The Check House

Updated 8 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The Check House provides care and accommodation for up to 57 people. At the time we visited, 49 people lived at the home; one of whom was on a respite stay. The inspection took place on 27 February and 7 March 2018. The first day was unannounced and carried out by two adult social care inspectors and one expert by experience. An expert by experience is a person who has personal experience of caring for someone who is living with dementia. On the second day one adult social care inspector visited.

Prior to the inspection we reviewed the Provider Information Record (PIR) and previous inspection reports. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.

We met people who lived at the service and received feedback from ten people who were able to tell us about their experiences. Some people using the service were unable to comment on their experience of life at the home. We spent time in communal areas observing staff interactions with people and the care and support delivered to them. We used the Short Observational Framework for Inspection (SOFI) in the unit. SOFI is a specific way of observing care to help us understand the experience of people living with dementia. We spoke with three visitors and eleven staff to ask their views about the service. We also reviewed the service’s own quality assurance system and feedback on an independent external care home review website.

We reviewed information about people’s care and how the service was managed. These included four people’s care records along with other records relating to the management of the service. This included two recruitment staff files, staff training records and a selection of policies, procedures and records relating to the management of the service. We also looked at people’s medicine records and the systems in place for managing medicines, and we checked how they were administered to people. We contacted health and social care professionals; we received five responses which were all detailed and complimentary regarding the high quality of the service.

Updated 8 June 2018

The Check 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. The Check House is registered to provide personal and nursing care. They provide care and support for older people living with frailty and for people living with dementia. The Check House accommodates 57 people in one adapted building which has been extended since our last inspection, which means there is additional communal space.

At our last inspection on December 2015, we rated the service as good overall, with requires improvement in the question linked to effective care. At this inspection we found evidence to support the continued rating of good in three key questions and outstanding in two key questions. From our on-going monitoring of the service there was no evidence that demonstrated serious risks or concerns.

There was a registered manager working at the home. A registered manager is a person who has registered with the CQC 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 a firm commitment to provide a creative array of activities to support people’s emotional and mental well-being. These enabled people to learn new skills. Staff recognised the importance of people's past lives, their interests and preferences, as well as providing them with an opportunity to be involved in new experiences. The contribution of pets to enhance people’s well-being was recognised; there were two house cats and several people had moved to the home with their dogs.

People had access to diverse activities and events both at the home and in the community, including dance therapy and physiotherapy. Examples included tea dances with a dance group, flower arranging, cake making and regular trips out in the service’s mini-bus to local places of interest such as cafes, museums, garden centres and the seafront. People were supported to have regular walks around the local area. People living with dementia were as involved with community activities as much as everyone else.

People living at and visiting the home praised the high standard of the food and its presentation. Catering staff worked alongside care staff to find food to meet people’s preferences and choices. They worked as a team with the outcome for the person at the forefront of their minds, discussing how to make choice meaningful for people living with dementia. Written feedback on an independent review website scored the home very highly recognising the “incredible caring staff”, the range of activities and the “very attentive care, both personal and medical”.

There was an on-going investment in the environment which reflected research and best practice to promote people’s independence and connection with their surroundings. The provider and registered manager recognised the effectiveness of the use of colour and contrast to ensure the adaptation, design and decoration of the environment was enabling, stimulating and suited to the needs of people living with dementia. Research influenced their decisions in how people were supported to navigate their way around the home.

People’s relationships and life experiences were respected and celebrated. This knowledge enabled staff to help people consider their wishes for their end of life care. Staff held a strong sense of pride in connection with the quality of end of life care. Staff knew people and who and what was important to them and significant events in their lives.

The registered manager acted as a strong role model for all the staff team and was accessible to people living, working and visiting the home. A visitor commented “Someone is always on hand if anything to discuss and office always open, with managers very approachable.” The registered manager and deputy manager motivated staff to offer care that was compassionate and considerate. The management team promoted the ethos of the home where each person was valued and treated as an individual. This inclusive ethos, which was adopted by staff, enabled people to feel part of the home’s community. Staff were skilled and were supported by a range of training and supervision to promote consistent good practice.

The provider understood the need to provide staff with the skills, knowledge and tools to provide care that followed best practice. They invested in staff development to promote staff motivation and confidence to provide a high standard of care. Their investment in staff with rewards schemes for long service meant the staff team was stable and committed. A commitment to meaningful training meant staff were skilled and this translated into their practice. A visitor commented “There is an atmosphere of patience, tolerance, warmth and kindness throughout”.

People living at and visiting the home complimented staff on their approach and compassion, “My mother spent the last two years of her life at Check House and we are deeply grateful to all the intelligent, hard-working staff for treating her with such kindness, affection and respect. Everyone was lovely and considerate and kept us well-informed”.

People looked confident as they moved around the home and people told us they felt safe. Medicines and pain control were well managed. Good recruitment practices helped identify suitable staff to work at the home. Risk assessments were in place for people’s physical and health needs. There were emergency plans in place to protect people in the event of a fire or extreme weather conditions which potentially could impact on staff availability. Staff knew how to report poor or abusive practice, and the management team responded to concerns appropriately. Staffing levels met people’s care needs; the atmosphere was calm and welcoming.

The staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. Staff supported people to be involved in making decisions and planning their own care on a day to day basis.

Further information is in the detailed findings below.