Archived: Chyvarhas Residential and Nursing Home

This inspection took place on 2 December 2020 and was announced.

We found the following examples of good practice.

The registered manager was communicating with people, health professionals, staff and family members regularly. This was to make sure everyone understood procedures and precautions being taken, and how to keep people safe during the current Covid-19 outbreak. The registered manager worked with the care staff team to ensure infection prevention and control measures were followed.

The registered manager provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic and the current outbreak in the service. They ensured people living and working at Chyvarhas had access to additional support. This included one-to-one meetings and contact by phone, with any emotional support needed in response to the current outbreak.

We observed there were effective procedures in place to support staff to follow current guidance on infection prevention and control in order to help people to stay safe. The registered manager ensured staff and people who used the service understood why the measures were in place.

The registered manager was supported by the organisation, and other health professionals including GP’s. Communication was enhanced using interactive technology. This enabled the registered manager to communicate regularly and gain advice and support during the current outbreak.

There were notices on people’s bedroom doors for those who were currently isolating. This alerted staff to what was required and what PPE was to be worn before entering the room. Staff were aware of the additional checks they needed to carry out to ensure of people’s wellbeing.

The design of the service had enabled staff to create zones where people who were positive were cared for in designated areas, to prevent the risk of the virus spreading to others. Some people found it difficult not to move about and we observed they had the space to do this safely due to the actions taken to create safe zones.

Staff helped people to stay in touch with family and friends through phone and video calls. The service was currently closed to all visitors.

Chyvarhas is situated in the town of Callington. It is a purpose built single storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Callington with links to public transport. There is a main lounge/dining area with three ‘wings’ where peoples bedrooms are located. In the foyer there is a fourth ‘wing’ where peoples bedrooms are also situated. All rooms were single occupancy. There was a large communal lounge/ dining area but smaller lounge areas were situated throughout the home for peoples use. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.

The last inspection took place on the 28 March 2017. The service was rated as Requires Improvement at that time. There were concerns around how risks for people were managed, how staff supported people who may become anxious, medicines were not always recorded safely and records had not been completed satisfactorily.

This unannounced comprehensive inspection took place on 5 June 2018. At the previous inspection (March 2017) the registered manager had been in post for a matter of days. Since that time she has remained in post and has worked with the staff team to implement the necessary changes. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection. The service is now rated as Good.

The service is required to have a registered manager and at the time of the inspection 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 and associated Regulations about how the service is run.

Staff told us with the change of registered manager and also changes at senior management level there had been a number of positive improvements to the service. Staff told us that there “Is now a process for everything we do, we know what is expected of us.” Staff felt that as their roles were clearer this meant that staff knew who was responsible for each task and these were now completed. Staff were also clear about how they needed to record information to evidence how they supported and monitored a person’s health and the process to follow if a person had an incident. We found records were up to date and reflected the person’s individual needs. Accident and incident records were also completed and audited by the management team.

The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation.

People, relatives and staff all told us they found the new management structure more open and approachable. They felt their views on the running of the service were sought and were complimentary about the changes to the service. A person told us “Things have definitely improved, especially recently with the new manager, and the new staff are just as caring as the staff I’ve known for many years.”

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

The service had implemented a ‘person for the day’ and this meant that their care records, risk assessments and incident records were reviewed to ensure they were in place and were accurate.

The service had implemented a daily ‘Stand up meeting’. The meeting consisted of senior care and nursing staff, activities coordinator, head of housekeeping and head of catering. Information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR).

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

People and their relatives told us they thought there were enough staff on duty and staff always responded promptly to people’s needs. Staffing arrangements met people’s needs in a safe way. The manager reviewed people’s needs regularly. This helped ensure there was sufficient skilled and experienced staff on duty to meet people’s needs.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. Staff monitored people’s food and drink intake to ensure everyone received sufficient each day. People told us, “There is plenty of good, wholesome food and we do eat well here. My appetite is still good, and I know what I like and I can tell you I don’t have any complaints at all about the food.”

The care we saw provided throughout the inspection was appropriate to people’s needs and wishes. Staff were patient and discreet when providing care for people. They took the time to speak with people as they supported them and we observed many positive interactions that supported people’s wellbeing.

Staff were proud to work at Chyvarhas and told us “Love it, you help someone [person] and see them smile”, “I find it humbling to look after people here” and “We want to provide the best for them [people] so when they leave here they know they were well cared for. We may be their [person’s] last friends they ever have.”

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time. People had access to some activities both within the service and outside. An activities co-ordinator was employed and organised a planned programme of events. The activities coordinator was passionate about making sure activities were fun for people.

Staff were supported by a system of induction training, supervision and appraisals. Staff meetings were held regularly.

The premises were well maintained. The service is registered for dementia care. There were people living at the service who were living with dementia and were independently mobile. The service was warm, comfortable and appeared clean with no unpleasant odours.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the registered manager and members of the senior management team.

A manager was employed to manage the service who was in the process of registering with the Care Quality Commission. 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 provider did not always act to keep people safe. People’s call bells were not always connected or within their reach which meant they were not able to call for assistance should they need it. Staff were not always aware of how to help alleviate people’s anxiety and did not always act to help people when they were experiencing anxiety. People did not always have risk assessments in place to guide staff how to reduce risks to people. Where people had experienced incidents, these had not been recorded accurately or monitored to ensure any learning was identified and implemented to reduce future risks.

People were supported with their medicines by trained staff, however staff were not ensuring they recording accurately what medicines they had administered and when. This meant it was not clear what medicines had been administered and what time people could safely receive their next dose. People were supported to see medical professionals, however records regarding what action had been taken in relation to people’s health concerns, and why, was not always accurate or up to date.

People were involved in planning their care and staff sought their consent prior to providing them with assistance. Staff had received training about the Mental Capacity Act but where people lacked the capacity to make decisions for themselves, processes had not always ensured people’s rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed.

People told us they were able to choose how they spent their day and that group activities were available. However staff members told us they did not have time to spend with people, beyond providing personal care. Feedback sought by the provider showed people and relatives felt activities were not personalised and staff did not have time to spend with people. People’s care plans did not always contain information about how people liked to have their care provided or what pastimes they were interested in.

The provider had not always acted to ensure the quality of the service was maintained. Feedback had not always been acted upon and gaps in records had not been identified.

People were supported by staff who treated them in a caring way and respected their privacy and dignity. People’s complaints were taken seriously and acted upon.

People told us they enjoyed the food. Mealtimes were a positive experience and people told us meals were of sufficient quality and quantity. There were always alternatives on offer to choose from and people were involved in planning the menus and their feedback on the food was sought.

Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. The manager was in the process of identifying what further training staff needed to fulfil their roles effectively. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.

The manager had clear values about how they wished the service to be provided and told us they were in the process of taking steps to improve the quality of the service provided. People told us they were happy living at Chyvarhas and staff were positive about the changes the manager was implementing to improve the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was safe.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm. People told us they felt able to 'speak their minds'.

We saw Chyvarhas understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people's needs. We were told the service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was caring.

We saw and heard staff ask permission and then explain what was going to happen when they provided care. For example, 'Is that okay?', 'May I?' and 'Please can you?' We saw staff paid attention to the choices we all make in our daily lives, such as 'would you like salt and pepper?' or 'would you like some sugar in your tea?' We observed staff responded to people in a kind and sensitive manner adjusting their own stance to ensure they were at eye-level with the person they were talking with.

People were treated with dignity and respect by the staff. Some of the comments received from visitors to Chyvarhas included 'X has been in Chyvarhas for eighteen months. I have nothing but praise for the care he receives. The only thing that could be better is the food' and 'I have always found the management and care staff to be friendly and helpful with any issues dealt with in an efficient and caring manner. I am happy that X's individual needs are being met and that they are being well looked after'.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Is the service responsive?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was responsive.

People confirmed they could have what they wanted at meals if they did not like what was offered. People were able to take part in a range of group and individual activities such as dancing, scrabble games and craft work.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of Chyvarhas we saw evidence to support a judgement that this service was well-led.

We were able to talk with staff and they were all positive in their attitude on how the home was organised and run. The home had a manager registered with the Care Quality Commission.

We saw that people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people's privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided, and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.

During the observations we saw staff helping people to mobilise. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interaction with people which was generally positive.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.