Chirnside House

Chirnside House is a residential care home providing personal care to up to 30 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 19 people using the service.

Chirnside House is one large, adapted building over 2 floors with private bedrooms and many different communal areas, and garden areas outside.

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

The provider did not have governance systems in place to monitor the performance of the service.

The provider did not have robust recruitment systems in place to ensure all staff were fit and proper persons. There were systems in place that had gaps or were outdated.

The provider was being supported by a pharmacist to ensure best practice with medicines administration and some systems were new and not yet embedded.

We found the care demonstrated to be of good quality and feedback from almost all the people we talked with was very positive about everything in the home, stating the care was good, they felt safe, and the home was well managed.

The service was going beyond best practice with regards to infection prevention and control to ensure the safety of people.

The registered manager was transparent when seeking to learn lessons from events that happened in the home to improve the service and embraced a continuous learning approach.

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

The last rating for this service was good (published 16 May 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection looked at the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this report. During the inspection the provider took appropriate action to address the shortfalls and mitigate risks.

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

Enforcement and Recommendations

We have identified 2 breaches and 1 recommendation during our inspection. One breach in relation to fit and proper persons employed and 1 breach regarding good governance. We also identified 1 recommendation regarding following best practice guidance with medication administration to embed the new systems. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

¿ The registered manager had ensured staff could access comprehensive and informative training in various aspects of infection control. Staff confirmed they felt confident in the training and their competency was checked to ensure they were implementing best practice.

¿ The environment had been arranged to minimise the risk of infection and was clean and clutter free.

¿ An area of the home was being developed to support socially distanced visits to take place in the home.

¿ Risk assessments were carried out to minimise the risk and spread of infection.

¿ Processes to minimise the risk of infection were known by staff and carried out to minimise the risk and spread of infection. For example, temperature checks, safe waste disposal and increased cleaning of the home took place. Specialist cleaning equipment had been purchased to help maintain the cleanliness of the home.

¿ Visitors arranged to visit people at the service in advance and handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support safe visits.

¿ Staff supported people to use electronic tablets and telephones to maintain contact with loved ones.

¿ People were supported to access health professional advice through the use of electronic tablets and secure email, care records were updated to reflect the advice.

¿ Covid 19 policies and risk assessments were available and known by staff. Staff told us they felt safe as the service was following best practice to minimise the risk and spread of infection and appropriate PPE was provided.

¿ The service was taking part in the whole home testing process. People at the home were supported to decide if they wanted to participate. If people were unable to make this decision for themselves, best interest discussions were held with relatives and documented.

¿ Appropriate signage was displayed throughout the home to promote best practice.

¿ Policies and procedures were reviewed against best practice guidance as this became available.

Chirnside House 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. Chirnside House is situated on the outskirts of Lancaster and close to local amenities. The home has communal areas which consist of dining rooms and lounges. There is also a garden area for people to enjoy. There is parking available at the home.

At our last inspection in April 2016 the home was rated ‘Good.’ At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required. We found some medicines were not dated on opening. We have made a recommendation regarding the implementation of best practice guidance in relation to medicines.

The registered manager completed a series of checks to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these. We noted some of the audits were not documented, therefore action plans were not developed. We have made a recommendation regarding improving the audit recording process.

Staff were able to explain the support individuals required and the way in which they supported people who lived at the home. Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found two care records required updating. Prior to the inspection concluding we were informed this had been carried out.

Staff were knowledgeable of people’s needs and the support they required to maintain their safety. People who lived at Chirnside Hall told us they felt safe.

We found people had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Chirnside House.

We found people who received support were able to raise their views on the service. People and relatives consistently told us they were asked their views on an individual basis. In addition, ‘residents meetings’ were held where people at the home were able to be informed of changes and give their opinion on the service provided.

During the inspection we observed people being supported to eat and drink in accordance with their assessed needs. People told us they were happy with the meals provided and we saw staff were attentive and discreetly observant when people were eating their meals.

We found the environment was clean and staff wore protective clothing when required. This minimised the risk and spread of infection.

Staff told us they were aware of the procedures to follow if they suspected someone was at risk of harm or abuse. Staff told us they would report any concerns to the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was accessible to people who lived at the home. People told us they had no complaints, but they were confident the registered manager and staff would respond to any complaints made.

Recruitment checks were carried out to ensure suitable people were employed to work at the home and staff told us they valued the training they received to enable them to fulfil their roles.

We found staff were caring. We observed warm and respectful interactions between staff and people and who lived at the home. We saw staff had time to spend with people and staffing was arranged to ensure people received support when they needed or wanted it.

We noted an activities schedule was displayed at Chirnside House and people told us they were invited to take part in these. People also said if they did not wish to take part in activities, their wishes were respected.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. Staff were able to give examples of how they supported people to make decisions. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Further information is in the detailed findings below.

Abbeyfield Lancaster Society Limited is a registered society and an exempt charity for tax purposes. The society owns a home on the outskirts of Lancaster. Chirnside House is registered to provide personal care and accommodation for up to 30 older people who may be living with dementia. Accommodation is provided over two floors, with a lift providing access to the first floor. There are a range of communal rooms, comprising of a lounges, dining rooms and kitchen areas. There are garden areas with seating for people to use. Car parking is available at the home. At the time of the inspection there were 29 people living at the home.

The home is managed by a registered manager. A registered manager has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were happy living at Chirnside House and the care met their individual needs. We were told, “I advise people to come here. It’s a superb home.” And, “I’m more than satisfied with everything here. I’m looked after very well.” People described staff as ‘very kind’ and ‘the salt of the earth’ and told us they were involved in their care planning.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document measures required to reduce risk. Staff were knowledgeable of the measures and we observed these were followed these to ensure people’s safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner. We found medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. At the time of the inspection we found some gaps in the training records of staff. The registered manager informed us documentation was not available to evidence the training staff had undertaken, therefore further training was being planned. We have made a recommendation regarding this.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We found people were offered a variety of foods and people told us they liked the meals at Chirnside House.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. During the inspection we spoke with three external health professionals who voiced no concerns with the care provided.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we noted people were supported to carry out activities which were meaningful to them.

There was a complaints policy which was understood by staff. Information on the complaints procedure was available in the dining room of the home.

We found systems were in place to identify if improvements were required. Quality assurance checks were carried out to monitor the service provided.

People who lived at the home were offered the opportunity to complete surveys and meetings were available for people to participate in. People and relatives also told us they found the registered manager approachable if they wished to discuss any matters with them.

The summery is based on our observations during the inspection. We spoke individually with four people living at the home, two relatives, a senior carer, a care worker, the laundry assistant, a member of the domestic staff team and the registered manager.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us that they felt safe and secure. From our observations it was clear that people were relaxed and comfortable living at the home. We saw that people were treated with respect and dignity by the staff team and their rights protected.

The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards although no application had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

We looked at the recruitment of new staff. This showed that people had only started working at the home, after all the necessary checks and clearances had been obtained and deemed to be satisfactory. This helped to ensure that people were not put at risk.

Is the service effective?

There was an advocacy service available if people needed it. This meant that when required, people could access additional support.

People told us that they were very pleased with the level of care that was being delivered to them and that their assessed needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated. A relative told us, 'They cater for individual needs and to a high spec, they know my mum, I can tell. She is happy here'.

Care needs had been assessed and people had been involved, as far as they wished or were able, in writing their plans of care. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, most had been signed by the person or a close relative, to confirm their understanding and agreement to the content. People's preferences, interests, aspirations and diverse needs had been recorded and care and support provided in accordance with people's wishes.

The visitors we spoke with confirmed that that were able to see people in private and at a time of their choice. The relatives we spoke with also said that they had good communication with the staff team and were always informed of any changes or concerns.

Is the service caring?

People were supported by kind and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. A relative told us, 'They (the staff) are fantastic I could not fault them at all'. A person living at the home said, 'They (the staff) are very nice people, very good. I am alright here, it is homely'.

People using the service, their relatives and friends and other interested people had been given opportunity to complete a satisfaction questionnaire that was freely available in a communal area of the home. We saw this covered a wide range of issues. The registered manager explained that if any comments, concerns or complements were highlighted, outcomes would be analysed and evaluated. Action would then be taken to address any concerns, where at all possible. However we were also told that very few questionnaires were actually completed and returned. People preferred to speak directly with the registered manager. A person living at the home and the relatives spoken with confirmed this.

Is the service responsive?

People said that they knew how to make a complaint if they were unhappy about anything. Although no formal complaint had been made for quite some time, documents were available to record the complaint, the name of the person making the complaint, the process of investigation and the outcome. We saw that there was an 'open door' policy with people expressing their views, or queries as they arose. This meant that any concern or query could be dealt with immediately. People living at the home and the relatives we spoke with confirmed this to be the case.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's preferences. This helped to ensure that people were provided with an individualised service that met their specific requirements.

Is the service well-led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. Records were kept of all health professional visits in respect of each person, which included the reason for the visit and the outcome.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a consistent service at all times.

Staff also told us that they felt very well supported by the registered manager and that they had opportunity to have their say that helped influence change. We were also told that the staff team worked well together for the benefit of the people living at the home. We saw that the staff team was stable meaning that people living at the home were cared for and supported by staff who knew them well.

A range of routine audits were in place including care reviews and fire safety. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

People told us what it was like to live at Chirnside. They described how they were treated by staff and their involvement in making choices and decisions about their care. People also told us how they had access to a range of care and support services and how they made their views known about the quality of care delivered. This was because the inspection focused on these important topics along with what systems were in place. This enabled people to raise concerns and complaints as well as making comments.

People spoke positively of the care they received and described staff as, 'Very kind and caring'. One relative told us, 'Staff are very helpful. They are always around when we visit. Nothing is too much trouble'. One person living at the home said, 'I really do like it here, I can do my own thing it really has given me a good life'.

We were shown around the building and checked maintenance records for fire, water, gas, equipment and electrical safety. People we spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, 'I have everything I need in here its home from home'.

People were seen to be cared for in ways that suited them. Those we spoke with told us that they were involved in the planning of their own care. We saw that people were given opportunities to inform staff of their personal support requirements. Staff were found to be involved in assessing people's needs, and there were systems in place to monitor how those needs were met. We observed some of the staff working alongside people in positive ways. People living at the home told us that they felt safe. One person said that staff were always there when you needed them. One visitor we spoke with thought the home had a good number of staff on duty who were, 'very courteous'. One person told us, "I call in at different times and it is always the same, very relaxed with staff around.' Another person said, 'We are very well looked after.'