Archived: Chelmer Valley Care Home

Updated 11 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 02 August 2018 and was unannounced

The inspection team consisted of four inspectors. Before we carried out the inspection we reviewed the action plan that had been submitted by the provider so we could check on the progress made about making the necessary improvements to ensure people’s safety.

Before the inspection we had been in contact with a representative from the local authority safeguarding team. They told us about concerns they had identified during their visit.

During our inspection visit we spoke to two visiting relatives. We spoke with 13 staff including senior staff, agency workers and nurses, the quality lead and the nominated individual.

We reviewed nine people’s care plans and used this information to case track people’s care needs, observing the care they received, checking their daily records and staff knowledge to ensure the care people were receiving matched their assessed needs. We also checked documentation that was relevant to the management of the service including quality assurance and monitoring systems

Updated 11 October 2018

We previously carried out an unannounced focused inspection of Chelmer Valley Care Home on the 02 May 2018. We carried out this inspection due to significant concerns raised about the safety of people living at the service. These concerns included insufficient staffing, people were not being supported by staff with adequate training and competencies and a lack of effective leadership and oversight of staff at the service. We inspected against two of the five questions we ask about services, is it safe and is it well led. During the inspection we found breaches of Regulation 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as inadequate in both domains and was placed in special measures.

Due to the high level of concerns we found, we imposed conditions on the providers registration restricting admissions and requiring the provider demonstrate to us how they would address the failings we had identified.

Following on from our inspection the provider sent us an action plan, which set out what they would do to meet the legal requirements in relation to the breaches and to improve the service.

On 18 June 2018 we undertook a further inspection to check the service had implemented their action plan and establish whether they now met the legal requirements. At this inspection we found whilst there had been some improvements there were still ongoing issues of concern resulting in continued breaches of regulations 12 and 13,17 and 18 and an additional breach of Regulation 5. This meant the rating for the service remained inadequate.

On the 02 August 2018 we carried out a further focused inspection following concerns identified to us by the local authority which included concerns related to staffing, pressure care, people waiting too long for personal care, people being moved without consultation, safeguarding concerns not being reported to the appropriate authorities and medicines management.

We again re- inspected the service against two of the five questions we ask about services: is the service safe and is service the well led. Whilst some improvements were found further improvements were identified resulting in continued breaches of regulation 12, 17 and 5.

Chelmer Valley is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service accommodates up to 140 people in one adapted building across five separate units, each of which have separate adapted facilities. At the time of inspection, the third floor which was designated for use for NHS respite beds was closed to admissions and was empty. People requiring support with dementia nursing needs resided on the ground floor of the building. 26 people were living on the ground floor at the time of inspection. The first floor of the service was a residential unit. At the time of inspection 16 people were living on the first floor. In total, 42 people were living at the service on the day we inspected.

On the day of the inspection the registered manager was not available. 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.

We were informed by the local authority that they had identified some concerns in relation to failing to report safeguarding concerns, lack of staffing, people being moved to the nursing unit without consultation and medicine management.

Staff had received training in how to safeguard people from the risk of abuse. We discussed the concerns identified by the safeguarding team and the provider told us this had been an oversight and these were subsequently reported.

Prior to the inspection the local authority informed us people were being moved without the appropriate consultation in place. This was because people’s needs had increased so they were being moved to the nursing unit. We found appropriate consultation had taken place with people or their representatives.

Prior to the inspection we had received concerns around staff competency in medicine management from external social care professionals. At this inspection we identified the provider had processes in place to manage medicines but found some improvements were required.

At our previous focused inspection in May 2018 we found staff did not have access to the information required to support people who were vulnerable and at risk. During a focused inspection in June 2018 we found some improvements but were still concerned that the overview in care plans was not being updated adequately with information required in relation to risk. At this inspection we found some improvements in terms of risk, however additional improvements were still required.

Concerns were also raised by the local authority with regard to people waiting too long for personal care and assistance with eating and drinking, and staff were not deployed effectively to meet these needs. At this inspection we found staff were deployed effectively to meet people’s needs, staff told us staffing had recently increased which had helped.

At our last focused inspection in June 2018 we recommended the provider review it’s systems and processes for recording and monitoring the food and fluid intake of people at risk. At this inspection we noted some improvements in this area and that documentation recorded people’s intake and output appropriately.

Staff understood the importance of good infection control practices. We observed staff using protective gloves and aprons and actively hand-washing before providing care and support to people to prevent the spread of infection.

Whilst improvements had been made in terms of monitoring the safety and quality of the service, an interim manager was new in post so people that used the service and staff were not clear about the changes to senior staff that had taken place and how this might impact on staff morale and the day to day running of the service.

We have therefore also made a recommendation that the service makes improvements to identify how people using the service and staff are involved and engaged in the running of the service.

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The provider had independently sourced the services of a crisis management company to take over the day to day leadership of the service. Whilst we noted some improvements had been made we were not assured about the sustainability of these improvements and the service will therefore remain in special measures. We were however assured that the service appeared to be moving in the right direction but required more time to evidence this.