This inspection took place on 23 and 24 November 2017 and was unannounced.Chaucer House 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 the inspection.
Chaucer House is registered to accommodate up to 60 people. At the time of the inspection there were 41 people living at the service.
We carried out a comprehensive inspection on 19 and 21 September 2016 and the service was rated Outstanding. This inspection was prompted by information from the local authority, other healthcare professionals and relatives that there were increased risks to people’s safety, health and welfare following the registered manager leaving. This inspection examined those risks.
There had been a change in the management of the service since our last inspection. There was a registered manager leading the service. 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 registered manager had started working at the service in August 2017.
There were not sufficient staff on duty to provide consistently safe, effective and person centred care. There had been a reliance on high levels of agency nursing and care staff; however, at the time of the inspection, the amount of agency staff had reduced. Staff did not always have the skills to provide the care and support people needed. Staff had not received consistent supervision and appraisal. The registered manager had increased the number of staff on duty, following the inspection; they told us that another member of staff would be on duty during the day. We will check this at our next inspection. Staff were recruited safely. New staff completed an induction when they started work at the service.
Potential risks to people’s health and safety had not been consistently assessed and there was not always detailed guidance for staff to following to mitigate risk. The high use of agency staff meant that people were at risk of not receiving safe care. During the inspection, we observed staff and staff told us how they supported people safely.
Checks to the environment and equipment were completed to ensure they were safe. Shortfalls were identified, however, action to mitigate risk to people’s safety was not always taken quickly.
Before the inspection, concerns were raised about unsafe management of medicines. The registered manager had taken action to reduce medicines incidents, these had been effective. During the inspection, medicines were being managed safely.
Each person had a care plan. The care plans contained information about people’s lives before they came to live at Chaucer House. However, the care plans did not consistently contain details about people’s care and support that was unique to them. During the inspection, we observed and staff told us about people’s preferences and how they provided person centred care. People were assessed before coming to Chaucer House. The registered manager assessed the person’s mental health, physical and social needs, including equality and diversity but this had not always been reflect in the person’s care plan.
Some people were receiving end of life care. There were not always enough staff to provide the skilled care and support to the person and their family. There were not detailed care plans in place to guide staff about the person’s wishes and the support required.
People and relatives told us, that staff were kind and caring. However, they told us that staff did not always maintain their dignity and treat them with respect, they felt this was due to not having sufficient numbers of staff on duty.
Audits had been completed, shortfalls had been identified but sufficient action had not been taken to rectify the issues and the same shortfalls were found at this inspection. There were systems in place to receive feedback from people, relatives and staff. Complaints had been received from relatives, but action had not always been taken to improve the service. There was an action plan in place, the registered manager, had started to complete actions required.
The building was purpose built, meeting people’s physical needs. However, in the dementia unit the signs to direct people to places such as the bathroom, were not clear and were not pictorial. There was a risk that people would not be able to find their way around the unit. This was an area for improvement.
People and staff had the opportunity to attend meetings. Staff meetings had not been held regularly, the registered manager had identified this and meetings were held regularly, to keep staff up to date and receive their feedback. . A relatives meeting had been held in May 2017, but there were no minutes available. There were activities available each day.
Staff knew how to recognise signs of discrimination and abuse. They were confident that any concerns would be dealt with appropriately. The registered manager had reported incidents to the local safeguarding team when appropriate and was working with healthcare professionals to reduce the risks of the incidents happening again.
People were supported to eat and drink enough to maintain a balanced diet. Staff referred people to specialist healthcare professionals such as dieticians when required and followed the advice given. People had access to opticians and chiropodists as needed. People were protected by the prevention and control of infection procedures.
People were supported to have maximum choice and control of their lives and staff supported them in least restrictive way; policies and systems in the service supported this practice. Staff were kind and compassionate when spending time with people, they supported people to make choices about their care and support where possible.
Staff told us that they felt supported by the registered manager and felt that the service had started to improve. The registered manager promoted an open culture within the service, they were visible around the service. There were mixed views from people and relatives, some people knew the registered manager and others stated they had not met them. The registered manager told us that they were trying to meet as many people as possible.
The registered manager was aware of the shortfalls in the service and was working through an action plan to rectify these. They had worked with other agencies and healthcare professionals to build relationships to reduce the risk of incidents in the future.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.
Providers are required by law, to display their CQC rating to inform the public on how they are performing. We found that the provider had conspicuously displayed their rating at the service and on their website.
At this inspection five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.