We carried out an unannounced comprehensive inspection of this service on 4 and 5 May 2016 and found significant breaches with regulatory requirements across all areas of the service. As a result of our concerns the Care Quality Commission took action in response to our findings by placing the service into ‘Special Measures’ and amending the provider’s conditions of registration. This included the provider not being able to admit anyone new to the service. We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the provider had shared with us at regular intervals their action plan detailing their progress to meet regulatory requirements and to achieve compliance with the fundamental standards. At this inspection considerable progress had been made to meet regulatory requirements, however some further improvements were still required.
Chilton Meadows Residential and Nursing Home provides care and support to a maximum of 120 older people, some of whom living with dementia and/or had complex nursing needs. People were accommodated across four ‘houses’ called Beech House, Munnings House, Gainsborough House and Constable House. At the time of our visit there were 78 people using the service.
The inspection was unannounced and took place over two days, on the 30 and 31 January 2017.
At the time of the inspection the home did not have a registered manager in post, however a manager was in post and following their appointment had submitted their application to be formally registered 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run. Following the inspection the manager was formally registered with us on 20 March 2017.
Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate a better understanding and awareness of the importance of having good quality assurance processes in place. This was a significant improvement and this had resulted in better outcomes for people using the service. Feedback from people using the service, those acting on their behalf and staff were positive and relatives spoke of the improvements made by the provider and management team following our last inspection in May 2016. This referred specifically to better visible management presence within the service and there now being optimism and confidence that the provider and management team were doing their utmost to make the required improvements to the service. Nonetheless, some improvements were still required to ensure that where issues were highlighted as part of the management teams auditing arrangements, information was available to show actions required had been addressed.
All staff spoken with at the time of the inspection described the management team as supportive and approachable. However, suitable arrangements were still needed to ensure that all staff received regular formal supervision and an annual appraisal of their overall performance. Staff told us and records confirmed that a range of training opportunities were available and provided to them, nonetheless staff had not received updated medication training or had their competency reassessed in this area for some considerable time. An assurance was provided by the provider that this would be addressed as a priority.
Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and liberties were not restricted. People were now routinely asked to give their consent to their care, treatment and support and people’s capacity to make day-to-day decisions had been considered and assessed. Minor improvements were required to ensure particular decisions which had been made in people’s best interests were recorded and evidence of Lasting Power of Attorney [LPA] arrangements sought.
Care records for people were much improved as they now centred on the individual rather than containing generic information. Care plans reflected people’s needs, choices and preferences and included information relating to people’s life history and experiences. Relatives confirmed they were now given the opportunity to be involved in the assessment and planning of their family member’s care. However, minor improvements were still required to ensure that people’s care plan documentation was accurate and up-to-date and care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Although suitable control measures were now in place to mitigate risks or potential risk of harm for people using the service, some risk assessments contained inaccurate and contradictory information.
Arrangements had been made following our last inspection in May 2016 to protect people from the risk of social isolation and loneliness. Additional staff had been employed so as to provide and undertake a programme of social activities for people living at the service. People and those acting on their behalf confirmed that social activities were available with the exception of weekends. Improvements were still needed in the way staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for those living with dementia or who had complex care needs. Although further improvements were still required, it was recognised that this only related to two of the four houses.
We observed that staff followed safe procedures when giving people their medicines, medicines were stored safely and records showed that people were receiving their medicines as prescribed. Errors that had been identified were reported to the management team and actions taken. Whilst medication practices and procedures were generally safe, improvements were required relating to the length of time the medication rounds could take, accuracy of records to show when medication was administered and more detail required for medicines prescribed to treat people’s psychological anxiety so as to ensure these were used consistently and appropriately.
Improvements were required to ensure that appropriate infection control practices, policies and procedures were applied, understood and followed by the management team and staff.
Significant improvements were noted at this inspection by the provider and management team to recognise matters that affected the safety and wellbeing of people using the service. Suitable arrangements had been carried out by the manager to take action when abuse had been alleged or suspected. People were protected from abuse and avoidable harm and people living at the service and others confirmed they were kept safe and had no concerns about their safety. Safe recruitment practices were now in place and being followed so as to keep people safe.
Comments about staffing levels at the service were variable. There was an anxiety about future staffing levels at the service following the embargo on new admissions to the service being lifted. Although these concerns were expressed the deployment of staff across the service was observed to be appropriate and there were sufficient staff available to meet people’s needs to an appropriate standard. Systems were now in place to determine the dependency needs of people using the service and these were used to support the service’s staffing levels.
People were supported to have enough to eat and drink. Significant improvements were now in place to monitor and record people’s nutritional and hydration intake so as to identify at the earliest opportunity those people who were at risk. Suitable arrangements were now in place to support people where they required assistance to eat and drink. People were supported to maintain good healthcare and have access to healthcare services as and when required. Records now confirmed people had appropriate access to external healthcare professionals.
Staff knew the care needs of the people they supported and people told us that staff were kind and caring. In general staff responded to people’s need for support and demonstrated appropriate concern for their wellbeing. People and those acting on their behalf told us that they were happy with the care and support provided by staff.
Staff told us that the overall culture across the service was now open and inclusive and that they felt supported by the management team. Staff told us that communication between staff and the management team was positive and that they felt listened to. Staff told us that morale within the staff team at all levels had much improved.