Archived: Chalkney House

We spoke with five staff, and ten people using the service. We looked at eight care plans and associated care records. We observed care being provided throughout the day in the three lounges and across lunch time. We identified concerns about how the service was being delivered and managed.

We considered our inspection findings to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? And, is the service well led?

Below is a summary of what we found during our inspection:

Is the service safe?

When we arrived at the service staff asked us for our identification and asked us to sign the visitor's book. This meant that unauthorised access to the service was prevented and people were kept safe.

We found that each person using the service had a care plan which told staff what their needs were and how staff should meet them. However we found that not all care plans had been reviewed or provided clear information on how to meet people's specific needs in a way of their choosing. This would ensure people received personalised care.

Staff training was on-going but we did not see evidence that an assessment of competence was carried out following practical training to ensure that staff could implement what they had learnt. Gaps in staff knowledge, skills and experience was a concern on the day of our inspection because a number of newly employed staff were on duty without clear evidence of how their practices were being overseen by more senior staff on duty. This potentially could place people at increased risk. Not all care staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us this was planned. Staff were clear about how they supported people with day to day decisions but this was not always recorded in people's care plans and we could not always see how people were involved and consulted about their care.

Is it effective?

We found that care was not always effective because some staff did not have the skills or training to meet people's individual needs.

We found that there was a programme of social activities but these were not suited to everyone and did not promote everyone's well-being. Activities were not provided on the day of inspection and our observations told us that staff provided task based rather than individualised care to people.

Is the service caring?

During our inspection we observed some good and poor staff interactions which meant that staff were not always responding consistently to people's needs. We found that some staff were familiar with people's needs but other staff were not. People's care records did not show us how staff were meeting people's needs according to their wishes and preferences, and daily care records were very brief and told us very little about how people's needs were being met.

Is the service responsive?

The service was responsive to people's needs but through our observations we found some people were left to sleep whilst others received a lot of interaction and attention. We found the people closest to the door were frequently responded to and staff did not make time to check the well- being of each person.

We found the service was adequately staffed and staff told us they received regular supervision and training for their role. We observed staff supporting people at meal times and staff appeared to work in a cohesive way. Staff told us they felt supported and said the manager was approachable. The manager told us a new deputy manager was coming into post which would help them enormously. They also had an administrator in post since our last inspection on 14 May 2014 which freed up some of their time to audit the quality of the service provision and make improvements to records.

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? And is the service well-led?

This is what we found:

Is the service safe?

There were sufficient staff on duty on the day of our inspection but no management cover We saw that people in the communal areas received regular supervision to ensure their safety. However the staffing rotas showed fluctuation of staff particularly at night so we could not be assured that staffing levels were always appropriate for the needs of people using the service. A high number of falls and our observations during the day led us to question whether staffing levels were appropriate to keep people as safe as possible, or if the shift was badly organised with team members poorly deployed. People's records did not always tell us what actions staff had taken to keep people safe so it meant risks to people were not always minimised.

Is the service effective?

The care records for people gave a good indication of what their needs were. However, the service was not always identifying when a person's needs had changed and when they had identified it the records did not always reflect a change required. Therefore we could not be sure the service was effectively assessing and monitoring in this area to ensure needs were recognised and appropriate action taken to meet them

Is the service caring?

We saw that staff spoke with people in an appropriate way and were caring in their approach. We spoke with the activities coordinator and observed them encouraging people to join in various social activities to encourage mental stimulation. We saw staff provide appropriate support around mealtimes and go at people's pace which meant their dignity was upheld.

Is the service responsive?

We saw that staff were caring and responsive to people's needs. We saw staff encouraging people to join in different activities. We saw staff provided most people with appropriate support at lunch time and encouragement to eat and drink sufficient to their needs.

Is the service well led?

On the day of inspection the manager was on leave. In the manager's absence senior staff called the provider and managers from other services to assist. They could not produce records we requested or give us the information we needed. This meant we could not see how the service was being effectively managed in the absence of the manager. We looked at records relating to falls, accidents or incidents that had occurred. We could see from a monthly summary what actions the service had taken but not always the outcome of that action, the lessons that had been learned and any changes to ensure practice improved going forward. Records were not up to date and people's care plans did not always reflect the changes in people's needs.

Is the service safe?

When we arrived we were met by staff and signed the visitors book which meant the home had a record of who was in the building. We looked round the home and found no immediate hazards to people's safety and saw that there was a designated person employed to carry out the health and safety checks on the building. We saw that there had been a significant incident recently involving a person who used the service. This had been reported to the appropriate authorities but we do not have the outcome of their investigation. There were systems in place to ensure regular fire drills and tests of fire equipment were made to ensure peoples safety. We identified some room for improvements in terms of the provider's fire risk assessment and contacted the fire safety officer to support the home in improving their policies and procedures.

We saw that people were monitored at regular recorded intervals to ensure their safety and well- being but saw at times of the day vulnerable people were left unsupervised. On the day of our inspection the home was short of staff which potentially could increase risks to people using the service. We saw that the manager had recognised and recorded a change in people's dependency levels and was increasing the number of staff per shift to meet people's needs.

Appropriate measures were in place to ensure the home was hygienic and staff were employed in sufficient numbers to keep the home clean. We saw that the home had taken appropriate action when a recent infection outbreak occurred.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

Is the service effective?

People we spoke with told us their needs were met. The manager and the staff spoken with or observed showed a good understanding of people's needs and acted in accordance with people's wishes. We saw that the home tried hard to find out about the person's life and provide care according to peoples wishes and needs. However we found care records were not always up to date or took into account recent changes in people's needs. We could not see how staff always responded to a change in need or risk because this was not always recorded.

Is the service caring?

We observed some good interaction and staff were kind to people they supported. Staff interacted with people in a caring, respectful and professional manner. People told us that the staff treated them with respect.

Is the service responsive?

We observed people using the service participating in a range of activities which met both individual and group needs. However we were not clear how people with cognitive impairment and dementia had their needs met. Activities took place in communal areas and not everyone was able or wished to join in.

We saw that the complaints procedure was displayed. We saw the manager took appropriate actions to concerns raised but the conclusions were not always recorded. People were given the opportunity to participate in regular meetings and have their ideas acted upon, such as choice of activities within the home.

People's care records showed that people's needs were mostly met and the staff contacted relevant health care professionals to ensure people's health care needs were met.

Is the service well-led?

The home had an experienced registered manager who had support from other registered managers from other homes owned by the same provider. They met regularly to discuss service development. The provider was 'hands on' and supported the manager and carried out regular service audits. However we were not always able to see what actions had been taken as a result of audits or who within the service and management team were responsible for taking forward actions. The audits varied in quality and did not always have sufficient evidence to show how the service was meeting regulation.

We found the manager and deputy roles were at times compromised because of shortages of staff. This meant that the manager was working on shift and covering various roles including ancillary roles. This resulted in some of the paperwork being left. We advised the provider that an administrator for this size of home would be beneficial and that staff roles and responsibilities should be clearly defined to ensure consistency and conformity. Care staff's skills should be developed to enable them to take greater responsibility on shift and be more accountable for record keeping.

The home had a quality assurance system which included sending out surveys to relatives annually but could be improved upon by asking staff and professionals for feedback about what the service does well and where it can improve.

During our visit on the 10 September we spoke with ten people using the service, five staff and two relatives. We observed the care being provided in different units and reviewed a sample of records relating to the management of the business. We found that the service had continued to make improvements but we still identified a number of concerns.

People had an assessment of need before moving to the service. This was used as the basis for a plan of care. However we found evidence that when people's needs had changed staff were not carrying out the required care so we could not be assured people were having their needs fully met.

At the last inspection we found the service was not cleaned to an appropriate standard and there were poor systems in place to monitor the cleanliness of the service. During this inspection the standards of cleanliness had improved and some areas had been refurbished. However standards of hygiene were not maintained throughout the service putting people at risk.

We could not be assured that systems in place to measure and evaluate the quality of the service were effective because of the number of concerns we have identified with this service over a number of inspections.

One person told us, "Social activities have improved and I am happy here, I have a television in my room and a telephone, my family visit regularly and there is a visiting library and exercises." Another person told us about concerns they had. This was raised with the manager and actions were taken by them to safeguard people in their care.

One person told us, "I don't like fatty food and staff don't give it too me. I don't know what's for dinner today. I am well looked after and see the chiropodist and hairdresser regularly." Another person said, "Staff are really nice. There are not many activities but you get used to it, I have friends to talk too." Another person told us "The television is on all day, and no one watches it, if it was turned off staff may get more work done."

We looked at six care plans and found these to contain information about people, but it was not always accurate or centred around people's individual needs.

We looked at six staffing records and these demonstrated the service had good recruitment procedures in place and staff were supported through induction, supervision and training.

We found evidence that the numbers of staff provided was inadequate to meet people's needs because people were not given adequate opportunities to engage in social activities and levels of staff interaction provided to them were poor.

There were systems in place to assess the quality of service being provided, but we could not always see what's actions had been identified as a result of the audits.