10 March 2022
During a routine inspection
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.