Cheswardine Hall Nursing & Residential Home

Cheswardine Hall Nursing and Residential Home provides accommodation and nursing for up to 48 people in a large 19th century house. There were 31 people accommodated at the time of the inspection.

People’s experience of using this service

People told us they felt supported and listened to as individuals. However, the formal assessment and planning of people’s care in care records lacked detail in some instances with some important care needs omitted and not referenced. We made a recommendation regarding this.

We saw there were systems in place to monitor medication so that people received their medicines safely. All the people we reviewed had received their medications. We found some minor recording anomalies in the medication records and discussed improvements to help ensure continued safe standards.

The registered manager could evidence a series of quality assurance processes and audits carried out internally and externally by staff and visiting professionals. These were overall effective in managing the home and were based on getting feedback from the people living there. These checks and audits were mostly effective in identifying any issues that required further development. The managers of the home were very responsive in responding to feedback we gave.

Arrangements were in place for checking the environment to ensure it was safe. We found the environment safe and well maintained.

There was a positive and relaxed atmosphere in the home which we found to be homily and well run. People living in the home interacted freely and staff were seen to be caring and supportive.

We were given positive feedback from the people we spoke with who were living at Cheswardine Hall. They told us they enjoyed living at the home and their quality of life was good. People said they were well cared for. People were listened to and felt they had the support they needed to express their needs and wishes. People could make decisions and choices. They were treated with respect and kindness.

All the people we spoke with told us they felt safe and well supported. One person said, “I feel very safe because there are always staff that pop in to check on me and see how I am or if I want anything.”

The home was staffed appropriately and consistently. Staff could explain each person’s care needs and how they communicated these needs. People told us that staff had the skills and approach needed to ensure they were receiving the right care.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

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. We discussed how best interest decisions, in some instances, could be better referenced.

We saw people’s dietary needs were managed with reference to individual needs and choice. Meal times provided a good social occasion.

Rating at last inspection:

The last rating for this service was Good (published 4 January 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Cheswardine Hall nursing and residential home is registered to provide accommodation for 48 people who require nursing or personal care. Some of whom are living with dementia. At this inspection 27 people were living there. The provider informed us that they had made a decision to reduce the number of double occupancy rooms to single for people thereby reducing their overall capacity. However, they remain registered to provide accommodation for 48.

A registered manager was in post at the time of 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.

At the last inspection on 12 January 2015, we identified one area where the provider was not meeting the requirements of the law. We identified that staff and the management team did not fully understand and apply the principles of the mental capacity act. We asked the provider to make improvements to address this lack of understanding. Following publication of the report in June 2015 the provider sent us an action plan telling us what they would do to make improvements and meet the legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to increase their understanding and application of the MCA.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse.

People had individual assessments of risk associated with their care. Equipment required to reduce risks to people was provided promptly and was appropriate to people’s individual needs. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained and assessed as competent to safely support them.

The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if required.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an induction to their role and were equipped with the skills they needed to work with people.

Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People had positive and caring relationships with the staff members who supported them.

People and staff felt able to express their views and felt their opinions mattered. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently.

People were supported to eat and drink sufficient amounts to maintain good health. People’s personal likes and preferences were known by the catering staff who supported them to make decisions regarding their diet.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and encouraged feedback. People felt confident they were listened to and their views were valued.

We spoke with five visitors who expressed high levels of satisfaction with the service. A relative of a person needing palliative care told us, "They have definitely extended (the person's) life. Care has surpassed all our expectations".

People were involved in planning and reviewing their care and treatment. Where people did not have the capacity to do so, relatives were involved in making decisions in the person's best interests.

People's care records contained detailed information about their needs. They had access to a range of health care specialists as part of their care and treatment. People enjoyed breakfast in their bedroom. One person told us, "It relieves the pressure of having to get to the dining room. It is more relaxed". People were able to make choices about their daily lives.

People had a positive dining experience with many choices. Suitably nutritious food and drinks were available at all times with assistance from staff if needed.

There was a safe system of medication in place. People received medicines safely and as prescribed.

Staff recruitment checks were in place to ensure people were protected from potential harm.

Relatives we spoke with were also very complimentary about the home. One said the care was, "Fantastic", and described their relative as being, "As happy as they've ever been".

We saw staff taking time with people and treating them in a polite, respectful way. Staff were very attentive to people's needs.

We found that people had been involved in planning their own care. Care plans were person centred and were designed to help people retain as much independence and control as they were able to. One person told us, "They only give me as much support as I need".

We found that care plans were detailed and up to date and that they gave the staff the information they needed to support people. The staff told us they felt well supported by the management.