Archived: Chelmer Valley Care Home

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.

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 that the service had implemented their action plan and establish whether they now met the legal requirements. At this inspection we found that 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 that the rating for the service remains inadequate.

The inspection team 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.

Guide at Broomfield, 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 second floor was closed for refurbishment and the third floor which was designated for use for NHS respite beds was closed to admissions and was empty. People requiring support with nursing needs resided on the ground floor of the building. Whilst one side of this floor was to support people with dementia who also had nursing needs, we found that on both sides people may or may not be living with a dementia illness. 22 people were living on the ground floor at the time of inspection. The first floor of the service was a residential unit, split across two sides to support people who may or may not be living with dementia. At the time of inspection 19 people were living on the first floor. In total, 41 people were living at the service on the day that we inspected.

A registered manager was in place at 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.

Staff had received training in how to safeguard people from the risk of abuse and the registered manager had been pro-active in identifying and reporting safeguarding concerns to keep people safe. However, following our inspection we received information that the provider had not notified the relevant authorities of additional organisational safeguarding concerns. We also found several incidents of poor practice where people were not protected from the risk of harm and additional information was received following our visit that highlighted historical and ongoing poor practices at night.

This was a continued breach of Regulation 13; safeguarding people from the risk of abuse.

Improvements had been made in terms of identifying and managing risks to people. However, information sharing about risks to people was not always accurate. This placed people at risk of harm, such as choking. People were supported to have enough to eat and drink however recording practices around food and fluid intake were inconsistent. This meant it was not possible for the service to have robust oversight of people’s nutrition and hydration requirements.

This was a continued breach of Regulation 12; safe care and treatment.

On the day of inspection there were sufficient numbers of staff available to meet people’s needs as the number of people living at the service had significantly decreased with no reduction in the number of staff on each shift. However, the provider had failed to meet one of the conditions imposed on their registration as was not able to provide a rationale for staffing numbers or demonstrate an awareness of the skill mix and competency of staff and how staff were being deployed. Following on from our site visit the provider also found additional evidence where staff were not appropriately deployed by team leaders at night.

This was a continued breach of Regulation 18; staffing.

There were systems in place to manage people’s medicines safely. We found that the storage, administration and disposal of medicines was undertaken safely.

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

Whilst improvements had been made in terms of monitoring the safety and quality of the service, further work was required to ensure robust oversight of the service at provider level to prevent further breaches of the regulations. An action plan was in place setting out the improvements required to ensure the safety and effectiveness of the service but many of the target dates set for completion of tasks had been missed and had been put back.

This was a continued breach of Regulation 17; good governance.

The provider failed to identify, appropriately acknowledge and adequately address concerns raised to them by staff and professionals entering the home, that contributed to the failings found. They demonstrated a lack of transparency with people living at the home, relatives and staff working at the home, which continued after the inspection in May 2018. The registered provider failed to recognise their own responsibilities to ensure the safety of people living at the home.

This was a breach in Regulation 5; Fit and proper persons: directors.

Lessons had been learned and an action plan developed for a phased re-opening of the third floor. The plan appeared robust in principle with greater consideration given to the planning and risks involved. However, it was not possible to make a judgement on the safety and effectiveness of the proposal as it had not yet been implemented.

Staff reported improvements in terms of improved morale and leadership of the service by the registered manager. The registered manager was ‘hands-on’ working alongside staff coaching them and leading by example. Staff reported feeling more supported and that the visibility of the registered manager and the clinical lead.

The registered manager continued to remain transparent and open about ongoing concerns at the service and alert the provider of concerns as they found. However, there was a disjoin between the registered provider and registered manager, which was not adequately addressed by the registered provider. The provider had expressed concerns about the registered managers ability to lead to the commission, but did not take action swiftly to address these concerns with the registered manager.

Despite some improvements being made the rating for this service remains inadequate and the service therefore remains in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection team inspected the service against two of the five questions we ask about services: is the service safe and is the well led.

Guide at Broomfield, 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 second floor was closed for refurbishment and a third ground floor unit had not been opened to admissions. At the time of inspection 74 people were living at the service.

People requiring support with nursing needs resided on the ground floor of the building. Whilst one side of this floor was to support people with dementia who also had nursing needs, we found that on both sides people may or may not be living with a dementia illness. 30 people were living on the ground floor at the time of inspection.

The first floor of the service was a residential unit, split across two sides to support people who may or may not be living with dementia. At the time of inspection 24 people were living on the first floor.

Lastly, the third floor had opened in January 2018 to accommodate up to 30 people being discharged from Broomfield Hospital. This was for people still requiring assessment and allocation of additional care packages, such as residential care or care at home and re-enablement care. These placements were designed to last for up to 72 hours, although could be longer depending on the availability of the aftercare needed. All 30 beds were being used at the time of inspection.

A registered manager was in place at 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.

We found significant concerns about the safety and welfare of people living at the service on the 2 May 2018, resulting in, multiple breaches of the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. We found staffing at the service was poor and not enough staff were deployed to meet people’s needs. In addition, the staff available did not always demonstrate competencies needed to support people and some were unkind. There was a serious lack of effective leadership and oversight of staff at the service and due to the shortages, staff had not received regular mandatory training and supervision.

People were not always protected from risks of harm or abuse. We found incidents where concerns had been raised by care staff which had not been escalated by senior staff so appropriate actions could be taken. Staff told us they did not know how to report safeguarding concerns and training in this area was poor. Relatives had expressed concerns to the Commission about loved ones being left and neglected when they needed personal care needs met. During the inspection we also observed this happening. In part this was due to lack of staff, effective staff deployment and delegation of duties. Whilst the registered manager had recognised this they were unable to take robust action because they did not have effective resources or time to address it effectively.

The admission processes to ensure all information received by the service from external services did not demonstrated an accurate picture of people’s individual risks, needs, and preferences. Nor were people always discharged from the service with the information needed to support successful placements. The processes in place for admission and discharge were not aligned to National Institute for Health and Care Excellence (NICE) guidance for transferring people between services. Whilst this was especially important for the third floor, we found these concerns across all units. This lack of accurate information about people’s needs resulted in poor care planning that did not address people’s actual risks and placed them at risk of harm.

On the nursing floor more information was available for staff but it did not always reflect people’s current needs. Reviews consisted of staff writing “No change”, despite other care records and observations demonstrating care needs had changed considerably. People were not mentally and socially stimulated and engaged. The culture was task led rather than person centred.

The registered manager had voiced concerns about staffing and new working arrangements with the provider’s directors. Their concerns had not been appropriately addressed to mitigate potential risks to people. Despite the registered manager sharing these concerns the overall systems for governance and oversight did not support them to ensure changes could be made quickly enough to be sustained and embedded.

The provider’s directors failed to mitigate the potential risks identified, whilst continuing to negotiate an additional 10 social care beds for people needing to be discharged from hospital whilst waiting for appropriate care packages. These people were accommodated across the service without adequate planning and consideration of their needs, or the needs of people who were already living permanently at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.