We found the following examples of good practice.
Staff were able to describe safe practices relating to infection prevention and control, including how to put on and take off their PPE.
Visiting was encouraged in line with current government guidance.
Staff said they had been kept up to date with guidance and had received good support during the pandemic.
Chibburn Court 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.
Chibburn Court accommodates three people with learning disabilities in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. On the day of our inspection there were three people using the service.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.
We last inspected the service in October 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.
Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.
Appropriate arrangements were in place for the safe administration and storage of medicines.
The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.
There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks before they employed staff. Staff were suitably trained and received regular supervisions and appraisals.
People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. However, support plans required updating to reflect people were no longer at risk of malnutrition.
Care records showed that people’s needs were assessed before they started using the service and contained evidence of people being supported during visits to and from external health care specialists.
People who used the service and family members were extremely complimentary about the standard of care at Chibburn Court.
Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Care plans were in place that recorded people’s plans and wishes for their end of life care.
Care records were person-centred. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.
People were actively encouraged to make choices and these were clearly documented in the care records.
People were protected from social isolation and activities were arranged for people who used the service based on their likes and interests, and to help meet their social needs.
The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.
The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.
The home had a registered manager who had been registered since October 2010. 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.
Relatives of people told us they felt their family members were safe and that staff treated them appropriately. Staff were aware of safeguarding issues, had undertaken training in the area and told us they would report any concerns of potential abuse. There had been no safeguarding incidents in the previous 12 months prior to the inspection. Staff were also aware of the registered provider’s whistle blowing policy. The premises were effectively maintained and safety checks undertaken on a regular basis.
Good staffing levels were maintained to support the changing needs of people living at the home. The home looked to maintain a ratio of two staff to each person to help facilitate individualized care and a range of activities. Proper recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. Medicines were stored and handled correctly and safely. There were plans in place for the use of “as required” medicines, homely remedies and the use of covert medicines, if necessary.
We saw people had access to adequate food and drink at the home and were encouraged to participate in cooking activities. Where professionals had given advice or guidance about people’s diet we saw that this was being followed.
The registered manager showed us the system employed to ensure staff had regular training and updating of skills. Records and quality assurance checks indicated that most staff had completed all mandatory training. Staff said they were able to access the training they required. Visiting professionals told us staff had the right skills to support people. Staff told us, and records confirmed there were regular supervision sessions for all staff members and each staff member had an annual appraisal.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Appropriate assessments had been undertaken in relation to DoLS and application made to the local authority. The CQC had been notified of DoLS being granted. Staff were aware of the need for best interests meetings to take place where decisions needed to be made and people did not have capacity to make their own decisions. We saw appropriate action had been taken in certain circumstances.
The home had been adapted to promote people’s independence with single level access and ramps available. The decoration was pleasant and people’s rooms highly individualised. Several professionals had written in the home's comments book about the homely atmosphere.
Relatives told us they were very happy with the care provided to their family members. We observed staff treated people with great patience and kindness and showed a genuine interest in them as individuals. There was a very strong “family” atmosphere to the home and with staff and people sharing time together. We saw people laughed and smiled greatly. People’s cultural and religious needs were actively supported and encouraged.
People had access to health care professionals to help maintain their wellbeing. Specialist advice was sought and acted upon, where necessary, and visiting professionals told us the service and support provided people was very good and that staff were committed to providing good care.
Staff advocated on behalf of people living at the home and were able to describe how this had brought about changes for people. Staff understood about treating people with respect and dignity and put this into practice. Staff and visiting professionals described how the home had provided unique and individual end of life care.
People’s needs had been extensively assessed and individualised care plans and risk assessments addressed all their identified needs. Care records and care plans were reviewed in multiple ways to ensure they were current and met individual’s needs. Potential improvements were identified early and innovative approaches trialled. People had access to highly individual activities based around their backgrounds, likes and dislikes. The home had adopted charities with close associations to people living there and raised money through activities which people also participated in. There had been no formal complaints in the last year. The home had received several compliments and positive comments about the care delivered and the atmosphere at the home. A professional told us staff had made a positive contribution in supporting people moving to live at the home from hospital.
The registered manager showed us records confirming regular checks and audits were carried out at the home. Staff were extremely positive about the leadership of the home and the influence of the registered manager. They said there was a good staff team and felt well supported by colleagues and management. Staff all talked expansively about the family atmosphere at the home and how they enjoyed working and being there. Families told us they always felt welcome at the home.
A professional told us how the manager and the home had actively participated in a research project which had improved care at the home. The lessons from this project continued to be applied in the care undertaken. Records at the home were complete and contained good detail.
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found '
Is the service caring?
People's needs were assessed and care delivered in relation to their identified needs. People were able to access outside events or visit local facilities. We saw that care plans were detailed and took note of advice from outside agencies or other health professionals. We saw that staff approached and dealt with people in a friendly, caring and patient manner and anticipated their needs.
Is the service responsive?
People's care plans were reviewed as their needs changed. Staff we spoke with told us that all of the people who used the service had been there for around eight or nine years, so they knew them well and had a good understanding of their needs, likes and dislikes. One staff member told us, 'It is really like having an extended family; you get involved in the same way.'
Staff told us, and records confirmed that people engaged in a range of activities such as attending a local church, visits to day centres and similar services, attending a tea dance at a local community centre and shopping trips. The manager told us that one person regularly goes fishing with a staff member and showed us photographs of a recent trip to Fontburn reservoir.
Is the service safe?
We found that medication administration records (MARs) were detailed and contained information on the name of the medicine, the dose to be given, how it was to be given and when during the day. We saw that each medication was signed for by two staff members, to say that it had been given correctly.
Staff records contained evidence that people had submitted a formal application and had been subject to a selection process. We saw that prospective staff had been subject to identity checks through the checking of passports and other personal documents and had undertaken a disclosure and barring service (formerly CRB) check.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us she was aware of the recent ruling on DoLS by the Supreme Court, was reviewing the implications for the people at Chibburn Court and would make any necessary applications in due course.
Is the service effective?
We looked at the care plans of people who used the service and found that they were reviewed regularly and updated as people's needs changed.
The home had a compliments book for relatives or visiting professionals to write comments in. We saw one recent comment from a relative which read, 'Been to visit relative. She looks well and that makes us happy. The staff at Chibburn Court are all so lovely and friendly.'
The manager showed us a copy of the homes most recent quarterly performance review, undertaken by the provider's quality and performance team. We saw the review confirmed that 94% of supervisions had been undertaken and 89% of staff had been subject to an annual personal development review. With the exception of two items all mandatory training subjects were 100% complete.
Is the service well led?
The manager told us that she carried out a range of checks and audits on the home and the care delivery. We saw copies of documents regarding checks on medication, care records, equipment and the general environment within the home, cleaning audits and work station assessments.
We found that daily records maintained, as part of the people's care were up to date and contained good detail of events, activities and the care that had been delivered.
We saw that any incidents at the home were also recorded, investigated and followed up.
Staff confirmed that they had access to regular supervision sessions and yearly appraisals.
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff supported people with care tasks sensitively and we saw many positive interactions between people and the staff on duty. Following the inspection we spoke with a professional who had visited the service. They described the care they had observed during their involvement as "exceptional" and confirmed that the manager had all the correct protocols in place for supporting care delivery.
People were protected from the risks of inadequate nutrition and dehydration and we saw people enjoyed their meals.
We found there were effective systems in place to reduce the risk and spread of infection.
We found there were suitable arrangements for providing and maintaining sufficient equipment to meet people's needs and support their independence.
The provider survey was carried out in September 2012 to obtain the views of people, families, friends and advocates. Comments included, "I visit without prior notice and always found X to be smartly dressed, clean and contented. X appears to enjoy a quality of life which was not the case during their many years spent in various hospitals and care homes" and "Chibburn Court is an excellent place to be."
Staff told us they enjoyed working at Chibburn Court. One member of staff said, "It is a great place to work, we support each other to provide the best care we can." We saw how people were treated by staff and their involvement in making choices about their care. We saw people could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community.
We saw the home was clean, comfortable and warm. People, their families and advocates were given the opportunity to comment on the service, change routine or raise complaints.
We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.
When we visited we talked to a friend of one of these people. This person told us they had nothing but praise for the way their friend had been cared for and treated whilst living at 10 Chibburn Court and said " You would be hard pushed to find a place better than this, (name) has come on a long way since coming here, they feel secure, it is like a family environment."
We saw in surveys returned to the service the following comment from a relative: " The care (name) is getting is excellent. I have seen a huge change in (name) since (name) moved to Chibburn Court."