7 March 2023
During an inspection looking at part of the service
Chosen Court is a residential care home providing personal care to up to 11 people. The service provides support to people living with learning disabilities, autistic spectrum disorder or mental health needs. At the time of our inspection there were 9 people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: We received mixed feedback from people and their relatives about the opportunities to engage in activities of interest. The registered manager told us that they were supporting people to reengage with activities after the pandemic. We have made a recommendation for the provider to review people’s activity preferences to ensure they remain current.
There was evidence of risk assessments for the building and environment. Regular health and safety audits and environmental checks were carried out to monitor the safety of the service
The environment did not meet the principles of Right support, right care, right culture as there were more than 6 people living in one communal home. However, despite the large environment, consideration had been given to the principles. The regional operational director told us, “All of the refurbishment and building work has taken place to personalise people’s environment. It has been needs based and we are making more space and a ‘break out’ area for people.”
People had not always been supported to take their medicines in accordance with their individual needs and preferences.
Agency staff had been used to ensure safe staffing levels had been maintained through a high level of staff turnover.
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.
Right Care: People's care records did not always contain the necessary detail to evidence the personalised care, support and treatment people received. A high level of staff turnover had meant the service had recently become more reliant on agency staff. Staff were not always able to explain their role in respect of individual people without having to refer to documentation. Therefore, the shortfalls we identified in relation to people’s care records meant that we could not always be assured people’s wishes and preferences would be met.
Right Culture: We received mixed feedback from people, relatives and professionals about the culture of the home. Some permanent staff told us they believed that, after a period of high staff turnover, things were now improving. The provider had put measures in place to make the necessary improvements and an agreed timeline for improvements had been implemented. More time was needed for this to be achieved.
Quality assurance processes included a variety of audits. These had been operated effectively at provider level, but internal home audits had not identified the concerns we found on inspection.
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 7 May 2021).
Why we inspected
We received concerns in relation to the management of finances, diet and nutrition and people’s personal care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
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.
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.
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 Chosen Court on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.