Chase Lodge Care Home

Chase Lodge Care Home is a residential service providing personal care for up to 21 people with mental health support needs. The service consists of one adapted building, which includes individual bedrooms and communal spaces and an accessible garden. At the time of our inspection there were 18 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

The service did not always provide people with care and support in a safe environment. 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. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that promoted their independence.

Right Care:

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. The service had plans and guidance to support people with their individual risks.

Right Culture:

Systems were in place to monitor the quality of the service to people. However, quality assurance systems were not always effective at identifying and resolving issues within the service. People received consistent care from staff who knew them well. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people's views. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 requires improvement (published 23 October 2020) and there was a 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 we found the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected

We carried out an announced comprehensive inspection of this service on 3 and 4 September 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staff recruitment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified a breach in relation to safe care and treatment at this inspection. We have made a recommendation regarding management oversight. 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.

Chase Lodge Care Lodge is a residential care home providing personal and nursing care to 20 people at the time of the inspection. The service can support up to 21 people in one converted property.

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

We found shortfalls in safe recruitment of staff; this was a breach of regulation.

Since the last inspection the provider had invested in the fabric of the building and the environment was greatly improved. The environment was now clean and smelt fresh throughout. The provider had refurbished most areas of the service with plans to improve other areas.

People living at the service were complimentary about the registered manager and staff. They said they liked living at Chase Lodge and liked their bedrooms. People received individualised care which respected their preferences. Care plans were now of a high standard and contained accurate information about people’s needs.

There were systems and processes in place to safeguard people from abuse. Medicines were stored and administered safely. Staff followed infection control procedures and there was a cleaner employed at the service. When incidents had occurred, these were analysed and measures put in place to prevent recurrence.

People now had access to a range of activities. During the Covid-19 restrictions further activities had been introduced to help support people who usually went out regularly. As restrictions were relaxed staff worked with people to help them understand what was happening and what the rules were.

People’s rooms had been refurbished and they had been involved in deciding colour schemes and other decorations. People were able to personalise their rooms as much or as little as they wished. Staff had encouraged people to discuss their wishes for the future and any arrangements for the end-of-life they may have.

There was now an effective governance system in place. The registered manager had a good oversight of the quality of the service being delivered. There was a system in place to monitor supervision and training and to take action on any staff performance issues.

All of the breaches from the previous inspection had been met, however we identified a shortfall in safe recruiting. We identified a shortfall in the recording of water temperatures in people’s taps, however the registered manager took action to rectify this on the day of inspection.

Staff morale was good and we heard comments about the improvements within the service and management team from both staff and people living at the service.

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 04 December 2019) 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 those regulations.

This service has been in Special Measures since 03 December 2019. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contained those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe recruitment of staff 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 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.

Chase Lodge Care Home is a residential care home. The care service accommodates up to 21 people in one building. At the time of our inspection 20 people were living at Chase Lodge Care Home. However, one person was in hospital. The service specialises in providing care to people living with complex mental health needs.

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

People did not receive their medicines safely and were not protected fully from the risk of infection. We had identified this at the last inspection, however improvements had not been made. Risks from uncovered radiators had not been identified and assessed. People told us they felt safe at the service. Staff understood how to keep people safe and what to do if they suspected abuse.

The environment was poorly maintained. Bedrooms, some beds, ensuite bathrooms, and some carpets in communal areas were in need of redecoration or replacement. The shortfalls had been identified but action was not taken for several months and the majority of actions were still outstanding. People’s care needs were not always assessed effectively although staff were aware of their needs. Staff had not all received the necessary training and had not received regular supervision. The service worked within the Mental Capacity Act but recording of capacity assessments was of poor quality. We have made a recommendation about this. People were positive about meals at the service.

People were very complimentary about the staff and the care they received, however the poor quality of the environment had an impact on people’s dignity. Staff respected people’s privacy, always knocking on doors and seeking permission to enter. Staff understood how people’s mental health could impact on their daily lives. People were able to express preferences for care and support and this was respected.

The provider had implemented a new electronic care records, however these records contained insufficient information about people’s care needs, history and preferences. Care plans were not person-centred and failed to reflect individual care needs. At the last inspection we found people had limited access to activities and this has not improved. There was one notable piece of person-centred work which had a significant impact on improving one person’s quality of life.

At the last inspection we found five breaches of regulation and these breaches had not been met. Whilst there was a more organised governance structure and audits had been introduced, these did not always result in quality improvement, which included management of medicines, the environment and the quality of records in the new electronic care records system. Staff told us the registered manager was open and approachable. The service met their responsibilities under the Duty of Candour regulations.

People were supported to have choice and control of their lives, people were able to come and go freely and choose how and where they spent their time.

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 requires improvement (published 18 October 2018) 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 not enough improvement had 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 individualised care, staff training and supervision, cleanliness and quality of the environment and the management of the service 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 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.

Chase Lodge Care Home 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. The care service accommodates up to 21 people. At the time of our inspection 21 people were living at Chase Lodge Care Home, however two people were currently in hospital. The service specialises in providing care to people living with complex mental health needs.

At the time of our inspection there was a registered manager in post. 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.

Appropriate governance arrangements were not in in place to monitor and improve the service. Errors we found during our inspection had not been identified when the limited audits in use had been applied to the service. There was no evidence of the provider or registered manager regularly auditing the service.

We found there were unsafe practices in managing the administration, storage and disposal of people's medicines.

People were sometimes put a risk of unsafe care as records were out of date or inaccurate. We found the involvement of people in the service was limited. Whilst there had been ‘Residents’ meetings, there had been no surveys for people or staff to complete about how the service was run.

The provider did not have an effective system to review incident and accident records and therefore could not always identify actions to reduce potential risks to people using the service.

Risk assessments were not updated when there was a change in the person's support needs. The provider had a range of audits in place but some of these were not effective and did not provide appropriate information to enable them to identify any issues with the service and act to make improvements.

Staff had not been supported with regular supervision and appraisals. There had been no regular meetings for staff.

During our inspection, we found that the service needed tidying, decorating and some repairs were required especially in the bathrooms. Some infection control practices around laundry procedures needed to be addressed.

We found there were few up to date mental capacity assessments in people’s files. This meant the provider did not always meet the requirements of the Mental Capacity Act.

Most of the people we observed spent long periods of time watching the tv, either in their rooms or in one of the lounges. We did not observe people engaged with meaningful activities

Staff employed in the making of meals knew what food people liked to eat. The kitchen was clean with daily, weekly and deep clean practices in place.

People positive comments to us about the caring nature of the staff. Staff protected people's privacy .

People confirmed there were sufficient staff to meet their needs. There were systems in place to safeguard people from abuse and the recruitment of staff was safely completed to make sure that they were suitable to work in the service. Staff were aware of their responsibilities and knew how to report any concerns.

The registered manager was experienced and was supported in their role by the provider. People who used the service and staff described the registered manager as approachable and supportive. The provider worked in partnership with other relevant agencies to assist in meeting people's needs. Staff understood about the need for confidentiality. Records were locked away and were inaccessible to other people.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection was carried out by one inspector, and one expert by experience. Chase Lodge Care Home provides care and support for up to 21 adults with mental health needs. Accommodation is provided in a large house and a four bedded annexe. They also provide support to one person who lives independently in their own flat.

On the day of our inspection 21 people were using the service. There was a registered manger in post. 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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

Effective recruitment processes were in place and followed by the service.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received a comprehensive induction process and ongoing training. They were well supported by the registered manager and senior carers and had regular one to one time for supervisions.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professional when required, including dentist, opticians and doctors.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well.

People and relatives where appropriate, were involved in the planning of their care and support.

People's privacy and dignity was maintained at all times.

People were supported to follow their interests.

A complaints procedure was in place and accessible to all. People knew how to complain.

There were some quality audits in place to ensure that people were kept safe and received a quality service. However not all audits were used effectively to make changes in a timely way.

We met with the manager and looked at medication records to gauge what improvements had been made. We did not speak with people who lived at the home on this occasion.

At this inspection we looked at the medication administration records for everyone who lived at the home. These gave evidence that improvements had been made in the recording of medication which ensured that potential risks to people were minimised.

All medication was administered by staff who had received specific training and been assessed as competent. The manager informed us that six members of staff had completed additional training in the administration of medication in October last year. We saw certificates of attendance to confirm this. Further training in the safe administration of medicines was booked for all staff before the home changed its pharmacy supplier next month.

We looked at people's individual files which incorporated their personal and social profile, care plans and risk assessments and found that they encompassed the safety and well-being of people who use the service.

Training records showed that staff had received all relevant training. We noted that staff supervision had not been conducted for 2013 and although annual appraisals were in place they were irregular and not reflected on the records that we looked at.

People who use the service told us that they knew how to raise a concern or complaints and felt confident in doing. They said if they had any issues or concerns they could "tell staff" or speak to their key-worker.

We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service.

People's needs were assessed with care plans written to meet those needs. We found that people's care plans were implemented and reviewed. The provider had in place a system for risk assessment and management to deal with foreseeable emergencies.

The provider had policies and procedures for safeguarding and staff were trained and knowledgeable regarding these. We found the provider had raised safeguarding alerts appropriately. We asked a family member if the felt they would be able to raise any concerns with staff regarding safeguarding, they told us 'yes, I could talk to staff if necessary".

We found the provider had sufficient staffing in place to meet people's needs with staff receiving training, professional development and access to relevant qualifications. We were told by one person that "they know me well and are very nice".

The provider had systems in place to seek people's views on the quality of service provided. We found these systems were used and changes were made as a result. We also found the provider learnt from any incidents and investigations and from comments and complaints. One person told us "they do everything they can to make it better".