and catering staff. We found the staff knew the needs of the people using the service well and were able to tell us how they met their individual nutritional needs. We saw within the food store there was a sufficient quantity of groceries fresh and frozen available. We saw that weekly menus provided people with a selection of hot and cold meals and alternative meals were available for people on a daily basis.

We saw that people had drinks, snacks and fresh fruit close to hand and access to call bells to be able to summon assistance.