This inspection took place on 10 January 2017 and was unannounced. Victoria Chatsworth is a nursing home registered for up to 22 people. It provides nursing care and personal support to older people with nursing care needs usually over sixty-five years of age. There were 19 people living at the service. The service is in a large detached house, arranged over two floors accessed by a passenger lift. The ground and first floor was used to provide people with nursing care, support and treatment. Long term care and respite care was provided. At the time of the inspection a contract was in place to provide six community short term beds (CSTS.) This is where people have been in hospital, or to prevent hospital admission and need a short period of rehabilitation before returning home.
This short-term rehabilitation is a joint partnership between Brighton and Hove City Council and the Sussex Community NHS Trust who work together to provide co-ordinated care. People have the guidance and regular support from the physiotherapists, occupational therapists, consultants for elderly care, GPs and a community mental health nurse. These specialists had worked with people to improve their independence and mobility prior to returning home.
There was a registered manager for 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.
Senior staff carried out a range of internal audits, including care planning, checks that people were receiving the care they needed, medication, and infection control. However, regular fire and health and safety checks of the building had only just started to be completed and so it was not possible to evidence this practice had been fully embedded in the service. This meant it had not been identified the PEEP’s (Personal Emergency Evacuation Plan) in place for people in the event of a fire had been regularly reviewed. The purpose of a PEEP is to provide staff and emergency workers with the necessary information to evacuate people who cannot safely get themselves out of a building unaided during an emergency. Residents meetings had not been regularly held to enable them to give their views on the care and support provided. Although there were opportunities for people to give feedback using the Choices NHS website, questionnaires had only just started to be used to gain feedback in the service. Therefore people had not had a range of opportunities to formally give their feedback, and for the staff to demonstrate how the service has moved forward and made improvements following feedback received. These are areas of practice which require improvement.
People told us they felt safe. One person told us, “There is always a member of staff around to reassure me. You only have to ring the bell and they come.” Another person told us, “I feel safe because I always get my pills on time.” A third person said, “It’s very safe here the carers are very good-they help me a lot.” People were cared for by staff who had been recruited through safe procedures. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, and plans were in place to promote good practice and develop the knowledge and skills of staff. People were comfortable talking with the staff, and told us they knew who to speak to if they had any concerns. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager. There was a maintenance programme in place which ensured repairs were carried out in a timely way. Medicines were stored correctly and there were systems to manage medicine safely. Audits and stock checks were completed to ensure people received their medicines as prescribed.
Staff were aware of their responsibilities from the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) Where people lacked capacity to make decisions about their care and treatment this had been considered in their best interests. People and their relatives told us staff were kind and caring. One person told us, “This is a home from home.” People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner.
People told us there were enough staff on duty to meet their care needs. Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us there were adequate staff on duty to meet people’s care needs. One member of staff told us, “Staffing is better now we have five on in the morning, it’s a really good team here and new staff says we’re friendly.” Another member of staff told us, “We have enough staff and normally finish the personal care by 11.00am. At the moment most are self-caring and mobile and there are only seven rooms that need help. We are there to encourage and supervise. It’s quiet at the moment.”
People told us they had felt involved in making decisions about their care and treatment and felt listened to. Care and support provided was personalised and based on the identified needs of each individual. One person told us, “I like my independence. They always listen to me, I have been here a long time so they know all about me .I tell them I am homeless because I couldn’t live alone at home. They say this is your home and we are your family. It is different care from the hospital when you depend on nurses, it’s free and easy here with no pressure. I leave my room once a day for activities.” People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. People’s healthcare needs were monitored and they had access to health care professionals when they needed to.
People were supported to take part in a range of recreational activities. These were organised in line with peoples’ preferences. Family members and friends continued to play an important role and people spent time with them.
Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They felt they knew people’s care and support needs and were kept informed of any changes. Senior staff used handover notes between shifts which gave them up-to-date information on people’s care needs. They confirmed that they felt valued and supported by the managers, who they described as very approachable. They told us the team worked well together.
People’s nutritional needs had been assessed and they had a selection of choices of dishes to select from at each meal. People said the food was good and plentiful. Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.