Archived: The Chanters

We found the following examples of good practice.

The service had updated their policies and procedures to ensure infection prevention and control (IPC) processes were robust. The front of the service had visible signage to inform visitors of COVID-19 risks. All visitors had their temperatures checked and were asked about symptoms before entering.

The provider had implemented a visitation room which included separate entry points for visitors and people, and both parties were separated with a perspex screen. Personal protective equipment (PPE) was available in the room for visitors and cleaning processes were in place after each visit. Risk assessments had been implemented for each visit,.

The service was working closely with Wigan Council's health protection team where telephone and physical support was regularly provided. The service was conducting regular infection control audits, to ensure IPC processes were robust.

Donning and doffing stations were situated in the service and personal protective equipment (PPE) was available throughout the building. Staff had designated areas to change into their uniforms and staff uniforms were washed on site. All staff had received training in IPC and PPE in relation to COVID-19.

Cleaning regimes and products had been changed to ensure robust processes were in place and that the products were suitable for COVID-19. Cleaning had been increased throughout the service and domestic staff’s hours had been increased by 10 percent.

The Chanters is owned by Larchwood Care Homes (North) Limited and is located in the Atherton area. The Chanters offers accommodation for up to 40 people who require assistance with personal care and support. At the time of the inspection there were 40 people living in the home.

The Chanters 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 this inspection.

There was a registered manager in post. 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.

At our last inspection in May 2016 the home was rated as 'Good' in four domains and overall, but Requires Improvement in the Effective domain because we had identified a breach of the regulations in relation to the use of the building. At this inspection we found this had been responded to fully by the home and significant improvements had been achieved which included, improving the environment for people living with dementia.

The home had effective systems in place to protect people from the risk of harm and abuse. Staff were knowledgeable about how to recognise and respond to concerns. We could see the home had been thorough in investigating and following up all concerns raised.

Staffing levels were calculated and reviewed regularly based on people's needs. We could see staffing had been amended when required. People living in the home and their relatives told us they felt the home was safe. People had been supported to assess and manage the risks in their daily lives while maintaining as much independence as possible.

Medicines were managed safely, some people had been supported to manage their own medicines.

Staff had been recruited safely, all the necessary checks had been completed to ensure staff were suitable to work with vulnerable people.

The building had been well maintained and there were regular cleaning schedules and infection control checks. We found there was a slight odour on the ground floor which we discussed with the registered manager who will address this. We will review this at our next inspection.

New staff received a comprehensive induction programme and regular training. At the time of our inspection the training records were being transferred to a new system and we could not see the most recent training matrix. We will review this at our next inspection.

The home had applied for Deprivation of Liberty Safeguards (DoLS) authorisations when required and had an effective system for ensuring these were up to date. Staff understood the principles of the Mental Capacity Act 2005 (MCA), the importance of supporting decision making and obtaining consent.

People had been supported to maintain all aspects of their health, they had access to health professionals when needed. The home ensured information about health needs and how to support communication had been transferred effectively when people went to hospital.

The home had considered the impact of the environment for people living with dementia. Using an assessment tool from the Kings Fund, The King's Fund is an independent charity working to improve health and care in England. they had devised an action plan and made changes to the lighting, seating areas, flooring and access to the garden. They had also improved signage around the home and encouraged improved nutrition and access to food and drink at all times.

People living in the home said they thought the staff were caring. We observed staff were kind and patient with everyone. Staff asked people before providing any support.

We used the Short observational framework for inspection tool (SOFI) to understand and represent the experience for people who were not able to communicate with us. We found staff were patient and respectful offering reassurance and support to a person who appeared upset. Staff interacted with people when they had time both in relation to care but also more socially.

People received personalised care that was responsive to their needs. Care plans included clear information about how people preferred to be supported. People's needs were reviewed and updated regularly. The home referred people to appropriate professionals such as the dietician when required. We could see other professional's advice had been recorded and followed by the care staff.

There were a variety of activities available inside the home and garden and also trips out to places people wanted to go to, for example a sensory farm and garden centres. The home arranged for entertainers such as singers to perform. Some people preferred not to engage in organised activities and remained in their rooms.

The home had a complaints policy and we could see they had followed this and responded to people's concerns. The home encouraged people's feedback and posted reviews they had received on the internet.

The home's values and culture were displayed in the foyer and included in the service user guide. Staff understood their roles and what was expected of them in relation to providing high quality care. Staff praised the leadership and support provided by the registered manager and the management team.

Regular monitoring and auditing of the care and support people received ensured good standards of care were maintained. We saw how the management team had identified concerns and acted quickly to address them.

Regular team meetings ensured staff were up to date and had an opportunity to share information and learning. Daily handover at each shift change ensured staff were aware of how people were and whether there had been any changes they needed to be aware of.

The home worked with other organisations in the community and with their partners in Wigan Council to improve the quality of the service and care provided.

The Chanters is a purpose built care home, owned and operated by Larchwood Care Homes (North) Limited. The service is registered with the Care Quality Commission (CQC) to provide personal care and accommodation to a maximum of 40 people. Accommodation is provided over two floors and there is lift access. The home is located near to the town centre of Atherton in Wigan, Greater Manchester. Car Parking facilities are available at the front and large gardens are located at the rear of the property.

During this inspection we found one breach of the Health & Social Care Act (Regulated Activities) Regulations 2014. This was because some aspects of the environment did not take account of national best practice and were not being used for the intended purpose. You can see what action we told the provider to take at the back of the full version of the report

We asked people who used the service if they felt safe and they told us they did. We looked to see how the service sought to protect people from abuse and found there were appropriate safeguarding and whistleblowing policies and procedures in place. All the staff we spoke with demonstrated they had a good understanding of the types of abuse and the procedure to follow if they suspected that a person was at risk of, or was being abused.

We asked staff about whistleblowing. All of the staff we spoke with told us they would not hesitate to use the policy and identified internal reporting protocols. Staff also referred to CQC as an external agency they could contact.

We observed a senior member of staff on a medicines round and found peoples’ medicines were given safely and as prescribed. We found safe systems were in place for ordering, storage and disposal of medicines.

Staff induction was robust and included mandatory training, shadowing and access to appropriate policies and procedures. Further training was on-going and staff were encouraged to access training as part of their on-going development.

We looked at care plans to establish that people were receiving the care and support they needed and if any risks to people’s health and wellbeing were being appropriately managed. We found that the care files were large and contained historical information that was no longer reflective of the person’s needs and this made eliciting the current clinical picture difficult. We spoke with the registered manager about this who informed us that a programme of streamlining the files was underway in conjunction with transferring the documentation to the new provider’s format.

We looked in detail at the care records of people living with complex needs. For example, people at a higher risk due to poor nutrition, falls or pressure care. We found that people’s risks were appropriately assessed and managed and that care plans had been updated to reflect people’s changing needs in a timely way.

People who used the service said the food was good and we saw that there was plenty choice. However, we found that people who used the service who were living with a diagnosis of dementia could have been better supported at mealtimes through the use of a pictorial menu. This would help people living with dementia to better understand the food options being presented to them.

During our inspection visit we asked the registered manager whether or not the service worked to a nationally recognised model of dementia care and we were told they did not. We found that some aspects of the service had been improved to enable people who might be confused to orientate themselves but overall the service was not sufficiently dementia friendly.

We looked at the communal areas of the upper floor and found the décor to be worn in parts and traditional in presentation. Storage space on this floor appeared to be limited and we found communal rooms intended for the use of people who used the service being partially used as storage areas. For example, the room used as a hair salon contained filing cabinets and a small communal lounge appeared to be used to store various miscellaneous items. We spoke with the registered manager about this who acknowledged that some areas of the home were not fully utilised in line with their intended purpose and that aesthetic improvements could be made to the upper floor.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a good working knowledge of capacity issues and DoLS.

People who used the service and their relatives felt staff were kind and caring. We observed care and support being delivered during the day and saw that there was a friendly and relaxed atmosphere and interactions between staff and people who used the service were pleasant. Consent was sought for all interventions offered.

Some people were being cared for were nearing the end of their lives and families told us they were impressed by the kindness and compassion of the staff and the home’s commitment to ensuring people’s end of life wishes were respected.

Care and support plans contained person-centred information which detailed people’s likes, dislikes, personal preferences and life and social history. We saw that people who used the service, or their lawful representatives, had been involved in planning and agreeing care.

There was a complaints policy and associated procedure and information about how to make a complaint was available in people’s own rooms and at the entrance to the building. People told us they had no complaints, but were confident any concerns would be dealt with promptly.

The registered manager was very visible within the home and actively involved in the provision of care and support. Throughout the course of the inspection we saw the registered manager walking around and observing and supporting staff.

Audit and quality assurance was completed on a regular basis and covered a wide range of topics. We saw that where internal audits had identified issues, action was taken and lessons learnt.

Staff were able to approach the management at any time for support and assistance.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also used a specialist advisor who assisted us on the day of our inspection.

There are two units at the Chanters which consisted of a residential and dementia unit. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect, dignity and felt safe in the presence of staff.

Safeguarding procedures were in place and staff were able to demonstrate how they would safeguard the people they supported. This meant that people were safeguarded from abuse.

There were systems in place to make sure that the management and staff learned from events such as complaints and concerns. We noted accidents and incidents were also monitored closely however action taken to prevent future re-occurrences was not always clearly recorded. We raised this issue with staff during the inspection.

On the day of our inspection we were told there was nobody currently living at the home who was subject to a Deprivation of Liberty Safeguards. We noted staff had received relevant training in relation to Mental Capacity Act (MCA) and Deprivation Liberty Safeguards (DOLS) and also received regular updates in this area.

We undertook a tour of the premises to ensure they were fit for purpose. We noted there was sufficient disabled access and a passenger lift to enable people with mobility problems to access the second floor of the home.

People who used the service, generally felt there were enough staff on shift to care for them appropriately. One person said; 'I don't think you can ever have enough can you. But the staff make the most of what they have got'.

We found staff recruitment practice was safe and thorough. This included ensuring DBS (Disclosure Barring Service) checks were undertaken and a minimum of two references sought before staff commenced employment.

Is the service effective?

Generally, the people we spoke with felt their care requirements were adhered too and that staff provided an effective service to them. One person told us; 'I think all the girls are very good at what they do. They get the job done and look after me well'.

People's health and care needs were assessed with the people who used the service or their representatives. Special dietary mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible. There were designated 'quiet areas' where people could spend time with their loved ones when they visited the home.

Is the service caring?

We observed people were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. We asked people who lived at The Chanter about their opinions of the care they received. Comments included; 'Very good' and 'I like it here. The staff are nice. They make an effort to spend time with me' and 'I would say the care is good. Nothing bad to say really'.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Whilst speaking with people, we noticed they were well presented and appeared well cared for. Two of the people we spoke with told us they were offered the choice of either a bath or shower and could choose what clothes they wanted to wear.

Is the service responsive?

The home employed an activities co-ordinator. The people we spoke to said activities took place most days. There was a display board at the home with an activities schedule which included bingo, dancing, exercise, entertainment, films and reminiscence. We observed an activity taking place on the afternoon of our inspection and people appeared interested and keen to take part.

People we spoke to were aware of the complaint procedure. On the day of our inspection the home had only one complaint on record which had been responded to appropriately. People can therefore be assured complaints would be investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw evidence of communication and involvement with health professionals such as dieticians, district nurses and general practitioners.

The service had quality assurance systems in place to monitor the quality of the service provided. This was done with use of audits, surveys and the learning from incidents and complaints. Although accidents and incidents were monitored closely, we could not see any records of where action had been taken to avoid repeat incidents and we raised this with the person in charge.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

We saw that staff knew the needs of people using the service. Care plans were based on a comprehensive assessment of risks and needs and were updated regularly. Care plans were signed by people using the service or, where people lacked the capacity to consent, by a relative or an advocate.

A relative said that they, 'have been really pleased with this home.' Another said that care staff were, 'really good,' and that the manager was, 'lovely and really caring.'

We looked at staffing rotas and saw that staff numbers were consistent and we reviewed the training records for all staff. People said there were always enough staff to care for the service users. We found that all staff received appropriate training to care for people using the service, and that it was updated regularly.

We saw that the home had a complaints policy, which was displayed. No written complaints had been made since the current provider took over the home. Issues or complaints raised verbally were documented and responded to appropriately.