Chaseview Nursing Home

We found the following examples of good practice.

¿ The registered manager had supported other local care homes by signposting them to government guidance and sharing examples of good practice during the pandemic.

¿ The management team had developed flexible yet safe visiting arrangements for people receiving end of life care to ensure people can spend time with their loved ones.

¿ The provider had set up an app where the management team can effectively monitor PPE, testing and staff well being daily.

¿ The provider had set up a direct line for relatives to contact them with queries or concerns around visiting the home and COVID-19.

¿ The management team supported staff wellbeing by purchasing regular treats for staff to lift their moods and thank them for their continued dedication.

Further information is in the detailed findings below.

Chaseview Nursing Home accommodates 60 older people some of whom were living with dementia. The provider also provided nursing care. On the days of our inspection 56 people were living in the home. The home is situated on two floors and was accessible to wheelchair users.

This inspection was unannounced and took place on 14 and 18 September 2018.

We completed a previous inspection of this home in May 2017 which we published in July 2017. The provider was rated Requires Improvement overall and was in breach of Regulation 12, Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At that inspection we issued a Warning Notice to the provider. In response the provider sent us an action plan to tell us what they would do to improve the service and to comply with this regulation.

A focused inspection was carried out in September 2017, to find out if the provider had addressed the concerns identified at the previous inspection and that they had met the legal requirements. We looked at the key question ‘Safe’ because we had received concerns from members of the public about people’s safety. At this inspection we found that the provider had not taken sufficient action to comply with the breach of Regulation 12. The provider was also in breach of Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 17, Good governance.

Following the inspection in September 2017, the registered provider was issued a Notice of Decision to apply conditions to their registration. The registered person was required to ensure that they supervised the management of Chaseview Nursing Home and monitor compliance against the regulations. This included their duty to ensure that people received safe care and treatment and that they were protected from abuse and improper treatment. The registered person was required to ensure that quality improvements were implemented and sustained.

At this inspection we found that improvements had been made and that the provider was no longer in breach of the regulations.

Chaseview Nursing Home had a registered manager in place who was present throughout this inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

People were safely supported with their medicines by competent staff members. People were confident that they would receive their medicines as prescribed and on time. There was guidance available to staff when supporting people with “when required” medicines.

People were safe from the risk of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the registered manager were acted on appropriately. There were enough staff to support people to meet their needs in a timely manner.

New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff members had access to on-going training to maintain their skills and to keep up to date with changes in adult social care. The provider followed safe recruitment procedures when employing new staff members.

People received care that was effective and personalised to their individual needs and preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support that was caring and respectful. People were supported by a staff team that was compassionate and engaging. People's privacy and dignity was respected by those providing assistance. People's individual preferences were known by staff members who supported them as they wished. People were supported at times of upset and distress.

People's human rights and protected characteristics, like faith and disability, were supported and promoted by those providing care and support for them. People received information in a way they found accessible.

People, and when needed family or advocates, contributed towards developing their own care and support plans. When changes occurred in people's personal and medical circumstances, care plans were reviewed to reflect these changes. People and their relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

People and relatives found the management team at Chaseview Nursing Home to be approachable and receptive. People's suggestions and comments were valued by the provider. Staff members believed their opinions and ideas were listened to by the provider and, if appropriate, implemented. The provider had systems in place to monitor the quality of service they provided and where necessary made changes to drive improvements. The provider learnt from incidents and accidents and worked in an open and transparent way.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We had also received information from members of the public who were concerned about the safety of people who lived at the home. This report only covers our findings in relation to those requirements and the safe question. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chaseview Nursing Home on our website at www.cqc.org.uk.

Chaseview Nursing Home provides nursing and residential care for up to sixty people. At the time of our inspection there were forty nine people living at the home. At the last comprehensive inspection we issued the provider with a warning notice to improve the way they managed medicines to ensure that people’s needs were met safely. At this inspection we saw that some improvements had been made but that further improvements were needed. We saw that the provider had implemented systems which meant that staff recorded when people did not receive their medicines as prescribed. However, these were not always followed fully to ensure that further errors were avoided. They also did not always take action to ensure that people had not been harmed when they had not taken their medicines. Similarly, when incidents were recorded which could mean that people were at risk of abuse these were not always reported to the relevant agencies to protect people.

Other risks to people’s health and wellbeing were assessed and managed. People were supported to move safely and any equipment that they used was regularly checked to ensure it was safe. There were enough staff to meet people’s needs and to keep them safe in communal areas. The provider continued to try to recruit new permanent staff because they recognised that people did not always feel as confident with agency staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60 people. There were 45 people living in the home at the time of our inspection.

This unannounced inspection took place on 11 May 2017. At our last unannounced inspection on 9 February 2017, multiple regulatory breaches were identified and the service was judged to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment from a sufficient number of staff that was responsive to their changing needs. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and drive improvements.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the management of medicines was safe and their internal monitoring was effective in identifying when errors had occurred.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

We found that medicine administration was not always safe and some people were not protected from the harm associated with their prescribed medicines. Staff did not understand the legal requirements for depriving people of their liberty to keep them safe and temporary restrictions on people waiting for assessment did not provide staff with guidance.

Risks associated with people’s care had been assessed but their management plans did not always reflect recent changes in their support needs. People’s level of support had been re-assessed and amendments had been made to the staffing levels to ensure people’s needs were met by a sufficient number of suitable recruited staff.

Staff understood how to protect people from abuse and poor care and how to assist them to leave the building in an emergency.

Staff training update had improved and there were arrangements in place to support staff with their development. Mealtime arrangements had improved and people with specialist nutritional needs were supported safely by staff with the training and competency to do so. People were provided with choices from a varied menu and regularly offered drinks. The advice and expertise of healthcare professionals was sought and followed by staff.

People were supported by kind staff who engaged with them and promoted their dignity whilst respecting their dignity. Relatives were able to visit whenever they wanted and were acknowledged warmly by staff. Staff knew people well and provided care which met their preferences.

There were activities for people to enjoy if they wished and they were given opportunities to reminisce with staff about their previous life experiences. People and their relatives knew how to raise concerns if they felt the need to do so.

The provider had been open and honest with people, relatives and staff about previous problems within the home. There was an audit programme in place to monitor the quality of care and an action plan to ensure improvements were made.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60, some of whom may be living with dementia.

There was no registered manager. A new manager had been appointed and was completing the process to register with us. This manager has since left the service. A registered manager is a person who has registered with the Care Quality Commission 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

People were not protected for harm because there were an insufficient number of staff to meet their needs and keep them safe. We had to alert the provider on three occasions because of our concerns for people’s safety relating to specialist nutritional care, a fall and the failure by staff to respond to a call bell which had been activated for 45 minutes. Staffing levels were based on an assessment of people’s individual needs but we saw this had not been completed correctly to reflect their requirements. Staff who should only have been shadowing experienced staff were left alone with people, including a person who presented with behaviours that challenged their safety and that of others, particularly staff. The way people’s medicines were managed required improvement. Some medicines had been refused but staff had not taken action to ensure the person’s wellbeing was not affected.

When people were seen by healthcare professionals their requests for investigation were not always done. People’s dignity was not supported because staff were delayed in providing personal care in a timely manner. The provider was using agency (temporary) staff but they did not know people or show an active interest in them or their welfare. Communication arrangements for agency staff were insufficient as they did not know about people’s long term conditions and behaviours.

People’s access to activities was limited because the activity co-ordinator was also fulfilling a care role. There was a complaints procedure however people were not always aware who to speak with to raise their concerns. People and relatives were provided with opportunities to share their views on the service but when shortfalls were identified there was no analysis or feedback to them.

The provider had improved the support they gave to people who were unable to make decisions for themselves. Staff were supported to attend training and gain nationally recognised qualifications. People were provided with a choice of food but there were no arrangements to support people who were living with dementia to pick their meals by using visual aids.

People had been asked about their likes and dislikes so that staff could provide care in the way they preferred. The provider had displayed their poster in a prominent position for relatives and visitors to see.

We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We undertook this focused inspection on 26 October 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chaseview Nursing Home on our website at www.cqc.org.

Chaseview Nursing home provides accommodation, personal and nursing care for up to 60 people. At the time of our inspection there were 56 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Staffing levels were at times insufficient to keep people safe and meet their needs. This was an ongoing concern following our last inspection. Relatives and staff did not feel their views about the number of staff available were listened to. People’s medicines were not always provided at the times they were prescribed and staff were not provided with guidance about some ‘as and when required’ medicines to ensure they were administered safely.

Some incidents where people had been at risk of abuse or poor care had not been reported or discussed externally as required. Some people’s freedom of movement was being restricted and causing them distress without the necessary legal permissions in place. Information about recent accidents was not readily available which demonstrated that communication within the home was not effective.

People’s risks had been assessed but the management plans did not always reflect the care they received to keep them safe.

People who lacked capacity to make decisions for themselves were supported by staff however the reasoning behind decisions made in their best interest was not always demonstrated. The provider had not met their own action plan in respect of mental capacity assessments and deprivation of liberty applications.

It was not clear what actions had been taken in response to shortfalls identified during the provider’s quality monitoring audits.

Staff were suitably recruited and received training to provide them with the skills they required to care for people. People were provided with a choice of food and drinks were offered regularly. People’s wellbeing was supported by healthcare professionals whenever addition guidance was required. People were asked for their views on plans for their future entertainment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the report.

At this inspection we found there were insufficient staff available to protect people from harm. Some relatives were unhappy about the registered manager’s response to their concerns regarding how staffing levels were managed. We also found that people’s ability to make choices had not been assessed and staff had not demonstrated why they had made decisions in their best interest, on their behalf.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

Staff were aware how they should protect people from the risk of abuse but some incidents of potential abuse had not been reported, as required, to the local authority and ourselves. People’s medicines were managed safely but guidance on the use of ‘as and when required’ medicines had not always been provided to staff.

People’s risk of harm associated with their care had been assessed and there were plans in place to ensure the risks were managed appropriately. Staff received training and support to provide them with the skills and knowledge to care for people effectively. People had a choice of nutritious food and plentiful drinks which met their individual requirements. Staff ensured that people who needed specialist care and treatments were referred appropriately.

Staff were kind and polite to people. Staff recognised people’s individual needs and provided care which met their preferences. Care was reviewed regularly to ensure it met people’s current needs. People’s dignity and privacy was promoted. People were supported to maintain the relationships which were important to them.

People were supported to take part in activities which interested them and had opportunities to socialise with members of the local community. There was a complaints procedure in place and people received verbal or written responses depending on their preference.

There were meetings provided for people, their relatives and staff to discuss changes in the home which might affect them. Staff felt well supported by the registered manager and were happy to approach them to discuss any issues. There was an audit programme in place to continually monitor the quality of the service and drive improvements for people.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had sent us with a written report which recorded the actions they had taken to ensure improvements had been made. We have spoken with the registered manager, who confirmed that the actions needed had been taken and implemented.

Staff had received further training in the Mental Capacity Act 2005 and the implications of the Act. Formal assessments had been completed for people who were deemed as lacking the capacity to make informed decisions about their care. This ensured that where people were unable to make decisions for themselves, action would be taken in their best interests.

Where decisions have been made for the action needed in the case of a medical emergency or for end of life care, do not resuscitate (DNAR) documents had been completed correctly and fully. This ensured people's personal preferences were upheld.

Consent had been obtained for the use of photographs for identity or monitoring purposes. This ensured that people were fully aware of and agreed to their photographs being taken and used.

At the time of our inspection 38 people lived at the home. We spoke with staff, visitors and people that used the service who were able to tell us about their experiences. One person told us: "The staff are very attentive to our needs". Another person told us: "It's nice here, staff are nice to me, they are patient if I don't understand what they are asking me.The food is good, I like it it's nice to chat with staff but they are busy".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people.

We looked at the care and support records of five people who were accommodated in the two units within the home. We spoke with staff, they told us how they provided care for people each day.The information recorded in the plans corresponded with what staff had told us. We did not see any formal process for assessing a person's capacity to make decisions or how decisions were made in the person's best interest.

We saw that staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care. The manager told us that additional training was being arranged.

We saw that records included the care and support needs for the people who used the service.

The provider has provided us with a written report which records the actions they have taken to ensure improvements have been made.

Arrangements have been made to ensure the views of people are sought and the information recorded in the care plans.

Staff have received training in the protection of vulnerable adults. Training in the Mental Capacity Act 2005 has been arranged.

Equipment is in working order and in sufficient quantities to meet the needs of people who used the service.