Chaston House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found breaches in relation to safe care and treatment and good governance. Medicines were not always safely managed. People received their medicines as prescribed, but records were not always clear. Additionally, the provider had not always disposed of unused medicines correctly. The environment was not always well maintained. Some areas of the building and equipment needed repair. Some areas were cluttered and this presented a risk. Staff did not always follow good infection prevention and control processes. For example, managing soiled laundry. Risks to people's safety and well-being had not always been assessed or planned for. Staff did not always record when things went wrong or the learning from these incidents. The provider had not always ensured records about people or staff were up to date, accurate or complete. The provider had not always ensured the correct authorisations when people were deprived of their liberty. There were enough staff and people felt they received the care and attention they needed. They told us they liked the staff. Staff were well trained and supported. People told us felt safe and knew how to speak up if they had any concerns.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they knew who to speak with if they had concerns. They told us these were addressed. One person told us, ''I have full confidence [that problems are resolved].''

The registered manager told us the staff team discussed things that went wrong. Staff confirmed this.

The staff had not always recorded incidents and accidents. This meant there was not always clear information to learn from these.

People were well supported when they moved to the service and when they accessed other services.

Staff and managers worked closely with external partners to help ensure safe transitions.

External partners told us people were well supported when accessing other services. They explained the registered manager transported them and escorted them to appointments. They also commented the registered manager was proactive at keeping partners updated about people's needs and any hospital admissions.

The staff liaised with health and social care organisations to help make sure people had the support they needed when transitioning between services.

People using the service told us they felt safe.

Managers and staff understood how to recognise and report abuse.

Staff supported people in a safe way.

There were suitable procedures to be followed in the event of abuse. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider did not have up to date or clear information to show the status of DoLS applications and authorisations for some people. Records indicated applications had been made in the past but not been followed up. The registered manager must liaise with the local authority and confirm the status of applications. They also agreed to improve records so this information was clearer.

People were placed at risk because there was not always enough information for staff about safe care and treatments. Some people found it difficult to move around the home because of mobility needs and sight impairments. One person told us they felt isolated at times. The registered manager explained they offered people support to access the stairs if they needed.

Staff told us they had a good knowledge of people's individual needs. They had undertaken training to help them understand how to support people in a safe way, for example when moving around the home.

We saw staff supporting people in a safe way. They were gentle and explained what they were doing to help people feel secure.

Risks had not always been assessed or planned for. Information about potential risks was not detailed enough. There was not enough information about people's individual health conditions, including their mental health. Some people were physically and/or verbally aggressive at times and some people were at risk of harm because they did not understand dangers. These needs had not been assessed or planned for. This meant people were at risk of receiving inappropriate care and treatment.

One person told us their call bell did not work. We noted that call bells were not always placed within people's reach. One person told us the lighting in their room was not adequate and this meant it was hard for them to see and move around. We discussed this with the registered manager who agreed to review the call bells and lighting.

The registered manager told us they were in the process of addressing repairs and renovation within the home.

Areas of the environment and equipment needed repair. In particular there was a broken light fitting in 1 person's bedroom. Some areas needed redecoration. We found some unsafe storage as well as broken equipment and furniture. The boiler room and a shed which contained potentially risky items were not locked and therefore could be accessed by people. Some small upper floor windows were not equipped with restricting devices. The registered manager agreed to address the immediate health and safety risks and explained they would develop a plan to address other areas of concern.

The fire risk assessment needed to be updated. Staff did not always carry out regular checks on fire safety equipment. However, an external company regularly visited and checked fire safety. We noted the fire panel showed a fault. The registered manager told us this had been checked and there was no identified area of concern, although this had not been recorded. The staff had not always carried out checks on health and safety and had not identified areas of concern. For example, the laundry room was cluttered and presented a potential fire risk. The registered manager agreed to address health and safety concerns and started to do this during our visit.

People told us they were cared for by enough staff. They said the staff were kind, well-trained and met their needs. One person commented, ''I do not have any problems if I need help, the staff are always around.''

The registered manager told us they had a full compliment of staff and good staff retention. Staff told us they felt supported and the registered manager worked alongside them.

There were staff available supporting people throughout our visit. People did not have to wait for care. Staff were attentive and interacted well with people.

The registered manager told us about the systems for staff recruitment. However, records did not always evidence checks they said they had made. Records of staff training within individual files were not up to date or clear. The registered manager told us they had regular meetings but records of these were not always available. The registered manager agreed to update the staff records to show when checks had been made. They also agreed to record the reasons why any information (such as references from previous employers) was not available and ensure this had been risk assessed. There were records of staff induction, competency assessments and regular supervision and appraisals with the registered manager.

People were at potential risk because of poor infection control practices within the environment.

The staff told us they had undertaken training around infection prevention and control.

There were potential risks relating to the spread of infection. Fabric towels were used in bathrooms and toilets. Communal use of towels presented a risk of cross infection. There was a malodour in parts of the home. Staff explained that 1 person would not allow them in to clean their room. The risks of this had not been assessed, planned for or mitigated. There was an open bin which contained food and needed to be covered. We discussed these potential risks with the registered manager. The kitchen and equipment were clean and there were appropriate cleaning schedules for food preparation and storage areas.

Some practices were not safe and increased the risk of infection. Staff washed soiled laundry in a shower which was also used by people for washing. There was no sluice at the service. We discussed this with the registered manager and explained they needed to find an alternative arrangement for dealing with soiled laundry. There were good procedures around managing infectious diseases and monitoring people's health.

We observed people being supported with medicines. The staff did this well, following good practice guidance. They explained what they were doing to people.

Staff responsible for administering medicines told us they had received training to understand about safe medicines management. The registered manager assessed their knowledge and competencies.

Medicines belonging to a person who left the service two months before our visit were still stored at the service. These medicines included a controlled drug. A controlled drug is a type of medicine which is subject to strict guidance about recording and storage. The staff had not been monitoring this medicine, told us they were unaware it was still held at the service, and did not keep an up-to-date record to show this was still held at the home. Some records relating to medicines were not clear. For example, there was no guidance for staff around a medicine which had been prescribed with a variable dose. Staff did not record the reasons why some people were administered 'as required' medicines or whether these had the desired effect. There was no information about how to identify when people were in pain for some people who had been prescribed pain relief to be administered when required. We discussed our findings with the registered manager who agreed to rectify these issues.