Chaston House Care Home

Chaston House Care Home is a residential care home providing personal care for up to 11 people aged 65 and over. At the time of our inspection, there were six people using the service.

People’s experience of using this service and what we found

Although there were risk assessments and support plans in place, not all risks to people’s safety and wellbeing had been identified and mitigated. People told us they felt safe; however, the systems in place did not always protect people from avoidable harm.

Health and safety checks were irregular, and some had not been carried out for several months. There were discarded items piled up in two areas of the garden which posed a safety risk to people.

People’s medicines were not always managed safely and we found discrepancies which had not been identified by the provider’s audits.

People’s needs were assessed but records of assessments were basic and lacked information. Care plans did not always indicate people were consulted in relation to how they wanted their care and support and some people could not remember if they had participated in the planning of their care.

We saw people taking part in activities on the day of our inspection. However, there was no activity board or individual activity plans for people who used the service, so we could not be sure their needs in this area were being met.

The provider’s quality monitoring systems were not always effective as they had failed to identify the shortfalls we found during our inspection and had not always ensured people were safe.

People using the service were happy with the care they received. They told us staff were kind and listened to them. Feedback from external professionals was positive and indicated people’s needs were met. People had access to healthcare services when needed and the staff communicated well with healthcare professionals to meet people’s needs.

The home was clean and some improvements to the décor had taken place. Further improvements were planned. There were robust procedures for preventing and controlling infection, and the staff followed these.

There was enough suitable staff who were trained and supported so they knew how to care for people. The registered manager regularly assessed staff competencies and skills. Staff received regular supervision.

There were systems for identifying, investigating and responding to complaints, accidents, incidents and safeguarding alerts.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after that inspection to show what they would do and by when to improve. We undertook a focused inspection on 4 November 2020 and found improvements had been made and the provider was no longer in breach of regulation 12 but remained in breach of regulation 17. At that inspection, we did not inspect the key questions effective, caring and responsive so we were unable to check if the provider has met the breaches of regulations 9 and 10. The service has been rated requires improvement or inadequate for the last three consecutive inspections.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chaston House Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chaston House Care Home is a residential care home providing person care for up to 11 people aged 65 and over. At the time of our inspection, there were eight people using the service.

People’s experience of using this service and what we found

Risks to people's health and wellbeing were assessed, and there were guidelines for staff to follow to deliver safe care to people who used the service. This included risks in relation to COVID-19. However, one person did not have a risk assessment in place.

Systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements had developed but further improvements were required to address the issues we found during our inspection.

Although there was evidence that safety checks were taking place, some had not been recorded since September 2020.

People were not always supported to be involved in meetings and decisions about home improvements.

There were systems in place to protect people from the risk of infection and cross contamination and staff had received appropriate training in this. There were good measures in place in relation to COVID-19 but staff did not always adhere to guidelines. For example, they did not take our temperature or check if we had symptoms of COVID-19 or had been in contact with anyone who did. Also, the layout of the home made it difficult for staff and people to observe social distancing.

We discussed the above areas of concern with the registered manager who agreed to address these.

People’s needs were met. The provider sought advice from external professionals where people’s needs required this. Staff followed instructions from them and took prompt actions as advised.

There was a policy and procedure for the recording of incidents and accidents. There had not been any incidents or accidents since our last inspection. Lessons were learned when things went wrong.

Staff were recruited safely and there was a full care staff team in place.

Staff felt supported by the registered manager and said they worked well together. Staff meetings had not always taken place regularly due to staff absence. However, staff felt they could approach the registered manager and issues raised were being addressed consistently.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12 but remained in breach of regulation 17. We did not inspect the key questions effective, caring and responsive so we are unable to check if the provider has met the breaches of regulations 9 and 10.

This service has been in Special Measures since 17 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chaston House Care Home is a residential care home providing personal care to up to 11 people aged 65 and over. At the time of the inspection, there were nine people using the service.

People’s experience of using this service and what we found

At our last inspection on 24 January 2019, we issued a breach of Regulation 19 because the provider had not sought references for some staff employed by the service and had relied on previous employers’ checks. At this inspection, we found improvements had been made in relation to this. However, we found other areas of concern.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Risk assessments and support plans were inadequate and did not support staff to ensure people received safe care. People told us they felt safe; however, the systems in place did not always protect people from avoidable harm. There was no learning from incidents and accidents and people were not always protected from the risk of reoccurrence. People were not protected from the risk of infection and cross contamination. Staff did not always follow the provider’s health and safety and fire policy and procedures and there were significant safety risks identified during our inspection.

The provider did not always ensure there were sufficient staff to meet people's needs. This increased the risk of people's needs not being met in a timely way and placed people at risk of harm.

People were not always treated in a kind and dignified manner. The staff worked in a task-focussed manner and did not always meet people’s needs or consult them in relation to what they wanted to do. Staff did not always know people as individuals and were not always aware of their needs. People’s communication needs were not always met.

Care plans were not person-centred, were inconsistent and did not always guide staff to provide person-centred care. People were at risk of social isolation and did not engage in community activities. There were few activities taking place, and the activities on offer did not meet people’s needs. The environment and activities had not been developed to meet the needs of people living with dementia.

The provider’s quality monitoring systems were inadequate as they had failed to identify the shortfalls we found during our inspection and had not ensured people were always kept safe. We found the service failed to demonstrate they were providing care and support that was safe, caring, effective or responsive. This put people at risk of harm.

Overall people received their medicines as prescribed. However, staff did not always follow the provider’s medicines policy in relation to medicines to be given ‘as required’.

People’s healthcare and nutritional needs were met, although mealtime was not always a positive experience for people who used the service.

Staff were supervised and received an induction and relevant training to help ensure they could provide effective care.

The provider acted in accordance with the requirements of the MCA. The service worked well with other health and social care professionals who spoke well of them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 March 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, dignity and respect and good governance at this inspection. We also issued two recommendations in relation to the environment and the management of medicines.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service:

People were happy with the service they received at Chaston House. One person said, “You get exactly the care you need when you need it.”

During this inspection we found one breach of regulations. This was because recruitment practices were inconsistent. There was a lack of references for some staff as well as a reliance on former employer’s criminal checks on staff.

There were discrepancies with the recording of safeguarding incidents, however, staff knew what to do if they suspected abuse. There was enough staff in place. People were risk assessed to ensure their needs were met safely. Medicines were administered safely. There were infection control measures in place. Lessons were learned when things went wrong.

People’s needs were assessed. Staff received training how to do their jobs. Staff told us they received induction and supervision. People enjoyed the food they were provided and were supported to eat and drink healthily. The service was adapted to meet people’s needs. People were supported with their healthcare needs. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and their relatives told us they were treated well. Staff understood equality and diversity. People could express their views and be involved with choices around their care and treatment. People told us their privacy and dignity was respected and their independence promoted.

People’s care plans recorded their needs and staff understood these needs. People participated in activities within the home. People were able to make complaints and when doing so these were responded to appropriately by the service. The service worked with people who were at the end of their lives and respected their wishes.

People told us they thought highly of the management team, however, we had concerns around the overall managerial oversight and felt improvements could be made to aspects of the service. The registered manager told us about changes they had made and those they wished to make. The service completed audits to monitor the safety and care of people using the service. The service had links with other agencies.

Rating at last inspection: At the last inspection the service was rated Good. (report published on 27 July 2016)

Why we inspected: This was a planned inspection

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Chaston House is owned by Chaston House Limited. Chaston House offers accommodation and personal care for up to 11 older people. There were seven single rooms and two shared rooms. At the time of our inspection, 11 people were living at the service, nine of whom were living with the experience of dementia.

There was a registered manager in post who had been managing the service for the past eight years. 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.

Areas of the home were in need of upgrading and redecoration. Some carpets were stained and worn, flooring was damaged in one of the bathrooms, and there was a malodour in the main lounge on the first day of our inspection. We have made a recommendation for the provider to address this. The home was clean and tidy and free of hazards.

A range of activities were provided at the home, and we saw a program of activities displayed. However, we saw very few activities organised on both days of our inspection.

Medicines were stored securely and staff followed the procedure for recording and safe administration of medicines. Staff received training in the administration of medicines, and this was refreshed annually. The registered manager undertook regular audits of medicines.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training and demonstrated a good knowledge of safeguarding adults.

Recruitment records were thorough and complete and the provider had ensured that staff had a Disclosure and Barring Service (DBS) check prior to starting work.

The registered manager told us that some of the people living at the service had mild dementia, and there were no restrictions in place at present but they told us that they would refer people to the local authority if they were aware that a person was losing the capacity to make their own decisions about their care and treatment.

People’s capacity to make decisions about their care and treatment had been assessed. Staff had undertaken training about the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS).

Staff received regular supervision and an annual appraisal, and told us they felt supported by their manager. There were regular staff meetings and meetings with people and their relatives.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

There was a complaints process in place and people told us they knew who to complain to if they had a problem. People and their relatives were sent questionnaires to gain their feedback on the quality of the care provided.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care. Relatives and professionals we spoke with confirmed this.

We saw people being cared for in a calm and patient manner. There was a relaxed, unrushed atmosphere which facilitated good communication between staff and people using the service.

People gave positive feedback about the food and we observed people being offered choice at the point of service. People had nutritional assessments in place. People had access to healthcare professionals as they needed, and the visits were recorded in their care plans.

During the inspection, we saw that people were consulted and consent to their care and support was obtained verbally. We saw evidence in people’s care records that they had consented to their care and treatment.

Care plans we looked at were signed by people, and there was evidence that people were involved in regular reviews of their care.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Care plans contained assessments of people’s needs and information on how care was to be provided. Care plans contained information about people’s daily routines and preferences.

People living at the home, their relatives and other stakeholders told us that the registered manager was approachable and supportive. They encouraged an open and transparent culture within the service. People and their relatives were supported to raise concerns and make suggestions about where improvements could be made.

The provider had systems in place to monitor the quality of the service and ensure that areas of improvements were identified and addressed.

During this inspection we spoke with the manager, three other members of staff and spoke with two people who use the service. The people who use the service had complex needs which meant they were unable to share their experiences with us. We found that steps had been taken to involve people and/or their representatives in care planning and the cameras that were previously installed in the communal areas of the home had been removed.

We found that care plans and risk assessments had been reviewed and updated to contain more detailed information about people's needs and how staff should meet these. However, some of the information was not personalised and did not include people's likes and dislikes.

Adequate arrangements were in place to ensure that people using the service were protected from abuse.

Systems had been implemented to ensure that staff received regular supervision and annual appraisals to assess their performance and identify training and development needs.

The records we viewed were generally up to date, in good order and could be located promptly.

We observed some positive interactions between staff and the people using the service. We observed the lunchtime meal and saw staff talking with people and assisting them in a sensitive manner and offering them choices. The people we spoke with were positive about the staff and one person said, "staff are lovely" whilst another told us, "they're pretty good."

We saw that staff had attended recent training provided by the local authority in areas such as food hygiene, dealing with challenging behaviour, nutrition and dementia, mental capacity and therapeutic activities. The staff we spoke with said that there had been a lot of training offered in the last few months and that this had supported them in their role.

We found that people and/or their representatives were not always involved in planning their care and people's privacy and dignity was not always respected. We also found that people's needs had not been adequately assessed and care plans were incomplete and therefore did not fully inform staff about how to meet people's needs. Identified risks were not being appropriately managed.

The service had inadequate systems in place to ensure that people were protected from abuse.

Not all staff were receiving regular supervision to ensure they received adequate support in terms of their performance and development.

There were gaps in the records kept by the service and not all records could be promptly located when required.