Chypons Residential Home

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• 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

During our assessment of this key question, we identified two repeated breaches of the regulations in relation to the safety of staff recruitment and compliance with the Mental Capacity Act. Recruitment systems were not robust. The provider had not completed capacity assessments and submitted them to the Local Authority. The provider responded to the concerns raised and provided a action plan in how they would be addressed. However, staffing levels were safe and risks to people’s wellbeing had been identified and mitigated. Where incidents occurred these were investigate and any learning identified. The environment was well maintained, and all necessary safety checks had been completed. Staff understood how to manage infection control risk and PPE was readily available throughout the service. People received the medication as prescribed and the service digital medicines management system worked well.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us the service communicated openly and shared details of all incident and accidents that occurred. Their comments included, “They are good on communication” and “I know they would let me know if anything was wrong, they always let me know if [My relative] is not well.”

The registered manager told us, “We do investigations into falls, we keep a file and monitor how many occur and where and call outside resources in when needed.” The service had access to a specialist chair to help people who had fallen but were uninjured up from the floor. Staff were confident using this device and told “The Raiser chair has proved really invaluable, I think it has been very good.”

Details of all accidents and incident that occurred were recorded and investigated. This helped minimised the risk of similar events reoccurring and enabled staff and managers to learn and improve their practice.

People were comfortable in the service and enjoyed laughing and joking with their care staff. Relatives told us, “Safe yes, it is secure, you have a hard job getting in if they are busy, I have seen the staff in action, staff are very calm and patient with [The residents]” and “I would recommend it, it feels like a friendly home from home, small enough for personal attention. Lots of the staff have been there a while.”

Staff ensured information was passed accurately to other providers during any transitions to ensure continuity. Where transitions had been unsuccessful, learning was identified and appropriate referrals made to regulators where appropriate.

Professionals were complimentary of the service systems and told us, “The staff are very knowledgeable of the people they support and their health needs.”

The service had robust systems in place to ensure information was shared promptly when transfers of care were necessary. Hospital passport documents had been developed for each person detailing their specific needs and preferences for use in the event of a hospital admission.

People told us, "They are looking after me. It’s good here" and “Staff are kind and look after me.” Relatives said, “The staff are really caring, never witnessed anything untoward” and “Safe, very much so, the staff are friendly and attentive. My relative is safe and secure here.”

Staff and managers understood local safeguarding procedures and were confident people were safe. Their comments included, “I think the residents are safe” and “The people living here are safe. I think they are safe living here.”

Information about to how raise and report safeguarding concerns were readily available to everyone using the service, staff and visitors. Staff treated people with respect and provided compassionate care when required. They were skilled at identifying people’s specific needs and provided reassurance or appropriate distraction when necessary.

The service did not have robust systems in place to ensure the rights and freedoms of individuals lacking capacity were protected. The registered manager did not fully understand the requirements of the Mental Capacity Act and necessary Deprivation of Liberty Safeguards applications had not been made to the local authority. This was a repeated breach of the regulations. The provider responded to the concerns raised and provided a action plan in how they would be addressed. The provider had effective systems place to ensure safety concern were shared promptly with the local authority. When necessary, the registered manager had appropriately sought support and guidance from the local authority’s safeguarding team and acted on the information provided to ensure people’s safety.

Relatives who visited regularly were confident risk were appropriately managed at Chypons. They told us, “[My relative] has a bell within reach”, “They are very good at health and safety lifting and that sort of thing” and “They do really well, [my relative] is happy and looks well, [they are] really well cared for.”

Staff had the skills necessary to manage risks and safely meet people’s needs. They said, “The training is spot on, the first month was constant training” and “I have had training on how to use the equipment.”

Staff supported people to mobilise safely and used moving and handling aids appropriately. Hoists and other lifting equipment had been regularly checked and serviced to ensure it was safe for use. On our arrival for the second day of the on-site assessment one person was distressed. Staff responded appropriately to this person and provided effective reassurance and support, calmly and with compassion.

The service had appropriate systems in place for the identification and mitigation of risks. People’s care plans included clear guidance for staff on the action they should take to ensure known risks were managed.

People enjoyed their environment and valued the service fine views. Relative told us, “Generally [my relative] and their bed are clean and [they are] made to feel more comfortable, properly cushioned and staff do things to help [my relative] to be comfortable” and “The home is the best, another relative went there and I have been visiting over the last 30 years, it retains a nice atmosphere, it is a large Victorian residence set up high, it has got lots of outside seated areas with wonderful views, nice rooms and it has retained its elegance. It is very comfortable country house experience.”

The service employed a small team of part time maintenance personal, and records showed minor defects reported had been promptly resolved. Where large issues were identified appropriate contractors were commissioned promptly, to complete any repairs necessary. Maintenance staff told us the provider had a ongoing plan for improving and upgrading the service’s environment.

All areas of the service were well maintained and appropriately decorated. People’s bedrooms were individualised with personal items and their was an interesting and varied range of art throughout service.

Maintenance records showed all necessary routine safety checks had been completed on fire detection systems, fire extinguishers and lifting equipment. An external audit had recently identified the need to some minor structural changes to ensure the integrity of fire partitions. The necessary improvement works were being planned to resolve these issues.

People told us, “The staff are all friendly” and “I ring the bell and they come, they come quickly more or less.” Relatives also spoke positively of the staff team and the quality of care they provided. Their comments included, “They are doing a remarkedly good job, nothing untoward happened”, “Staff are good, everyone seems good”, “It is well run, seems a strong core team, they are positive and friendly and always happy to answer my questions” and “It is very calm, no bells ringing.”

Staff were confident there were sufficient staff on duty to meet people needs. They told us, “We normally have enough staff” and “I think there is enough staff, today there’s 4 on. I think that is a good number, one day last week there was 3, it was ok. We managed all right.” The registered manager recognised there was a small number of staff vacancies at the service due to recent staff retirements and planned absences. As a result, a staff recruitment campaign was being planned. The registered manager commented, “We are not currently using agency staff but have identified a recruitment agency to use.”

The service was appropriately staffed and rotas showed planned staffing levels were routinely achieved by the employed staff team. During both site visits, we observed that staff responded promptly and appropriately to people’s requests for assistance. Staff were not rushed and had time to sit and chat with people.

The service’s recruitment practices remained unsafe. Two staff employed since our last inspection had been permitted to work independently in the service before necessary pre-employment Disclosure and Barring Service checks were completed. This had unnecessarily exposed people to risk of harm and was a breach of the regulations. Following the on site assessment the provider sent evidence that recruitment checks had now been completed.

Relatives were confident the service was appropriately managing infection control risks. They told us, “It is clean and tidy, they hoover the biscuit crumbs up from elevenses when people go into lunch” and “Personal cleanliness is really well looked after, when I visit early in the morning [My relative] is washed.”

Staff told us there were normally 2 domestic staff on duty each day and the different roles and responsibilities of domestic and care staff were well defined and understood.

The service was clean and domestic staff were on duty during both assessment visits. Personal protective equipment was readily available to staff and used appropriately. People’s clothing was clean.

Staff had completed infection control training and managers understood how to respond to any outbreaks of infection. The service’s laundry facilities were well maintained. However, carpeting had been installed in the laundry area contrary to best practice.

People and their relatives were confident staff knew how to support people with their medicines. Comment received included, “Medicines, no problems in the last 6 to 12 months. Now they are on top of that” and “Meds no problems, at mealtimes I have seen [my relative] being given a couple of tablets, the medicines are locked away in a cabinet [when not needed].”

Staff were complimentary of the providers new digital Medicines Administration Record system. They told us, “It is a lot easier on computer than the old MAR (Medicine Administration Records, which are paper based) sheets.”

The service’s systems for managing medicines had improved since our last inspection. A digital MAR chart system was in use and had been regularly audited to ensure information had been accurately recorded. Were errors were identified these had been appropriately investigated to ensure people’s safety. All topical creams had been dated on opening and a date set for when the cream should be disposed of if unused. Processes for the management of medicines that required stricter controls had also improved. At this on site assessment visit we found these records had also been accurately maintained and regularly audited.