Chelmsford Care Centre Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 7 quality statements under this key question: learning culture, safe systems, pathways and transition, safeguarding, involving people to manage risks, safe and effective staffing, infection prevention and control and medicines optimisation. At this assessment we found although risks to people’s health and wellbeing had been assessed, further improvements were required in relation to more detailed guidance around people’s behaviours and medical conditions such as diabetes being routinely monitored in line with the person’s care plan records. Nutrition and hydration and turning and repositioning records were not always effectively monitored to mitigate the potential risk of deterioration in people’s health and skin integrity. There was a positive culture of safety based on openness and transparency. Concerns about safety were listened to, investigated and reported where required. The service used a ‘lesson learned’ approach and shared information to improve the quality of the service. Staff had been recruited safely and there were enough suitably trained staff to meet people’s needs. People’s medicines were managed and administered by trained staff whose competencies were regularly undertaken. Effective infection prevention and control measures were in place.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall people and relatives were complimentary of the service and the care they received and were confident accidents and incidents involving their family member would be shared with them. Relatives told us, “The care [person] gets is really good, so no complaints in that area”, “I can't fault this place; it has made me feel a lot easier in myself now [person] has been placed here” and “Any problems at any time we always know, as they [staff] keep us informed.”

Staff told us when incidents had occurred, these were reflected on and used as a lesson learned discussion in team meetings to help improve staff working practices. The registered manager described actions they had taken to support continued learning and to help identify themes and trends to improve the service. A member of staff told us, “The learning culture is high here, the process of sharing information and knowledge is very good. We are encouraged to know the values of the company. We have regular staff meetings, supervision and appraisal. We do a weekly unit meeting and then general staff meeting. The managers are very supportive. The manager comes round, and they will show staff what they want, and will demonstrate this to staff.”

Systems and processes were in place to support continued learning. These included supervision, staff meetings, additional training support and reflective practice. Investigations of concerns, completion of logs for incidents, accidents, potential safeguarding events and complaints were in place for analysis of any themes or trends within the service.

People and relatives told us communication was good, and they were kept informed and updated regarding any changes to their/their loved one’s health and wellbeing. Relatives’ comments included, “The other thing is they're good at keeping us informed about [person’s] health and it's nice the staff always have time for us”, and “We are informed about [person’s] health, so we always know what is going on.” Although people and relatives’ feedback regarding the service was positive, most relatives we spoke with told us they had not all been involved in the assessment and admission process into Chelmsford Care Centre. One relative said, “We were told where [person] was going, we did not have say in it. Anyway, it has turned out to be a lovely place indeed, it is really a wonderful place for [person].”

The registered manager told us, “When we receive a discharge to assess (D2A) assessment, we speak to the hospital to confirm anything of which we are unsure. This ensures discharges are not delayed from the hospital. If an assessment comes through that we need to query we can contact the team, and they will get any updated information or send over any charts we request also. The hospital also carries out an over the phone handover with our staff prior to the person leaving the hospital.”

Professional feedback we received spoke highly of working collaboratively with staff at Chelmsford Care Centre. They told us, “Staff continuously provide good communication across our teams, they are very quick to respond and in turn very effective at support with flow across our three acute hospitals. They promptly and compassionately provide thorough assessments of our patients ready for discharge to enable quick turnaround and avoid failed/problematic discharges.”

We had received concerns regarding assessments for some people being admitted to the service not being undertaken. We reviewed a sample of pre assessment documents for the most recent admissions, these included both D2A and the service’s own preadmission documents. We found systems were in place to promote the safe transition of people from hospital or their own home to the service. Following our visit the registered manager told us moving forward the admissions process undertaken through D2A would be explained to people/and or their relative to help alleviate any concerns.

All people and relatives we spoke with told us they/their loved ones felt safe and had no concerns about their safety. Comments included, “Yes I feel safe here because there are always people about to look after me,” “[Name] is very fortunate to be in a place like this, they safe and cared for here” and “It is total peace of mind now [person’s] in here, we know they are being well cared for. The communications are very good here, we are kept informed all the time about [person’s] well-being.”

Staff confirmed they had received safeguarding training and demonstrated they knew how to prevent, identify and report allegations of abuse. They were confident the management and office staff would take appropriate action if concerns were raised. A member of staff told us, “I have received safeguarding training. I learned about recognizing signs of abuse, the importance of reporting, and whom to contact. I would report any concerns to my line manager or the safeguarding lead. I know to escalate concerns to the registered manager or the safeguarding authority if necessary.”

During our onsite assessment visit we observed staff undertaking safe moving and handling practices. On one observation we found a person was reluctant to be assisted from their chair at first, so carers backed off. The carer then spoke with the person trying to support them to stand with encouragement; by gently placing their hand on the person’s back and the person used the arm of their chair to stand. It was unrushed, gentle and reassuring.

The provider had systems in place to ensure all concerns were investigated and action taken to ensure people’s safety. Records showed the service had made appropriate safeguarding alerts to the local authority when necessary. The registered manager was aware of recent safeguarding concerns and was in the process of investigating new concerns raised. Safeguarding policies and procedures were in place for staff guidance. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA. Staff understood the definition of the Mental Capacity Act and its importance.

People and relatives told us they/their family member were being cared for safely and staff understood their specific needs and how best to support them. A relative told us, “When [person] came here, they were wheelchair bound and unable to walk any more. The care staff supported [person] and in 3 weeks they were up and about. So going from a wheelchair to walking well again, the change was amazing and better for their health in general.” However, 1 relative we spoke with was not always assured around certain aspects of their family member’s care. They told us, “It takes a long time to get anything done.” We shared this feedback with the registered manager who took immediate action to arrange a meeting with the relative to discuss their concerns.

Staff understood how to manage risks to people’s wellbeing. They explained how they read risk assessments and kept themselves up to date with people’s care needs. A member of staff told us how they cared for people at risk of skin breakdown, “To mitigate this risk, we regularly reposition them, use appropriate equipment, and conduct routine skin inspections. Risk assessments are documented in the care plans within the electronic app, and all care staff and nurses have easy access to them.” However, whilst staff we spoke with appeared confident in their knowledge in recognising and monitoring risks to people, our assessment found elements of care and the monitoring of risks for people did not meet the expected standards.

During our mealtime observation on the first floor, a member of staff was observed to overfill a person’s fork with food items and to place this in the person’s mouth whilst they were being assisted to eat their lunchtime meal. Additionally, the same member of staff was observed to outpace the person whilst they were eating by repeatedly placing a fork of food close to the person’s mouth as they attempted to chew and swallow the previous mouthful. The registered manager responded to our feedback and told us daily monitoring of people’s mealtimes experience by the management team had now commenced.

Risks to people's health and wellbeing were assessed and recorded in their care plans. However, where people exhibited behaviours that could be distressing to themselves and others, there was insufficient guidance for staff to mitigate the risks to the person and others. De-escalation techniques were not routinely used or considered prior to the use of psychotropic medication. Records did not routinely provide necessary information demonstrating staffs’ interventions and outcomes when a person became anxious or distressed. Records showed people at risk of dehydration were not routinely meeting their fluid intake targets. No information was recorded to demonstrate how this was being monitored and addressed to mitigate the risk of dehydration. For example, the daily target for 1 person was 2270 millilitres. Records viewed over a two-week period showed this target was not achieved. Following our assessment the registered manager advised they had been working with a visiting professional reviewing people’s fluid target to ensure realistic and achievable fluid targets were in place. Where people had a catheter in place, fluid intake/urine outputs were not routinely recorded and monitored. A catheter is a medical device used to empty the bladder and collect urine in a drainage bag. If the bladder is not emptied, urine can build up and lead to pressure on the kidneys which can lead to kidney failure. One person was diabetic and required their blood sugar levels to be monitored 4 times a day. We reviewed their records over a 6-day period which showed this was not being completed. We could not be assured staff had sufficient information to help identify trends and understand what affects the person’s blood sugar, such as food and medication. Personal Emergency Evacuation Plans recorded the level of assistance to evacuate people safely. No consideration had been made to identify people’s physical and neurological needs which could affect their ability to evacuate.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives, we spoke with did not raise any concerns regarding current staffing levels within the service. Their comments included, “I like it here, it is homely. At the weekends it is the same staff wise all round”, “Here there are plenty of staff around all the time to keep an eye on [person]” and “Staff come in all the time to chat or check [person]. I was astounded by the difference in the quality of care, surroundings and staffing, it is so much better here.”

Staff were complimentary about working at the service, and their feedback regarding staffing levels was positive. Comments included, “I believe people are well cared for and safe. There is always an adequate number of staff on duty, including nursing staff, who are well-trained and compassionate. Any concerns raised by people are promptly addressed and escalated to management as needed”, “We have enough hands; some staff look after people on a 1:1 basis. We do have an occasional issue if staff call in sick. They do try and cover this and put it to other staff. We have enough staff to meet people’s needs” and “The staffing ratio is well thought out and enough to meet people’s needs. If we have sickness, we put it out and usually staff will cover.”

On the day of our onsite assessment visit, we found there was enough staff present to support people safely. Some people received 1:1 support throughout the day and night. The communal lounges had a member of staff present to attend to people’s care and support needs, people’s call bells were attended to in a timely manner and the home’s atmosphere felt calm and relaxed. Although the service currently had no activity coordinator, we did observe care staff supporting people out to the garden areas and carrying out social activities such as arts and crafts, crosswords, ball games and listening to music.

Systems were in place to ensure there were enough suitably qualified, skilled and experienced staff. Safe recruitment practices were followed. We checked the recruitment records for 4 members of staff and all the required pre-employment checks had been completed. Nurses employed had their registration confirmed with the Nursing and Midwifery Council (NMC). The NMC is the independent regulator for nurses and midwives in the UK, and nursing associates in England. This included disclosure and barring service (DBS) checks and obtaining up to date references. The registered manager informed us of a new clinical lead due to start to support the nursing staff and oversee the clinical management of the service. The registered manager was in the process of recruiting to fill their activity coordinator vacancies and had identified this as an area for improvement.

People and relatives, we spoke with did not share any concerns in relation to infection prevention and control. Comments included, “It's clean and pleasant in here, the toilets are immaculate that's the first thing we noticed when we came in” and “[Person] has a really nice room. They are clean and have their hair washed now so they are well presented again which was not the case at the other place. [Person’s] clothes are always clean.”

Staff were able to tell us how they use personal protective equipment (PPE) and follow infection prevention and control procedures in accordance with best practice guidance. A staff member told us, “Infection control is a top priority. We adhere to regular cleaning schedules, and PPE is always readily available and used in accordance with policy. In the event of an active infection within the unit, we strictly follow the relevant protocols, complete appropriate care plans, and conduct risk assessments as required.”

The service was in good decorative order, clean and tidy throughout. People’s bedrooms, communal areas and bathrooms were free of malodours. Personal protective equipment was readily available for staff. However, we did observe a person who received a late breakfast of toast due to them choosing to get up later. The member of staff was observed to use their fingers whilst placing the toast in the person’s mouth, without using appropriate PPE or washing and sanitising their hands between tasks. The same member of staff was observed carrying the toast in their hand whilst the person mobilised up and down the corridor, attempting to get the person to eat whilst they were on the move. We discussed this with the registered manager who told us there is now a new unit manager on the first floor and daily monitoring of people’s mealtime experiences have commenced. Their role included making sure staff gave people a positive mealtime experience.

Staff had undertaken infection prevention and control training (IPC) and were provided with personal protective equipment (PPE). The provider had an up to date policy in place to support effective infection prevention and control and was following current guidance. Regular IPC audits were undertaken which identified any areas where improvements were required and actions to be taken.

Relatives told us their loved ones received their medicines where required. Comments included, “I know [person] is getting the correct care here and they are receiving the right medicines”, “The other thing which is better here is they (staff) are sorting [person’s] medicines out for us” and “[Person] has diabetes, and they (staff) are managing that well enough too.”

Staff told us they completed training to manage and administer people’s medication and confirmed that their competency was assessed at regular intervals. A member of staff told us, “As a trained nurse, I have completed extensive training in medication administration, with my competency assessed annually. If a resident refuses their regular medication, I reassess the situation based on their capacity and the reason for refusal, offering it again if appropriate. After two refusals, the GP or pharmacist is informed as a concern.”

Staff administered medication with dignity and respect for the people being supported. However, although the medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together, people living within one unit, received their medicines later than they should, with the morning round only completing at 12.10pm. The latter is not good practice, and consideration should be made to ensure that appropriate measures are in place to address this. Following our assessment visit, the registered manager took steps to address this and advised there are now 2 nurses administering people’s medicines on the first floor with a new two-sided medicines trolley. Medicines training was underway for 5 senior care staff to support with administration if there was only 1 nurse available to mitigate the risk of people receiving their medicines later than they should. Medication Administration Records (MARs) were in good order, provided an account of medicines used and demonstrated people were given their medicines as specified by the prescriber. However, improvements were required to ensure where people were administered a medicated adhesive patch to deliver a specific dose of medication through the skin, the site of application was not routinely recorded. Additionally, where people were prescribed PRN ‘when required’ medication, specific protocols to ensure the medication is administered as intended, were not always recorded. We found some medicines for a person had failed to be administered on the day of our onsite assessment visit. The member of staff had signed the person’s [MAR] record, however had not signed the stock record and our medicines reconciliation identified those medicines had not been administered. The registered manager immediately addressed the concerns we found and updated us with the actions they had taken.