Chandlers Ford Care Home

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 assessed a total of 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was requires improvement. Our rating for this key question has improved too good. People and their relatives told us people received safe care and treatment. However, we received feedback from people that they did not always feel there was enough staff and care at times felt rushed. Staff understood people’s needs and risks to people were well managed. Staff supported people with their medicines and received appropriate training to maintain their skills and knowledge. Where we identified some shortfalls in people's medicines management records we have addressed this under the well-led section of the assessment report.

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.

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

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People we spoke with told us they felt safe. Comments included, "I do feel safe. This is generally to do with the atmosphere and the care I receive.”; “Yes [I feel safe], staff will always check that the windows are shut, make sure the curtains are pulled and things like that.", and, "We have our own rooms and we can lock the door if we wanted to and there are always staff here.” Most people told us they would raise any concerns with staff; however some people were not sure who they could speak with if they had any concerns. Relatives told us they felt their loved ones received safe care and were looked after well by staff. One relative said, "I know she is very safe and very well looked after. They look after her very well.", and another relative said, "I think [loved one] is safe there, the care is good and they keep me informed. I don’t have any concerns.”

All staff we spoke with said they had received safeguarding training and complete this annually. Staff could identify different forms of abuse and explain what they would do if they witnessed abuse and who they would report this to. Some staff mentioned the whistle-blowing policy and they can report to organisations outside of the home such as CQC. One member of staff said, “If I saw unexplained bruising, I would raise it to my line manager and report it to the nurse in charge." Staff said they felt confident to report concerns to the manager out of hours if necessary. One staff member said, “It doesn’t matter what time it is. If something happened, I would email [manager] and she is very responsive. I've even emailed her at midnight. She is always supportive.” All staff said they have received training on the Mental Capacity Act 2005.

We made positive observations of people's interaction and engagement in communal areas, particularly with activities staff. We also observed staff using the appropriate moving and handling techniques to support people. They provided reassurance and explained to people what they were doing.

Incidents and accidents were reported and investigated. Lessons learned were shared with staff via supervision, staff meetings and the provider’s electronic communication tool. There were clear processes in place to ensure staff knew how to identify, report and escalate concerns to keep people safe. People were assessed for their capacity to consent to their care and treatment where this was required. When people were assessed as lacking capacity to make a specific decision, best interest decisions were made. Records showed how these decisions were reached and who was involved. The provider operated effective systems and processes to ensure where required, deprivation of liberty applications were made and followed up regularly and authorisations were clearly recorded.

People we spoke with did not raise any concerns in how people's risks were managed. Relatives told us they felt risks were well managed and they were informed of any changes. Examples included, "[Loved one] is a high falls risk, they have a sensor mat by the bed and [staff] move it to the chair when [loved one] is moved. It is always plugged in and the carers have a check list in the care plan book with a tick list which includes this.”, and, “[Staff] will always phone me if [loved one] has a fall or if there are any problems.”

Staff understood how risks were assessed. One staff member said, "New admissions have a pre-assessment, and we find out people's needs. But when they come here, we do our own assessment. I would assess people and see if they need support from one or two staff. If people's needs change it will be in the care plans. We refer to the plans; they [nurses] do keep them up to date here. Any doubts, I can speak to colleagues. I do go into handover as well, so I hear about any changes and updates." Staff knew how to support people who required repositioning support and how often this was needed. One staff member said, "The information is in the care plan but there are supplementary charts in people’s rooms. It tells you there how often to move people. We do daily air mattress checks. These are set to the weight of the resident. We weigh people at least monthly." Staff told us they knew how to access information about people who were at risk of choking and any associated dietary needs. One staff member said, "Everything should be in the care plan and it should be in the supplementary folder and in the kitchen. At the start of my shift I brief my team and check they know all the residents. I make sure they know who is on thickener, if they need support etc."

We observed staff use the appropriate moving and handling techniques to support people. They provided reassurance and explained everything they were doing. For example, we observed staff support a person to safely transfer. They explained clearly what they were going to do and reassured the person throughout. We also observed staff were present in the dining room and in people’s rooms during mealtimes. People who needed support were assisted with their meals. We observed staff supporting a person who was becoming distressed. Staff supported the person calmly and redirected them to another area of the home.

People had been assessed for risks such as falls, skin damage, choking and malnutrition. Assessments had been regularly reviewed. However, information within care plans in relation to risks was not always consistent. For example, we looked at the plan for one person and in the moving and handling section it was documented that the person could not walk. In the same person’s falls plan, it was documented that they sometimes forgot to use their mobility aid and would walk into other people’s bedrooms. The sleep and rest plan also referred to the person walking around. We discussed this with the area relief manager who confirmed the plan was incorrect and the person was unable to walk. The plan was reviewed, and we saw the new plan was in place on the second day of the site visit. Some people experienced episodes of distress due to their cognitive impairment. Care plans in these cases provided clear information for staff on how to recognise when people were starting to show signs of distress and any known triggers. However, the guidance for how to manage episodes of distress was limited. For example, in one plan, it was written, “Staff to use kind words and empathy.” Some people had been assessed as a high risk of skin damage. In these cases, plans detailed any pressure relieving equipment in use, and informed staff how to monitor people’s skin and the frequency of any position changes needed. Records showed daily checks of air mattress settings were carried out. All the air mattresses we looked at were set correctly. Position change charts showed people had their position changed in line with care plan guidance.

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

Most people we spoke with told us they felt there was not always enough staff. People told us their experience of care sometimes felt rushed and they had to wait for prolonged periods after calling for assistance. Comments included, "[Staff] don’t respond quickly, they might be with someone else and then they can’t come to you. Sometimes I have waited over half an hour."; "Sometimes you have to wait for a long time to be seen to answer the call bell. They answer your call and then you have to wait a long time again for them to come back. The staff’s excuse is people are off sick or they’re on holiday. If you’re in bed at 10:30 at night residents are calling out."; "It feels rushed. Sometimes I feel like they don’t even listen to me.", and, "There’s never enough staff is there. You do have to wait a while when you call someone using the call bell. I find waiting after ringing the bell happens often but they are busy people, so I understand." Relatives told us there was a noticeable difference in staffing levels between weekdays and weekends, and one relative said, “Sometimes when I have been there, I have noticed that there are residents in the lounge but no staff, not for long but long enough to raise it." However, some people we spoke with provided positive feedback on their experience which included, “Yes, I never have to wait for anything. The staff are always busy, but they are absolutely brilliant, everyone is so friendly.” In the lounge it was mainly the two activity coordinators present and supporting residents with activities and their needs. Care staff were only present in the lounge for short periods of time.

Most staff commented positively about staffing levels. Comments included, “In my opinion, I believe there is enough staff. It’s the same at weekends. If we tell [manager] we are short we will get the go ahead to get another person in” and, “I think yes there is [enough staff]. Levels are OK at nights and weekends too. If someone goes off sick, the manager will try and get someone else to come and do an extra shift. We haven't had agency staff for quite a few months now. It's usually the regular staff here who cover.” Some staff told us although they felt that there were enough staff on shifts, they did feel they were sometimes rushed when supporting people. For example, one staff member commented, "I think staffing is good here. There are some days where there are fifteen of us and other days there aren’t as many but that doesn’t mean we’re short staffed. It does feel a bit rushed. The only time we get to spend with [people] is normally after supper when the majority of things are done." Staff told us they felt supported in their roles and had regular supervisions with a line manager or supervisor. Comments included, "I feel very supported. [Name] is a great support, I know I can call her anytime just for advice" and "We have fabulous support from the big bosses." All staff we spoke with were happy with their induction and felt confident starting their role. Staff felt that they have received all the necessary training and completed regular online learning. We raised people’s feedback with the provider. The area director discussed how staffing levels were constantly monitored and adjusted accordingly. For example, they told us they were reviewing night staff numbers and skill mix based on staff feedback.

During our on-site activity we found staff were present in communal areas and interacting with people. We noted activity coordinators mainly supported people in the lounge and engaged people in activities. We observed that activity coordinators would find care staff if people needed support. We observed interactions where staff promoted people's privacy and dignity and were responsive to people's needs. We found staff were visible around the building and they did not appear rushed including mealtimes which were relaxed. People were supported when needed and we observed staff sat adjacent to people when supporting them with meals and drinks. We did note call bells were ringing frequently, and some took a while to be answered.

The provider used a dependency tool to support them to calculate staffing levels. We reviewed the assessed level of staff in line with staffing rotas and found that rotas reflected more staff were on duty than the tool indicated. Staffing rotas indicated the service was fully staffed. The provider reviewed the staffing levels on a monthly basis, and we saw evidence that staffing numbers were reviewed in line with their processes and staff feedback where appropriate.

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

Most people we spoke with told us they had no concerns regarding their medicines support. People told us they received their medicines as part of their routines with staff support. Relatives we spoke with did not raise any concerns about the medicines support their loved one received.

Staff were able to demonstrate how they identified and recorded creams administered as part of personal care, checking where and when to apply them. Staff were aware the significant risks medicines at the service could pose residents and knew how to mitigate them.

We were not assured staff consistently supported some people in line with their medicines care plans where they required diabetes blood glucose monitoring. For example, staff were not consistently undertaking the monitoring described in an individual's care plan and records for capturing people's results were not always clear. We raised our concerns with the provider who took action to review and address the shortfalls. Information and the quality of care plans, variable dose and when required protocols were inconsistent. Some records were clear, short and had personalised information and other records lacked sufficient personalised information. The provider used electronic medicines records. We noted the electronic medicines administration record (eMAR) had a PRN (when required) facility. However, the fields and number of characters limited the content. This meant records generally replicated the label and therefore were not personalised or individualised. The provider told us they were aware of some of the electronic system shortfalls and had implemented paper care plans as an interim measure. As part of our feedback the provider gave us assurances that care plans, eMAR and PRN protocols had been reviewed and were robust to meet people's needs. Signage providing warnings and information about oxygen cylinders was not always correct. Medical oxygen signage should be reviewed to ensure the warnings and symbols reflect the cylinders held. We observed some equipment on the premises including syringe pumps had expired. We raised this on-site with the manager to action.