Chignal House

Chignal House is a residential care home, providing personal care and accommodation for three people who may have a learning disability and or complex/physical health needs.

The size of service meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

People’s experience of using this service:

People were safe living in the service. Risks had been identified and people were looked after safely.

Staff were kind and caring and supported people to be as independent as possible.

People had access to healthcare professionals when required.

Staff knew how to care for people. Staff used their skills and the resources and equipment provided so the risk of accidental harm or infections was reduced. Staff had developed effective skills to meet the complex needs of the people at the service.

People were supported to have their prescribed medicines safely to remain well.

People were supported to eat and drink. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The registered manager had clear oversight of the service and worked alongside staff. Staff were respectful of the register manager and told us they were approachable and supportive.

Rating at last inspection:

Good (date of the last report published was 11th December 2018).

Why we inspected:

This was a follow up comprehensive inspection. In December a focussed inspection was carried out looking at safe and well-led. The rating at the last inspection was Good.

Follow up:

We will continue to monitor this service in line with our re-inspection schedule for those services rated as Good.

Since our last inspection the provider and registered manager had worked hard to address the concerns in our last inspection. As a result of the improvements we found there were no longer any breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The new registered manager had settled in well and had developed positive relationships with people, staff and families. They worked effectively with the provider to promote a culture which was focused on the needs of the people living at the service. Although the registered manager was still stretched as they were managing two other services, the provider was addressing this issue. A new deputy manager had been appointed to support the registered manager.

Some of the processes and records at the service needed streamlining to ensure systems worked effectively. New quality audits had been introduced and were effective at supporting the improvements at the property. The provider met with the registered manager and senior staff to implement any actions from the audits. There was open discussion about mistakes and any lessons learnt were used to improve the service.

Communication had improved across the service and staff felt supported to speak out about any concerns they had. The provider and registered manager communicated well with families and people and had consulted with them about the proposed building work.

Staff worked well with external professionals to meet people’s needs. There was scope for the registered manager to develop positive networks outside the service for support and to lean and share about best practice.

The registered manager had significantly enhanced the administration of medicine. There was improved training and guidance about the support each person needed. The registered manager observed staff competency and carried out detailed checks to ensure people received their medication as prescribed.

There were enough safely recruited staff to meet people’s needs. The registered manager recognised the importance of people receiving support from staff who knew them well.

Staff supported people to remain safe. The quality of the risk assessments had improved. Staff had the necessary guidance to support people to minimise risk, while ensuring they enjoyed their lives and were not overly restricted. Staff knew what to do if they were concerned for people’s safety. People were protected from the risk of infection. The property was clean and homely. The building work was not impacting on their quality of life.

See more information in Detailed Findings below.

Rating at last inspection: Requires Improvement overall, with caring and responsive rated as good (report published 22 May 2018)

About the service:

Chignal House is a residential care that provides personal care and accommodation to up to three people with learning disabilities. At the time of the inspection there were three people living at the service. The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live lie as any citizen ‘Registering the Right Support’ CQC policy.

Why we inspected:

We carried out this focused inspection because the provider was carrying out building work at the property and had applied to increase the numbers of people living at the service. We wanted to check whether the existing people living at Chignal House were receiving safe care during the application process. At the time of writing this report, the provider had withdrawn their application to increase the service while they completed the building work.

Follow up:

We will continue monitoring the service to ensure people receive care which meets their needs.

The inspection of Chignal House took place on 08 March 2018 and was unannounced.

When we completed our previous inspection on 26 January 2017, we found there was a lack of good governance systems in place to monitor the quality of the care provided at the service. This was a breach of regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found care plans were not always person centred or regularly reviewed to ensure they reflected people’s current needs. Medications were not always stored safely and their recruitment process needed reviewing to ensure people were safe. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. The provider did not send this action plan within the set timescales. The inspector contacted the provider to request a copy of this via email; however, at this inspection the provider told us they had not received these emails.

At this inspection, we found that, there continued to be a breach of regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to information not being analysed to identify an overall picture of how well the organisation was meeting people’s needs and performing. Although the provider spent a lot time working across all three services, we found a lack consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning management of risk and regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty.

We recommend the provider review their building risks assessment to ensure risks to people are assessed in line with recognised guidance on managing health and safety in care homes.

The manager and staff had not understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm and / or abuse.

Improvements had been made to the storage of medicines, however the medicines audit had not identified inconsistencies in the amount of a person’s medicines held, resulting in medicine being unavailable when they needed it to help manage a period of distress and anxiety.

Following this inspection, the provider sent us a plan to address the issues we raised during our inspections of all three of Paradise Lodge Care Homes Limited services. This showed they had taken seriously the issues we raised and had taken steps to address these, including but not limited to carrying out an investigation into missing medicines, health and safety concerns and identifying a different training provider to deliver a robust MCA and DOLS training programme for all staff.

Chignal 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. Chignal House accommodates three people in one adapted building.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a manager in post. Following an interview with CQC they have been approved as the registered manager as of 16 March 2018. 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.

A contingency plan was in place with contact details for staff to respond to emergencies and staff knew who to contact should an emergency occur. The service had infection prevention and control systems in place, which ensured people’s health was protected. Staff were trained and understood their roles and responsibilities for maintaining cleanliness and hygiene.

Safeguarding matters and people's finances were well managed. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Where people had moved from a previous service, relatives were complimentary about how staff had supported their family members to make this transition.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.

Staff understood what people could do for themselves, where they needed help and encouragement and how they communicated. Staff talked passionately about the people they supported and knew their care needs well. People’s care plans were regularly reviewed to ensure they reflected people’s current needs and covered all areas of the person’s health, welfare and safety. These provided detailed guidance for staff to know how to support and provide care and treatment. Different communication methods had been used to support people to understand information about their care and decide how they spent their day. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.

People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.

The provider’s mission statement contained a clear vision and strategy to deliver high-quality care and promote a positive culture achieving good outcomes for people. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect. Equality and diversity, was understood and promoted across all three services owned by the provider. The provider had taken steps to meet people’s cultural needs.

People’s relatives and staff spoke positively about the provider and the manager. Staff felt supported and said there was good communication between the management and themselves Staff felt supported. They described both the provider and manager as approachable, very hands on, supportive and demonstrated good leadership, leading by example.

At the time of our inspection, no one using the service was nearing the end of their life, and therefore we were unable to assess how this aspect of the service was managed. However, we noted that peoples’ care plans did not contain information about people’s preferences regarding future care at the end of their life, where they wished to die or their spiritual and cultural needs.

We recommend that the service seek guidance from a reputable source, about supporting people with learning disabilities to express their views and involve them in decisions about their end of life care arrangements.

This is the second time the service has been rated Requires Improvement. We found 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.

People at the service told us they felt safe and supported by staff working there, and we saw risk assessments and care plans that promoted their independence whilst managing well any potential risks.

Medication was provided by staff that were trained, and supported people’s safe involvement. However, it was not safely stored. The registered manager took immediate action to remedy these concerns.

Whilst we saw that staff received good supervision, oversight, and support by the registered manager, recruitment processes were not robust and we fed back to the registered manager that the provider should review these processes urgently.

Once employed, staff received training and support to carry out their care duties to a good standard. We saw that staff received regular training updates and attended regular staff meetings to keep up to date with changes in the service and to review the care they provided to people.

People at the service told us that staff treated them with dignity and respect. We saw that staff were caring and supported people with a compassionate and caring approach. However, some wording in care plans was condescending and did not represent the care that people told us staff provided and that we observed. We requested that the registered manager review these urgently.

Care provided was inclusive and supported people to remain independent, learn new skills, and lead fulfilling lives. We saw that the provider and registered manager, supported staff to meet people’s individual communication, physical and mental health needs in a manner that supported people’s preferences and involved other relevant agencies and resources to ensure that these could be met.

Governance systems in place were not robust and did not reflect the good standard of care that people received. However, the registered manager had already identified that systems needed a thorough review to be more effective and at the time of inspection was already in discussions with external organisation to review these processes. It was evident however, that staff felt they were supported by a management team who were visible, and approachable to both staff, and people living at the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the end of the report.

People received care and support that met their needs and which took into account their individual preferences. Staff were able to demonstrate that they understood people's specific needs and that the care provided was person-centred.

We reviewed the provision of food and drink, and people told us they liked the food provided.

We examined recruitment processes and found these were providing staff suitable to perform their role.

We reviewed how records were maintained and stored and saw records were in good order.

We observed that people were comfortable with the staff who were on duty and that people had made choices about what they wanted to do that day. The person we spoke with said they made all their own decisions, which included that they did not wish to help with the housework. Care records showed that published guidance relating to the Mental Capacity Act 2005 had been followed to record people's ability to make decisions about their lives.

Care and support plans gave staff detailed guidance on the ways in which each person preferred to be supported. Assessments of any risks to people were carried out so that people were supported to be independent but kept as safe as possible. Each person's healthcare needs were met. Medicines were managed safely and given as prescribed.

Staff undertook a range of training so that they were equipped for their role. Staff told us they felt well supported by the manager. One staff member said, 'I enjoy working here. I love working with people.'

The provider had a complaints procedure in place that was in easy read language and pictures so that people could understand it better. Staff said they knew people well enough to know if anything was not right.