Cheriton Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the legal regulations. Staff did not consistently protect people from potential harm. They did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete or not in place and did not include risks we identified during our assessment. There was a lack of effective recording of accidents and the actions taken after the event to prevent a reoccurrence. Recruitment practices were not always safe and in line with the provider’s recruitment policy. In addition, we received mixed feedback from people in relation to feeling safe. Two people told us they did not feel safe. They described the service as noisy especially at night. Other people spoken with confirmed that they felt safe living at Cheriton Care Home. They provided a range of different reasons to substantiate their views. A person commented, “I am definitely safe, very safe. I am very well looked after, and I can ask for anything, and they try to provide what I ask for. I have a call bell and I do use it if I need help. Someone always comes along”. Relatives confirmed that they considered their family members to be safe, primarily because of the comparison they made with the less safe and stable environments their family member had been in previously before moving to the service. People had moved to the home after often lengthy stays, in hospital or after falls whilst living alone or with family members as care providers.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives praised how the equipment was provided to people to promote their safety following a fall. A relative commented, “[Family member’s name] has a walker now. The home sourced a specific one for them, but they were reluctant to use it, so they have gone back to the hoist now, which is good. It took a few weeks to get used to it, but all runs smoothly now.”

Staff told us there were systems in place for accidents and incidents to be discussed. Staff told us any changes in people’s care was discussed in daily meetings. We discussed the legal requirements of the Duty of Candour regulation with the registered manager. We found there had been accidents which would have triggered the Duty of Candour requirements. Although the registered manager was aware of the provider’s policy, they were unable to clearly demonstrate they had met the requirements under the regulation. In particular, to provide a written apology. We found records were lacking to identify what action had been taken following each event. We observed and staff told us, the manager or senior staff facilitated daily meetings with staff. Usual topics of discussion were “priorities for the day”, “accident and incidents including injury” and “hospital admissions” as examples.

The provider had a number of policies to support staff understand how to promote a good learning culture. This included a Duty of Candour and accident and incident reporting policy and procedure. These policies were reviewed regularly. However, we found they were not routinely followed by the registered manager or staff. We found incidents recorded in the daily notes or in behavioural charts which had not been reported in accident records. We discussed this with the registered manager who acknowledged incidents and accidents were not routinely recorded. The registered manager responded swiftly to our feedback, and this was a topic of discussion at the next daily meeting with staff. The provider told us the service had recently introduced a lesson learnt section to all their audits.

Relatives confirmed staff were efficient with updating families if there were any health or welfare concerns for their family member.

Staff told us how they facilitated information sharing when people were either admitted or discharged from hospital. Staff told us they routinely sent a GP medical history summary when a person was admitted to hospital. On return from hospital, staff always checked a hospital discharge letter.

Partners had no specific feedback on this area.

The provider and registered manager had systems in place to ensure information was shared with external professionals. We observed good communication between staff and visiting external professionals when we were at the home. We noted where a letter had not been sent with the person on the discharge staff followed this up with the hospital to ensure they had all the required information to provide safe care.

The majority of people felt safe. However, 1 person told us how they felt isolated within the service. The location of their bedroom added to the isolation, as well as their bedroom not having an outside window and the internal conservatory which they overlooked being used for storage. They commented, “I did feel safe but not so much since they have stopped talking to me so much and they keep telling me to use the call bell, but I don’t know where it is.” We observed the call bell was attached to their bed rail but not in an obvious position where the person could easily see and use it. Another person commented, “No, I don’t think I am safe here. It is not the best place for me to be. I am told it is not the best place for me to be. No promises are kept here”. They added, “I want to go. 95% of the people here don’t speak, nothing, I don’t want to stay, there are people shouting at nighttime. I often have to wait for up to two hours for someone to come and help me with my shoes, I know the carers are doing lots of things for other people”. These concerns were fed back to the registered manager to address.

Staff told us they had received training in how to safeguard people from abuse. Staff knew what potential signs could indicate abuse. Staff told us they would not hesitate to raise a concern to the registered manager or to external parties. However, we found not all occurrences had been reported as a safeguarding concern. For example, we saw reference in team meetings to a person not being supported with their continence aids appropriately and other incidences of altercations between people which had not been acted on to safeguard people.

We found some people were subject to restrictions. For instance, bed rails were in situ and lap belts were on wheelchairs. These were in place without a full assessment of the need for them. Whilst some of the people who had them in place may have consented to having them, no records were in place to support this. We discussed this with the registered manager and provider and asked them to take immediate action. People and staff had access to information about how to raise safeguarding concerns. However, some daily notes contained entries demonstrating potential safeguarding concerns. As a result of this, there had been no safeguarding referral made to the local authority and no action taken to clarify the records with staff. We have asked the registered manager to review and make referrals where appropriate.

The service had policies and procedures in place to follow to protect people from abuse. However, we found these were not routinely implemented. The provider had recently advised registered managers to record lessons learnt from safeguarding concerns and cascade the learning to team members.

Relatives confirmed they, or other family members, had been consulted on their care plans. They confirmed measures such as specific walking aids, hoists or bed guards were introduced to further protect their family members from injury due to falls. A relative commented, “The care plan makes clear that [family member] is a falls risk. They have not had any falls since they have been in the home, or at least I have not been told that they have had any. They have a walking frame now although they do like walking around without using the frame though, but I know that they [staff] are always reminding and encouraging them to use the walking frame.”

Staff were knowledgeable about risks posed to people. They told us information about risks were available to them in care plans and were discussed in daily meetings. However, we found this was not routinely the case as risk assessments had not been routinely written and made available to staff.

People were at increased risk of harm due to lack of effective management of risk. People at risk of dehydration were not routinely supported to prevent a deterioration in their health. People’s care plans stated they were at risk of dehydration and needed their fluid intake to be monitored. However, we found people’s fluid monitoring records failed to demonstrate they had been supported to reach their daily fluid target. Choking risks were not always identified and mitigated. A person’s care plan stated “I am on a soft diet, bite sized diet and normal fluids (level 0). If in bed staff are to remain with [the person] due to choking risk.” Throughout the inspection we found this person consuming food items like toast without staff supervision. No choking risk assessment was in place. This placed the person at a higher risk of choking than necessary as risk assessments were not in place and staff did not follow nutritional care plans.

The provider and registered manager had policies and procedures in place to manage risks. However, we found these were not routinely followed. For instance, a risk management policy and procedure document stated, “risk assessments will be carried out in each area of Cheriton Care Home and reviewed on a regular basis as identified by an appropriate risk matrix”. We asked the registered manager and provider for a copy of the risk matrix; however, they were unable to provide this as the document was not in place. Following a further discussion with the provider the CQC received a copy of a risk matrix document that the provider planned to commence using.

People told us the home was mostly kept clean. However, several people thought that the general appearance of the home, its bedrooms, and facilities, was a little tired and in need of better attention and some upgrading. A person told us they were unable to have hot showers. They commented, “There is a nice shower here but there is no hot water.” This was an ongoing issue that a plumber had attended too but still was not rectified at the time of our visit. A relative told us it took 3 weeks for a simple maintenance issue to be dealt with. Another relative commented, “They certainly wipe the table down and the bed linen seems to be freshly washed most of the time. The bedroom does seem a bit grubby and certainly needs a lick of paint or something like that. The flooring is lino, or something similar, which is probably practical, but it doesn’t make the bedroom feel homely.”

Staff told us that they had received health and safety training and explained they would report any health and safety concerns to the manager or maintenance staff. Staff told us maintenance concerns were responded to in a timely manner.

We noted some areas of the home had been decorated. However, other areas of the home required remedial action to promote a safe environment. There were low water temperatures throughout which was not rectified in a timely manner and impacted on people. A sling that was in use was frayed and unsafe to use. Storage areas of the home were cluttered, and an external storage area had flammable chemicals stored next to cardboard. This had the potential to put people at risk of fire. The registered manager took immediate action to rectify these.

The provider’s processes to monitor the safety of the environment were not always effective. We found required routine water safety tests were not carried out and recorded. People were placed at risk of fire as their Personal Emergency Evacuation Plans (PEEPs) were either not in place or accurate. We found PEEPs had been incorrectly completed, with wrong names and wrong room numbers and routine weekly fire alarm testing had not been completed for nearly 3 months. There was a delay in addressing actions identified by the fire service. We also found the provider had assured the fire doors had been made safe, but we found this not to be the case. The registered manager agreed to take immediate action to address our findings.

Relatives indicated staffing levels were sufficient and staff appeared trained in roles. Relatives commented, “I think the staff numbers are probably about right. I have to say that it seems that there is always someone cleaning when you go in,” and “There seems to be enough staff. There is always staff around when I visit. I tend to go at mealtimes, and it always seems busy then.” People and their relatives generally considered staff had adequate training and skills to enable them to care for people correctly.

The registered manager told us they used a dependency tool, and a review of people’s needs monthly or as and when needed to ensure good numbers and skill mix of staff and to meet people’s diverse needs effectively. They advised agency or bank staff were used to cover staff absences. Staff told us they thought there were enough staff on duty to support people's needs. Staff had raised concerns with us about care staff having to do the laundry which took them away from care. The registered manager told us the ancillary, day and night care staff were carrying out laundry services and they planned to employ laundry staff.

We observed staff were not always suitably deployed on shift. A person required a staff member to support and observe them with meals. We saw this was not provided and the person was placed at risk of choking. The provider expected a member of staff to always be available and present in the lounge area when residents were seated there. We found this was not routinely the case. This was fed back to the provider who took immediate action to rectify.

Staffing levels and skill mix were not always appropriate to make sure people received consistently safe, good quality care. Rotas detailed that on occasions, there had not always been the required number of care staff on duty. Recruitment practices were not in line with the providers recruitment policy. Five staff files did not contain the information to demonstrate the required recruitment checks had been completed. This meant people were at risk of being supported by unsuitable staff. New staff had an induction and a period of shadowing experienced staff. They completed the Care Certificate induction which is an agreed national set of standards that define the knowledge, skills and behaviours expected of specific job roles in health and social care. However, systems were not in place to evidence observations and knowledge checks of new staff to ensure full completion of the process. Agency staff were used to cover gaps in the rota however, their records of induction were not consistently completed to ensure they were aware of their role and tasks.

People and their relatives told us the home was generally clean.

Staff told us they had received training in infection prevention and control. Staff were aware of what personal protective equipment they were required to use. Staff told us they thought the environment was clean and prevented any risk of infection being spread.

Staff did not always comply with infection control best practice guidance. For instance, we observed a hoist sling which had been used by one person to support them move position had not been laundered before being used again on another person. A sling was found in another person’s room, which was not the one used by that person. We observed ancillary staff now worked hard to keep the home looking clean and clutter free.

Policies and procedures were in place for staff to follow regarding preventing infections within the home. The registered manager had undertaken an infection control audit and whilst the audit identified some of the concerns we observed, we found further concerns in relation to staff wearing the same gloves through corridors in between people’s rooms and a delay in getting the dishwasher repaired or replaced.

People received medicine reviews by the local GP practice. Medicines were given to people in a safe, person centred and caring way. People’s care plans had the necessary information to support people with their health needs and prescribed medicines. Medicines were administered in a timely manner and recorded on medicines administration records.

Staff and managers understood the principle of medicines optimisation and said they helped people receive medicine reviews. Staff said they received an induction, and training and their ongoing competency was assessed to handle medicines safely.

The staff carried out medicine reconciliation effectively. Medicines reconciliation is the process of accurately listing a person’s current medicines. Medicines were stored securely with effective monitoring processes in place. Guidance was in place for staff to administer ‘as required’ medicines to ensure people received them consistently.