Cheddar Grove Nursing Home

Cheddar Grove is care home providing personal and nursing care to seven people with a learning disability or autistic people. At the time of our inspection there were six people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

Staff were passionate about providing care that was tailored to the person. Relatives praised the home on the care and support provided to their loved ones. Regular contact was maintained with family and the person’s named representative was involved in reviews of care. Overall, relatives felt communication was good. People continued to be well supported with meaningful activities in their home and the community.

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.

Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

People were supported by enough staff. The home was experiencing workforce pressures and agency staff were being utilised to ensure there were enough staff supporting people.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report safeguarding concerns.

People had access to healthcare professionals when they became unwell or required specialist support. The interim manager was proactively working with professionals to improve communication and ensure people received care that was safe and meeting their individual needs.

Right Care:

People were not always kept safe as the advice of health professionals and risk assessments were not always followed.

Staff interaction with people was warm, caring and respectful. People were involved and staff were observed asking people how they wanted to be supported. Family members told us their relative were cared for and treated well.

Medicines were managed safely. Although during the summer they had experienced some difficulties with the pharmacist not supplying medication in a timely manner. Staff told us they were looking to change to a local pharmacist to aid improvement in this area.

Right Culture:

In the last two years there had been a high turnover of staff. There had also been a change of management. Health and social care professionals had raised concerns in respect of the communication between the team and themselves and as consequence not following their advice. An interim manager had been redeployed to assist with making improvements and providing leadership and direction to the team.

The staff were committed to getting it right for people. Care was person centred and tailored to each individual. Health and social care professionals were regular visitors to the service.

The provider and the manager had implemented a robust system to monitor the quality of the service. However, improvements were needed to ensure records relating to the care of people were consistently completed such as fluid charts, monthly summaries and epilepsy monitoring charts.

Rating at last inspection and update

The last rating for this service was good (published 16 February 2019).

Why we inspected

The inspection was prompted in part by a notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks to people. This inspection examined those risks.

Since the death the management team had reviewed risks assessments and an interim manager had been brought into work with the staff team.

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 changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: 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 monitor the service and will take further action if needed.

We have found evidence that the provider needs to make improvements. We have identified breaches in relation to safe care and treatment and in good governance relating to record keeping. Please see the safe and the well led section of this 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 Cheddar Grove on our website at www.cqc.org.uk.

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.

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.

There was a registered manager for the service. 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.

There was an effective system in place to ensure that medicines continued to be managed safely in the home. Staff continued to be recruited safely and trained to meet the needs of people who lived in the home. There was still enough staff to provide people with a safe level of care and support. Staff in the home knew how to identify the different types of abuse that could occur and they were aware of how to report it and keep people safe.

There was a sufficient number of suitably trained and properly supported staff supporting the people at the home. People had access to healthcare professionals when they became unwell or required specialist supported. People continued to be well supported with therapeutic and meaningful activities in their home and the community. People were supported to maintain contact with friends and family.

People’s needs continued to be met and the type of care they received was planned and delivered in a way that was effective. People continued to be supported to eat and drink enough to be healthy. People were preferences were included in in menu planning. Meal choices and individual preferences were included in the menu options available.

There were systems in place to ensure that the requirements of the Mental Capacity Act 2005 were followed. This law protects people who lack capacity to make informed decisions in their daily lives. The provider had completed applications under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. These had been accepted and necessary safeguards were in place for people who required them or for one person?.

The staff continued to understand the needs of the people they supported. People were encouraged to make choices about their care and to become more independent in their lives.

Staff supervision remained in place and was up to date for all staff. This meant there continued to be proper support in place to provide staff with the support they needed to do their jobs effectively.

The registered manager continued to ensure that people’s complaints were investigated by following the provider’s complaints procedure. Complaints were well managed.

A provider’s representative continued to visit the home regularly. They carried out quality checks on the overall quality of care and service people received. Where needed they had identified actions for the registered manager to implement to improve the service. They had recently picked up that certain policies and procedures needed updating. This action had been carried out by the registered manager.

Cheddar Grove Nursing Home provides accommodation and nursing care for up to 7 people. People at the home had a learning disability. At the time of our inspection there were 6 people living at the home.

A registered manager was in post at the time of our inspection. 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.

At the last inspection in February 2015 we found records relating to people’s care and treatment were not always accurate. At this inspection we found improvements had been made to ensure records were up to date and accurate. Staff had been issued with clear guidelines around record keeping. Audits were in place so the registered manager and a senior staff member checked that records were accurate.

At our last inspection in February 2015 we found that a notification had not been sent to the Commission as required. Notifications are information about important events that affect people or the home. The registered manager now had systems in place to show when a notification may be necessary and to record that it had been submitted to the Commission.

The home ensured people were safe by having thorough recruitment procedures. Staff received on-going training to ensure they were skilled and effective in their roles. Staff were supported by regular supervisions with the registered manager. Staffing levels were safe. Recent adjustments to the staff team were being managed to keep a settled and stable environment for people.

Medicines were administered safely and regular checks were in place. People had assessments to minimise risk and there was suitable guidance for staff in risk management. People received the support they needed in nutrition and hydration. Systems were in place to monitor people’s health and well-being.

We observed positive relationships between people and staff. Staff knew people well and respected people’s dignity and privacy. Positive comments were made by relatives about staff’s kind and caring approach.

The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The registered manager kept clear records of the steps taken in the DoLS process. Staff were aware how the Mental Capacity Act 2005 was relevant to their role and applied the guiding principles through choice and enablement. When a person lacked the capacity to make a particular decision it was recorded clearly how this had been established. When a best interest decision was needed, this was fully documented with the involvement of family and health and social care professionals.

Staff were responsive to people’s care and support needs. Care records were person centred, showing people’s personal preferences. Staff supported people to be involved in a range of activities both within the home and in the community. Feedback was sought from people and relatives. This resulted in changes and improvements being made.

We received positive feedback about how the home was led and run. Regular staff meetings were arranged. This enabled staff to be involved in how the home was organised, gave opportunities for feedback and provided communication. Staff felt valued in their roles and commented about the positive atmosphere of the home. A range of systems were in place to monitor the quality of care provided to people.

October 2013. This was because there was a lack of monitoring in place to ensure that the home was kept clean and the risks of cross infection minimised. Not all areas of the home were cleaned to an appropriate standard.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 8 infection control and outcome 16 assessing and monitoring the quality of service provision of the Health and Social Care Act. They told us they would be compliant by 30 November 2013.

The actions the provider told us they were planning to take had been implemented within the service. Systems were now in place to assess and monitor the quality of the service that people received in relation to keeping the home clean and minimising risks of cross infection.

The provider sent us an action plan that detailed how they would achieve compliance with outcome 16 of the Health and Social Care Act. They told us they would be compliant by 30 September 2013.

The actions the provider told us they were planning to take had been implemented within the service. Systems were now in place to assess and monitor the quality of the service that people received. However, during the inspection we saw there were a lack of monitoring in place to ensure that the home was kept clean and the risks of cross infection minimised. Not all areas of the home were cleaned to an appropriate standard.

We spoke with two people about what it was like to live at Cheddar Grove. Both people told us they were happy with the care and support. Comments included 'the staff are good, they ask me what I would like to do', 'I like living here, I can go to work and everyone gets on well'.

For those people that were unable to tell us what it was like living in the home, we observed staff interactions while supporting them in communal areas. We cross referenced this with their care plans to ensure care was being delivered in line with their assessed needs. We found this to be the case during our inspection.

People that were able to tell us of their experiences had positive comments to make about living in the home. Comments included; 'staff are nice and I feel safe here, its ok'. Another person told us 'I go to work and I've been to London. It's lovely here'.

Staff we spoke with during our inspection were knowledgeable about the needs of people that lived in the home and we observed people being treated in a respectful and dignified manner. Staff were observed knocking on bedroom doors prior to them entering and personal care was delivered behind a closed bedroom or bathroom door.

Staff told us there had been changes in the management of the home over the last eight months but felt the new manager was moving things forward in a positive way. Staff comments include;"there is plenty of support within the staff team" and "the manager is bringing in some good changes".