The Chase Rest Home

The Chase Rest Home is a care home that accommodates up to 24 people. The service supports a wide range of people including those living with dementia and other mental health needs. At the time of our inspection there were 19 people living at the service.

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

Since the last inspection the manager had worked hard to make improvements. At the last inspection the manager had only worked at the service for a week. Following the inspection, the manager spent time getting to know people to enable them to be able to develop care plans and documentation. Initially the manager focussed on the areas of high risk, they are aware that further work is required to meet all regulations but have done a lot of positive work to improve. Feedback from people, relatives and staff was positive and people told us they liked living at The Chase Care Home.

Although it was apparent a number of areas had improved, further work was still required to embed changes and develop the service to ensure all regulations were met.

The provider had not maintained appropriate oversight and governance to ensure all areas of the day to day running of the home and health and safety was being monitored effectively. Some issues found at the last inspection had not been addressed. Governance needed to be improved to ensure maintenance was identified and carried out in a timely manner.

Infection prevention and control (IPC) measures needed to be improved, we observed staff not using Personal Protective Equipment (PPE) or handwashing effectively to prevent the risk of infection. Cleaning schedules were not being consistently completed and some areas of the home required further cleaning.

Recruitment records were not robust. Further information was required to ensure that references were accurate and dates of previous employment were correct. Information about staff’s working restrictions needed to be explored and recorded.

A lot of work had been completed to improve documentation. However, care plans and risk assessments needed further improvements to ensure information about people’s health needs were person centred and up to date.

Staff were aware of safeguarding procedures. Accidents and incidents were reported appropriately, and documentation was completed to ensure a robust process was in place following any accidents or incidents.

New staff completed an induction and were supported during their probationary period. Staff received training and support. Staff meetings had been carried out and staff had one to one and group supervision.

People were involved in choices and decisions and supported to be as independent as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s nutritional needs were assessed and managed. Referrals were made to other agencies to support people’s mental and physical health. The manager and staff worked with health professionals to ensure people received the support they needed.

Staff were kind and caring. Activities were provided for people and they were supported to spend their time how they chose.

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 10 November 2022). CQC served a Warning Notice to the provider due to the lack of good governance.

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 that although improvements had been made in some areas, the provider remained in breach of regulation.

Why we inspected

We undertook this comprehensive inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this inspection and remains requires improvement.

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.

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

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Chase Rest Home is a care home that accommodates up to 24 people. The service supports a wide range of people including those living with dementia and other mental health needs. At the time of our inspection there were 19 people living at the service.

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

The service was not well-led. There was no effective governance system in place to ensure the service was meeting regulation. In the absence of a registered manager, the provider had not maintained oversight of the service to ensure that people’s safety was maintained.

Documentation had not been maintained to an appropriate standard. Care plans and risk assessments were confusing and contradictory. People's care was not always planned or delivered in a person-centred way as staff did not have access to up to date and relevant information about people’s care and support needs.

There was not an effective system in place to manage the environment and to review overall maintenance and safety in the home. This included fire safety, general maintenance, systems and service checks.

Staff did not demonstrate a clear understanding around safeguarding people from abuse. The provider had not reported an allegation of abuse in line with regulatory requirements.

We identified staffing and recruitment concerns. Staff did not receive an appropriate induction or training before working unsupervised. Recruitment processes were not robust to ensure people were safe to work in the home. Staff were covering roles without the appropriate training and experience.

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 and in their best interests; the policies and systems in the service did not support this practice. Documentation around Deprivation of Liberty Safeguards (DoLS) was not clear, staff were not sure who had a DoLS authorisation currently in place or what this related to.

Improvements were needed to ensure people’s nutritional needs were met appropriately. Staff were not appropriately trained to ensure meals were provided in a nutritional and appetising way. Information about people’s nutritional needs had not been updated.

Infection prevention and control (IPC) concerns were identified. Areas of the home were not suitably clean. Laundry and kitchen procedures needed to be improved.

People told us they liked staff; we saw staff engaging with people in a polite manner. The service worked with outside agencies to support people’s mental health needs.

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 17 July 2018). At this inspection breaches were identified. The service has now been rated as requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about safe care, medicines, staffing, training, reporting allegations of abuse and maintenance. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this 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.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, safety, staffing, recruitment, mental capacity, infection prevention control and good governance. Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect. We will meet with the provider to discuss our concerns.

We found the following examples of good practice.

People were supported to maintain contact with their family and friends. Staff were aware of current government guidance and this was displayed throughout the home. There was a visitation pod to ensure people remained safe during visits. The deputy manager had also provided simple visiting guidance to relatives following feedback that they were confused about changes.

PPE was available throughout the home and staff were seen to be using this appropriately. The home was clean and tidy with a robust cleaning rota being followed. This included the use of a ‘Fogging machine’ which sprayed disinfectant and cleaned and sanitised large areas of the building quickly.

People and staff followed testing guidance, which included ensuring visitors were vaccinated and had received a negative Covid lateral flow test (LFT). All visitors also had their temperature taken before entering the service. Staff completed an LFT before each shift.

The management team had focused on promoting positive mental health with people and staff. This included supporting people when they were isolating and providing activities that were socially distanced. At one point, staff morale had been low, and the deputy manager had provided them with individual notebooks. These were used to share positive messages and compliments with each other.

The Chase Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People had care needs relating to their mental health, dementia or older age.

The Chase Rest Home can accommodate up to 24 people. There were 16 people living in the home at the time of our inspection. Each person had their own private room with toilet and sink, and there were shared bathroom facilities.

The service had a registered manager. 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.

As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk. The home was clean, and people were protected from the risks of poor infection and prevention control.

There were enough staff to support people to stay safe and meet their needs. Staff knew how to report incidents and accidents, and if these did occur, they were properly investigated. Information about these types of incidents were shared, so staff could learn from mistakes. Risk assessment and risk management practices were robust.

People were supported to eat and drink enough, and specialist dietary needs were met. People gave us positive feedback about the quality of the food. People were able to access the healthcare they needed to remain well and their medicines were safely managed.

People were supported to express their choices and preferences and staff supported people in the least restrictive way possible. People led the lives they wanted to and were able to maintain contact with those people that were important to them. People were able to participate in a range of activities, and go out when they wanted to.

People experienced care that met their needs, and were supported by kind, caring staff. People had their privacy and dignity respected, and staff knew what to do to make sure people’s independence was promoted. People experienced person centred care and were supported to make their end of life care wishes known.

People had their care needs regularly assessed, and people were involved in their care reviews. People experienced care and support that was in line with current guidance and standards. Staff made sure they worked within the organisation and with others, to make sure people received effective care. The building and environment was properly adapted to meets the needs of the people who lived there.

Staff were properly supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. Specialist training had been arranged where needed, for example dementia care.

People were asked for their consent before any care was given, and staff made sure they always acted in people’s best interests. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be deprived of their liberty for their own safety or unable to make informed choices about their care.

People had access to a complaints process, and said they would be happy to raise a complaint if they ever needed to. There had been no recent formal complaints, but the registered manager and staff knew what action to take if a complaint were made.

The service was well-led and staff felt supported. People’s views were sought and acted on to improve the service. Regular checks and audits were carried out to make sure people experienced good quality care and staff provided good support. The registered manager had notified the CQC of events that were reportable. The service had met all the fundamental standards and the registered manager and staff had improved the service so it was now good. Further information is in the detailed findings below.

The Chase Rest Home was inspected in January 2016. No breaches of regulation were found but we identified some areas of improvement we asked the provider to make to ensure peoples care met best practice at all times. At this inspection we found the provider was not meeting all regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Chase Rest Home had a registered manager who had just recently completed their registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Systems in place to assess and monitor the quality of service provided were not robust. Maintenance and infection control issues found during the inspection had not been identified during recent audits completed by the registered provider and registered manager. Premises and equipment had not been kept clean, suitable for the purpose for which they were being used, properly used and properly maintained.

Medicines policies and procedures were in place; however some areas of medicine practice needed to be improved to ensure that people received their medicines in a safe and consistent manner.

Recruitment processes needed to be improved to ensure that adequate checks and references were in place before people commenced work at the home. There were enough staff to keep people safe. Staff had received training to ensure they had the knowledge and skills to meet the needs of people living at the service. Staff felt supported and had regular staff meetings and individual supervision and appraisals. Staff told us that improvements being implemented were positive.

Staff knew people well. Interaction between staff and people were open and friendly. We saw that staff were kind and patient when providing care. People were always treated with dignity and people’s personal choices were supported.

Risks relating to people’s individual needs were identified and managed to help ensure people remained safe. Staff had a good understanding about how to recognise and report safeguarding concerns.

Management and staff had an understanding regarding mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). People were actively involved in day to day choices and decisions around how they received their care. Care was assessed and reviewed regulary to ensure it was person centred and information about the person was up to date. Staff made sure people did not become socially isolated and worked with other outside professionals to improve people’s day to day lives.

Meal choices were provided and people gave positive feedback regarding the meals. People had access to fruit, savoury snacks and drinks when they wished. Kitchen staff were aware if people had any specific dietary needs, allergies or preferences.

Many people went out alone regularly or with relatives. People were encouraged to maintain their independence as much as possible. Staff were involved in providing daily activities for people his included games, quizzes and exercise. The registered manager was looking at further ways to improve activity provision. Staff were aware of people who may be at risk of becoming socially isolated and worked hard to involve people and encouraged them to come to the communal lounge.

People were involved in gaining and providing feedback about the home. Information fed back was used to make changes and improvements. A complaints procedure was available for people to access if needed.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The home was a converted older building and the accommodation was on four three floors, a lift enabled people to access most of the home. There were large communal seating areas on the ground floor; people using walking aids were able to access the large garden to the rear and a slope enabled people easy access to the pavement at the front.

A registered manager was responsible for the day to day management of the home. 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 inspection took place on the 14 January 2016 and was an unannounced, which meant the provider and staff did not know we were coming.

A quality assurance and monitoring system was in place and, had identified the issues we found during the inspection, in relation to care plans and mental capacity assessments. There was an action plan in place to address the issues and staff training had been arranged to ensure these were addressed.

People said they felt safe and involved in decisions about the support provided. Risk had been assessed to ensure people were able to take risks. Staff provided support if required, such as assisting people to keep mobile with the use of mobility aids and, where appropriate additional support was provided to enable people to go into the town safely. There was guidance for staff to follow, staff knew people really well and they had a good understanding of people’s individual support needs.

People had access to health care professionals, which included the community mental health team, the GP, district nurse, optician and dentist. People were supported to maintain a healthy diet and if people lost weight or their appetite there were systems in place to support them. The menus were based on people’s preferences, they chose what they wanted to eat and said they food was very good.

There was an open and relaxed atmosphere in the home, people were encouraged to be involved in developing the support provided and were able to talk to the registered manager and provider at any time. People did not have any concerns, they said there were enough staff working in the home to look after them and they had the skills and knowledge they needed to provide the right support to meet their needs.

During our inspection we found that people had been involved in decisions about their care and chose how they spent their time. Care plans documented the needs of people and their preferences.

Safeguarding measures were in place to protect people living in the home. The provider had systems in place to ensure staff recruitment measures were followed.

A copy of the complaints procedure was displayed in the main reception, and included in the homes statement of purpose. A complaints policy was available for people to access if required. Evidence was seen that comments and complaints were documented, listened and responded to in a timely and appropriate manner.

We found that care plans clearly documented the needs of people. Generally care was provided to meet individual needs and the provider had appropriate systems in place to monitor and improve the service.