Archived: Chylidn

Updated 28 June 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors and an Expert by Experience over two days. Two inspectors were present in the service on each inspection day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Chylidn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did have a manager registered with the Care Quality Commission. However, the registered manager had been promoted to become one of the provider’s regional managers. An acting manager had been appointed at Chylidn and was currently running the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We met everyone who lived at the service and spoke briefly with people about the quality of care they received. We observed the care and support people received during both inspection visits to help us understand the experience of people who could not talk with us. We used our quality of life tool to investigate people’s lived experience of care. We also spoke with eight members of staff, the acting manager and the provider’s deputy head of operations. We reviewed a range of records. This included people’s care records, medication records, staff rotas and the provider’s policies and procedures.

We sought clarification from the provider to validate evidence found. We looked at incident reports, training data and quality assurance records. We gathered feedback on the service’s performance from four people’s relatives and spoke with the provider’s regional manager.

Updated 28 June 2022

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.

About the service

Chylidn is a residential care home providing personal care and accommodation for up to five people with learning disabilities or autistic spectrum disorders. Five people were living at the service at the time of this inspection. Two people lived in self-contained flats and three people lived in the main house sharing the kitchen, dining room and lounge. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

The service did not employ enough staff to meet people’s support needs. Three agency staff had been allocated to support the service. Agency staff and a team of bank staff had been deployed to support the service, however the service regularly operated at or below emergency safe staffing levels at the weekend and in the evening.

Agency staff were routinely scheduled to work long shifts. Risk assessments had been completed to manage the risk of excessive working hours impacting on the accuracy of record keeping and staff wellbeing. These risk assessments did not recognise the impact of long working hours on the quality of care people received. One member of agency staff had worked a large number of consecutive, long care shift contrary to these risk assessments.

The provider had a team of bank staff who knew people well and were able to support them to access the community during weekdays. However, at weekends and in the evening the service often operated at minimum safe staffing levels which restricted people’s freedoms and opportunities to go out at those times.

Staff and the acting manager understood local safeguarding procedures and whistle blowers had contacted the commission prior to the inspection to raise concerns about the impact of current low staffing levels on people’s wellbeing.

People were supported to have choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care was designed to maximise people’s choice, control and independence. However, low staffing levels meant people were not always able to engage with activities when they wished.

Right care:

Staff cared for the people they supported and acted to ensure their dignity and human rights were protected. Staff responded promptly and were proactive in preventing situations that impacted negatively on people’s wellbeing.

Right culture:

There was a significant risk of closed cultures developing at Chylidn. During the inspection we identified numerous warning signs and indicators of closed cultures within the service operations. However, staff reported that they were well supported by their managers and audits had recognised that staffing levels had impacted on the service’s performance.

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. (Report published 12 August 2019).

Why we inspected

We received concerns in relation to staffing levels and staffing working hours from whistle-blowers prior to this inspection. A decision was made for us to inspect and examine those risks and the overall performance of the service.

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.

We have found evidence that the provider needs to make improvement. Please see the Safe, Responsive and Well-led sections of this full report.

Enforcement and Recommendations

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 Person Centred Care, Safe Care and Treatment and Staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations in relation to the medicine’s competences, the storage of potentially confidential information and how to ensure staff understood people’s communication preferences.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.