Chandos Lodge Nursing Home

Chandos Lodge Nursing Home is a care home providing personal and nursing care to older people and people living with dementia. The home can accommodate up to 31 people in one adapted building. At the time of our inspection 30 people were living at the home.

People’s experience of using this service and what we found

People were safeguarded from the risk of abuse or neglect, however we have made a recommendation in relation to the reporting and recording of safeguarding concerns. We have also made a recommendation in relation to systems for managing risk and learning from accidents and incidents. Systems were in place to assess a range of risks. Staff received training to equip them with skills to work safely and respond to risks.

People were supported by sufficient numbers of trained staff to meet their needs, however robust recruitment practices were not evidenced. Systems were in place for the safe administration of medicines, however we identified concerns in relation to the storage of topical creams and thickeners, and systems for the stock control of prescribed medicines. We also identified concerns in relation to arrangements for infection control including the use of personal protective equipment (PPE).

People told us they felt safe and we received compliments regarding staff approach and the quality of food. People’s comments included, “There’s absolutely nothing wrong in this place”, “The food is lovely” and “I don’t mind it here.” A relative commented, “[Staff] are kind and caring…they have got to know me as well. I can see that they have a good rapport with my relative.”

Some people provided more mixed feedback, with one person commenting “There’s a carer here who’s adopted me, like a mum…[however] the only way you can get any attention [at night] is to shout for it.” Another person commented, “The staff are wonderful…the building can be very hot and uncomfortable…it gets very noisy in here sometimes; the shouting.” People were encouraged to use the communal lounge where planned activities took place. We observed positive interactions between staff and people.

Governance systems were in place, however audits had failed to identify all of the concerns we found. People provided positive feedback regarding the manager. One person commented, “I know [name of manager]. He’s very nice”. Staff provided positive feedback about the management of the service and told us they felt supported. Most relatives also provided positive feedback regarding the service management and described examples of open and effective communication.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider arranged training in the management of Legionella and consider guidance about calculating staffing levels in accordance with people’s level of dependence. We found the provider had acted on these recommendations and made improvements in these areas.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance and safe recruitment procedures.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chandos Lodge Nursing Home on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe recruitment, managing risks and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chandos Lodge Nursing Home is a care home providing personal and nursing care to older people and people living with dementia. The home can accommodate up to 31 people in one adapted building. At the time of our inspection 28 people were living at the home.

People’s experience of using this service and what we found

People were not always protected from risks around unsafe recruitment. Records were not always held or fully completed in relation to staff’s prior conduct, suitability or employment history. Staffing levels were based on the number of people rather than their level of need. We received mixed feedback from people about staffing levels, although they did not feel this impacted negatively on their quality of life. We have made a recommendation about the calculation of staffing levels.

Legionella risks were not managed effectively; health and safety checks were not fully implemented and risk assessment actions had not been followed-up. We have made a recommendation about this. Systems were implemented successfully for other health and safety risks such as fire evacuation. People’s specific risks were identified and mitigated. Medicines were stored safely and administered to people as prescribed. Staff followed infection control procedures to reduce risk to people.

Management were not familiar with all regulatory requirements such as recruitment or legionella requirements. These areas had not been checked or identified as requiring improvement through the provider’s own audits. Quality assurance audits had been implemented and covered people’s care needs and other areas of risk. People, relatives and staff were positive about the leadership of the service and the standard of care provided. Management made sure that the Commission was notified of events in line with requirements.

Scheduled activities did not always meet people’s individual preferences to provide meaningful engagement. We have made a recommendation about this. People’s needs and preferences were assessed and documented, and staff knew people well. A complaints procedure was implemented to make sure concerns were investigated and outcomes were communicated. People’s end of life wishes were explored and recorded in care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were respectful of people’s rights and people felt they were treated well. Records showed that people and their relatives were involved in reviews of people’s needs and planning care. Staff demonstrated they valued and protected people’s privacy and dignity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 8 April 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to staff recruitment checks, understanding of regulatory requirements and ineffective monitoring systems at this inspection.

We are considering what action to take in light of the Covid-19 emergency. This is to make sure the action we take is proportionate, considers current risks to people's safety, as well as the potential impact of our actions upon people, care providers, registered managers and the wider system during this time.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chandos Lodge Nursing Home is a service registered to provide accommodation and personal or nursing care to older people. The service can provide accommodation and care to up to 31 people and there were 27 people living there at the time of the inspection.

People’s experience of using this service:

People told us they were safe at the service. There were a sufficient number of staff to keep people safe. However, people were not always protected from risks around unsafe recruitment as there was not always evidence available the provider sought evidence of staff conduct prior to the staff working with adults at risk. People received their medicines in a timely manner and the medicines were stored safely. However, we found where people received their medicines covertly (in food or drink) the provider did not adhere to the good practice guidance therefore we could not be reassured medicines remained effective. Risks to people’s well-being and individual conditions were assessed and recorded. Risks surrounding infection control were managed appropriately and the service was clean. Individual people’s accidents and incidents were recorded but there was no overview to monitor the accidents for any trends and lessons learnt. Arrangements around planning for emergencies, such as in an event of evacuation needed improving.

People were supported to make their own choices and staff were aware of principles of the Mental Capacity Act. However, we found there was not always written evidence available that people’s capacity to make specific decisions had been assessed. People were supported to access health professionals and any advice received was incorporated into the care planning process. People were encouraged to maintain a good diet and nutrition. Staff received ongoing training and told us they felt supported.

People continued to receive caring and kind support. We observed kind and caring interactions. Staff respected people’s privacy, dignity and their individual needs including people’s individual communication needs. People told us they built positive working relationships with the staff.

People received support that met their assessed needs. The feedback received from people, relatives as well as the records demonstrated people did not always receive meaningful activities in line with their choices, preferences and assessed needs. People knew how to raise any concerns, we saw complaints were managed in line with the policy. No people were receiving end of life support at the time of our inspection, people’s end of life wishes where appropriate, had been recorded.

There was a registered manager in post who was supported by a team of staff. The provider’s quality assurance processes were not always effective as they did not identify concerns we found during our inspection. This included the requirement to display the rating and to inform the Care Quality Commission about reportable occurrences. People and staff were involved and their views were sought. The team at Chandos Lodge worked well in partnership with other agencies and the local social and health professionals.

At this inspection we found improvements were required as the evidence gathered for Safe, Effective, Responsive and Well-Led domains demonstrated the service met the Requires Improvement characteristics. We found three breaches of Regulations 17 and 19 of the Health and Social Care Act 2008 (Regulations) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We also made one recommendation to improve the quality and safety of the service.

Rating at last inspection:

Good (report published 15 April 2016).

Why we inspected:

This was our scheduled, planned inspection based on previous rating.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in Detailed Findings below.

Chandos Lodge Nursing Home is registered to provide residential personal and nursing care for up to 31 older people. At the time of this inspection there were 29 people living there.

Chandos Lodge Nursing Home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission(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.

We previously inspected the service in December 2015. When assessing whether the service was; safe, effective, caring, responsive and well-led we found safe required improvement with effective, caring, responsive and well-led rated as good and the overall rating of the service as “Good”.

The areas assessed under safe at the previous inspection which required improvement were; inconsistent monitoring and recording of medicines and inconsistent recruitment checks. During this inspection, we followed up on progress by the home in improving these areas of its operation.

We also followed up concerns raised with CQC since the inspection of December 2015 about issues affecting the safety of people who used the service and staff. These were in summary; medicine administration, training for new staff to ensure they could provide safe care, problems with the heating and hot water system and the unsafe use of extension leads in conjunction with auxiliary electric heaters. Concerns also included staff recruitment and unreasonable restrictions placed on the use of personal protective equipment (PPE) by staff and of incontinence products by people who required them.

Staffing levels on the day of our unannounced inspection agreed with the staffing rota. During this inspection we observed people received care and support from an appropriate number of staff to do so safely.

In the staff recruitment records we saw, there was no evidence of staff working outside of their approved immigration status. Training records for the three most recently recruited staff included a basic induction into their role and the required initial training in, for example, moving and handling and safeguarding. This meant staff had the basic level of skills and competence to provide people with a safe standard of care.

Those staff we spoke with confirmed there were no unreasonable restriction placed upon the use of incontinence products for people’s use. The incontinence pads had a visual indicator to show when they required changing and were provided free of charge to the home.

The provider did monitor the use of, for example, protective gloves. They agreed they did try and avoid waste through inappropriate use or unnecessary changes of PPE during the provision of care. We have made a recommendation about this in the report.

Medicines were managed safely and people received their medicines, regularly and as prescribed. Whilst the times of morning medicines administration could vary, there was no indication that people were having their medicines at inappropriate or unsafe intervals. The covert administration of medicines was covered by appropriate safeguards and records.

Records for medicines administered only as and when required had improved since the previous inspection and in most cases now recorded the actual amount given. In one case, the variable dosage was not recorded. We were told by staff this was because there was not room to record it on the medicines administration record. We have made a recommendation about this in the report.

The provider accepted there had been problems experienced with the heating and hot water systems with the boiler failing for part of one day. They told us this had now been addressed. The maintenance staff member we spoke with and the registered manager, agreed there had been occasions when electric fires had been plugged into extension leads which were then plugged into a socket. There was no risk assessment in place to assess the risk of this practice which is not considered safe. We have made a recommendation about this in the report.

We previously inspected the service in June 2013 when we found the service was meeting the requirements of the regulations in place at that time.

Chandos Lodge Nursing Home is registered to provide residential personal and nursing care for up to 31 older people. At the time of our inspection there were 30 people living there.

Chandos Lodge Nursing Home had 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.

We received very positive feedback about the service from people who lived there. “They couldn’t do any better than they already are doing” and “Very welcoming and good communication” were some of the comments made.

Healthcare professionals told us the home referred people appropriately and staff were responsive to any advice or recommendations they made. They were positive about the standard of care records they saw.

Staff were provided with the skills and knowledge they needed to recognise and respond to any safeguarding concerns. Risk to people’s health, welfare and safety were appropriately and effectively managed. Risks to individuals were identified and risk assessments were in place which set out the action to be taken to reduce the likelihood of injury or harm to people during the provision of their care. There was a training programme in place for staff to provide and update them with the necessary skills and practical knowledge to meet people’s needs effectively and safely.

Staff recruitment was essentially satisfactory, although recruitment records did not always include evidence that applicants’ physical and mental health was satisfactory. We have made a recommendation about this in the report.

Medicines were managed safely and people received their medicines, regularly, on time and as prescribed. However, the records for medicines administered only as and when required did not always record the actual amount given. We have made a recommendation about this in the report.

Relatives were generally satisfied that there were sufficient staff to meet people’s needs.

Care plans were in place which set out people’s needs and how they were to be met. Care plans included details of people’s preferences for how they wanted to be supported. Care plans were reviewed and kept up to date to take account of changes in people’s needs.

The service was effectively managed. Staff told us they worked together well as a team. Several of the staff we spoke with had worked at Chandos Lodge Nursing Home for a number of years. This consistency of staff was something people who received care and support, their relatives and visiting health and social care professionals commented on positively.

The provider/registered manager constantly monitored the quality of care being provided, was active throughout the home and had a very high profile within the service as they provided support to the administrator and staff.

The nurse said that one member of staff was allocated to the lounge area to ensure people had their needs met whilst there. This staff member ensured people were comfortable, had drinks or nutritious snacks, and helped them with activities. Two people told us what a valuable service this gave to the people in the home.

We saw that the medications were stored and delivered safely, in accordance with good practice. Staff who gave medications were qualified and were trained to do so.

We read staff files and saw that good recruitment practices were in place. Their format and content ensured that staff had the knowledge and skills to meet the needs of people using the service.

The manager told us of checks undertaken to ensure the safety and quality of the home. They included care plan audits, medication checks and an infection control audit. These provided a monthly assurance scheme.

We examined staff and care records. We noted they were usually well written, and nearly always audited within the home's guidelines. We saw that storage of files was adequate.