Cheriton Care Home

Cheriton Care Home is a residential care home, providing the regulated activity accommodation and personal care to up to 27 people. The service provides support to older people, including people with dementia. At the time of our inspection there was 15 people using the service.

Cheriton Care Home accommodates people in one building, over two floors.

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

People told us they felt safe and were accepting of their care. Relatives were happy with their family member's care. They commented “I’m very happy and pleased with the service.” Relatives felt their family members got safe care and were well looked after, with their health and care needs met. Relatives commented “I am very happy that he is safe. They(staff) do a fantastic job.”

Whilst risk management had improved, not all risks had been identified and mitigated.

Staff were not suitably deployed which impacted on the care given, access to person centred activities and the cleanliness of the service.

Areas of the service had been refurbished. However, further improvements are necessary to ensure the service is safe, clean and fit for purpose.

Records had been organised and systems set up to make them accessible. However, some records were contradictory, incomplete and not suitably maintained. Auditing had commenced. Further improvements are needed to ensure the audits are picking up the issues we found, so that these are addressed in a timely manner.

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.

People’s care plans were under review and development to make them person centred. Regular person- centred activities were not established. We have made a recommendation to address this.

Safe medicine practices were promoted. People’s health and nutritional needs were met. Systems were in place to safeguard people, including review and oversight of accident and incidents to mitigate the risk of reoccurrence.

Staff were suitably inducted, trained and supervised in their roles.

Systems were in place to enable people and their relatives to raise concerns. Issues raised were investigated and addressed.

The service had a new registered manager whom had made improvements to the service. They worked closely with the group compliance manager in setting up systems, auditing, and in developing the person-centred software. They had established links with relatives and were working with staff to develop and support them to improve practice to benefit people.

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 inadequate (published 20 May 2022) and there was breaches of regulations. 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 improvements had been made however, the provider remained in breach of regulations.

At our last inspection we recommended that the provider works to best practice in relation to learning from accidents and incidents, to improve their approach to developing staff and promoting good practice, to follow good practice to improve people's mealtime experiences, to seek advice from a reputable source about improving the environment for people with dementia, to be compliant with the Accessible Information Standard, to develop staff to become end of life champions and to improve their understanding of the duty of candour requirement.

At this inspection we found the provider had acted on the recommendations, made improvements and further improvements were planned.

This service has been in Special Measures since 20 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on the 4 March and 4 April 2022. 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. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well- led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, environment, dignity and respect and good governance at this inspection.

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.

Cheriton Care Home is a residential care home registered to provide care for up to 27 people. It was providing personal care to 19 older people and people with dementia aged 65 and over at the time of the inspection.

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

People did not receive safe care. Staff did not consistently follow good hygiene practices at the home, to prevent the spread of infection. For example, staff did not always wear face masks to keep their nose and mouth covered. Beds had been made with linen which was stained; in one case a valance was wet from urine. The risks of contamination and spread of infection had not been recognised, from the practices we observed.

Risks to people’s health and safety had not been adequately assessed and measures put in place to prevent avoidable harm. For example, people could easily open an upstairs fire exit door which led onto the fire escape steps. The provider was aware someone was known to tamper with this door but had not taken action to mitigate the risk of people being able to get onto the fire escape and try to get down the steps. There was a risk people could fall and suffer extensive injury.

Staff did not respond when someone was coughing whilst eating their lunch. There was no recognition the person may need some assistance or checking to see if they were alright. We were concerned staff were not alert to the risk of people choking. In another example, a person’s care plan had not been updated with guidance from a speech and language therapist regarding the correct texture of food and drink they required. There was a risk the person could be served with food and drink they could not safely swallow.

People lived in a building which had not always been maintained to a safe and comfortable standard. For example, a door closure was broken and had been taped together to keep it in place. We found a strip to seal a bedroom door in the event of a fire had come away. The provider was not aware of these and other maintenance issues we found. Staff were aware in February this year one person’s television was not working. Whilst we were at the home on the second day of the inspection, we saw the television was still not working and the person asked us if we could fix it for them.

The provider was unable to provide evidence of learning from accidents and incidents. We have made a recommendation about developing their approach, to prevent incidents recurring.

Improvements had not been made to make the environment more suitable for people with dementia. The premises were worn in places. Bedroom furniture provided by the home was basic and not always in good condition. Memory boxes had been placed outside some bedrooms. The idea of these boxes is for them to contain an item or items which are meaningful in some way to a person with dementia. This could be things such as a wedding photograph or postcard from a holiday destination. None of the boxes had been put to use.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; how the service implemented the policies and systems did not support this practice. Staff did not fully understand about mental capacity. We found some applications to deprive people of their liberty had been inappropriately made because people they related to did not lack capacity and could make their own decisions. Records of deprivations approved by the local authority were not accessible in the building. This meant staff did not know what restrictions were legally permissible and if any conditions were in place for these.

Staff told us they received training and support. However, we found the provider had not acted on a recommendation we made at the last inspection to carry out probationary assessments before staff were confirmed in post. We were only provided with evidence of one staff meeting taking place in the past six months. We were not assured about the quality of staff training as an induction record showed one member of staff had completed 11 training topics on one day. We have made a recommendation regarding developing staff and promoting good practice.

There was a detailed assessment format for identifying and recording people’s care needs. However, some important sections were left blank such as moving and handling and medical history. Good practice guidance was not being followed on recording the needs of people with diabetes. Care plans were not always focused on the full needs of the person or written specifically for their circumstance. For example, some information about medical conditions was generalised and did provide details of any symptoms the person experienced. We have made a recommendation regarding end of life care.

People were not always treated in a way which promoted their dignity. Interactions by staff were task-based rather than focused on the needs of people. There were few activities provided to keep people stimulated.

People were not always offered choices at mealtimes. Staff did not interact with people over lunchtime, just placed food in front of them without speaking. We were not confident dietary needs were being safely managed as there was little understanding about the needs of people with diabetes. Food was cut up for some people without there being a need recorded in their care plans. We have made a recommendation regarding meals and dietary needs.

There were some systems to seek people’s feedback but we were not provided with significant evidence of this. Improvements had been made to the complaints procedure, staff recruitment practices and medicines practice since the last inspection.

People spoke positively about the manager. However, in the manager’s absence, we found the provider was not aware how the home operated and could not locate records which should be in everyday use. This showed the management structure and processes were ineffective in ensuring people received good quality care. There was a lack of understanding about the requirement to be open and transparent under duty of candour and what was required to provide person-centred care. We have made a recommendation about improving understanding of duty of candour. The provider had not always notified us of events it was required to. The quality of people’s care had deteriorated from the previous inspection.

People’s feedback about the home was positive. One relative told us “I feel that the staff and management have worked efficiently and effectively during these challenging times, delivering a good quality of care.” Another relative said “Overall the care my (family member) receives at Cheriton is very good. The staff and management are kind, cheerful, helpful, welcoming, understanding and respectful to her individual needs.” However, we observed limited interactions between staff, the providers and people living at the home, there was no laughter or light-heartedness around the building and people had little to provide them with interest or stimulation.

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

This service was registered with us on 7 May 2021 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 3 April 2019.

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 the service developed its approach to recruitment of staff, prevention of injuries, improving the environment for people with dementia and assessing staff performance before they are confirmed in post. Further recommendations were made regarding fire practice evacuations, improving care plans for people with diabetes, improving the complaints procedure, developing the approach to the Accessible Information Standard and the duty of candour requirement.

At this inspection we found improvements had only been made to the complaints procedure, fire practice evacuations and recruitment practice.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 providing person-centred care, dignity and respect, notification of incidents, safe care and treatment, good governance, the condition of the premises and safeguarding people from abuse and improper treatment at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provi