Chataway Nursing Home

Chataway Nursing Home is a residential care home providing personal and nursing care to up to 26 people. The service primarily provides support to adults living with mental health conditions. At the time of our inspection there were 22 people using the service.

People’s experience of the service and what we found:

We were not assured risks connected to the premises safety had been responded to in a timely manner. Following our inspection assurances were provided that all outstanding works would be addressed.

While people received care and support from regular staff who had the required skills, we found staff induction was not robust particularly for new staff members entering health and social care. We have made a recommendation the provider reviews their training and induction processes.

Medicines were not always safely managed. We found concerns in relation to the storage and safe administration of medicines.

People were not always 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; the policies and systems in the service did not support this practice. We have made a recommendation the provider reviews best practice guidance in relation to the application of the Mental Capacity Act.

The service previously followed a recovery model that focused upon health promotion and rehabilitation. However, at this inspection a bespoke recovery model was no longer deployed. We have made a recommendation the provider consults current guidance on rehabilitation support models.

Managers evaluated the quality of care and support provided to people. However, existing quality assurance processes were not always effective or completed in a timely manner as they had not identified the issues we found at this inspection.

People received care and support from a caring staff team and were involved in making decisions about their care. Staff supported people to remain socially engaged by participating in various activities.

Staff were observed to be kind and caring. People told us they were happy with the support they were receiving. Staff were safely recruited. The provider carried out the required checks on newly appointed staff before they started working at the home.

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

Rating at last inspection

The last rating for this service was good (published 13 August 2018).

Why we inspected

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

The provider has taken action to mitigate risks following our inspection.

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.

Chataway Nursing Home is registered to provide care and accommodation for up to 26 people with enduring mental health problems. The building is a large detached property situated in the Crumpsall area of north Manchester. The home provides both shared (twin) and single room accommodation arranged over two floors, accessible by both stairs and a passenger lift. All bedrooms have a wash hand basin and there is a shower room and three bathrooms for people to use.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, we have made one new recommendation regarding equality, diversity and human rights.

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 demonstrated they adapted the support provided in response to people’s changing needs to mitigate risks. People had comprehensive and individualised risk assessments in place which had been updated timely. We saw control measures had been implemented and reviewed regularly to ensure risks were managed and restrictions imposed were removed promptly and appropriately when the risk had reduced.

People’s health needs were assessed and people were supported to access the required support to ensure their physical health needs were addressed.

Staff developed meaningful relationships with people and treated people with dignity and respect. Staff demonstrated they understood people’s individual needs and tailored the support provided to attain the best outcomes for people.

The service was responsive to people’s individual circumstances and supported people to increase their independence and to exercise choice and control over their lives.

People who used the service were diverse and multi-cultural. The service also benefited from an equally diverse workforce that was reflective of the local community.

The service strived to ensure people were not socially isolated and maintained links within the local community.

The service was well-led and the registered manager and support manager were held in high esteem by people using the service and staff.

The provider was visible within the service and played an active role. This included a good level of oversight through audit, quality assurance and questioning of practice.

Chataway Nursing Home provides nursing and personal care for up to 26 people with enduring mental health needs. There were 23 people currently living at the home. Three people were in hospital at the time of our inspection.

The manager had commenced employment at the service in August 2016. At the time of our inspection she had applied to be registered with CQC as the registered manager. Following our inspection, she became registered with CQC as a registered manager. 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 told us that they felt safe at the service. Positive feedback was received from the health and social care professionals whom we contacted. There were no ongoing safeguarding concerns and staff were knowledgeable about what action they would take if abuse was suspected.

We found that the management of some people’s finances did not follow best practice guidelines since designated staff were appointees for certain people. The manager was aware of this issue and told us that there was a back log of appointeeship referrals at the local authority and she was liaising with people’s care coordinators to resolve this issue.

Checks and tests were carried out to ensure the safety of the premises. There was a no smoking policy inside the home. There was a designated outside smoking hut for people to use.

Medicines were managed safely. We checked medicines administration records and noted that these were completed accurately.

Risk assessments were in place which had been identified through the assessment and care planning process. This meant that risks were minimised to help keep people safe. Accidents and incidents were monitored and no trends or themes were identified.

Recruitment checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. People told us and our own observations confirmed that there were sufficient staff deployed to meet people’s needs.

Improvements were required to ensure the design of the premises met the specific needs of people. We have made a recommendation that the design of the premises meets the specific needs of people who lived at the home.

Not all staff had completed training relating to the specific needs of people who lived at the service, however, plans were in place to source additional training. We have made a recommendation that training is carried out to ensure that staff can meet people’s needs. Staff told us that they felt supported. A supervision and appraisal system was in place.

Staff followed the principles of the Mental Capacity Act 2005. Further improvements were required however, to ensure there was documentary evidence to demonstrate how the requirements of the MCA were met with regards to people who had fluctuating capacity because of their mental health illness.

People’s nutritional needs were met. The chef and staff were knowledgeable about people’s dietary requirements. People had access to a range of healthcare services.

People told us that staff were caring. One relative said, “Chataway is a compassionate caring home.” We saw positive interactions between people and staff.

People told us and our own observations confirmed that staff promoted people's privacy and dignity. The manager had ordered dignity screens for all shared rooms to promote people’s privacy. We saw evidence that people were involved in their care and treatment.

Care plans were in place which detailed the individual care and support to be provided to people. A life skills coordinator was employed to help foster people’s well-being through social inclusion. The service worked in partnership with local community businesses and charitable organisations to help meet the needs of people.

There was a complaints procedure in place. Action to address complaints was documented.

There was an effective system in place to monitor the quality and safety of the service. Various audits and checks were carried out. Actions were taken when any deficits in standards were identified. We looked at the maintenance of records and saw that care files were stored securely. The manager was able to locate all records we requested promptly.

There was evidence that people and staff were involved in the running of the service. Feedback systems were in place to obtain people's views. Meetings and surveys were carried out. One relative told us that they would like to be more involved in the service. Staff told us that morale was good and they enjoyed working at the service.

The manager had submitted notifications to CQC in keeping with their obligations under the Care Quality Commission (Registration) Regulations 2009.

The home had a robust recruitment process in place which included a check with the Disclosure and Barring Service (DBS). This ensured support workers employed at the home were not barred from working with vulnerable people.

We spoke with a newly appointed member of staff who told us: 'I had to fill in an application, have an interview, give references and wait for my DBS to come back before I could start work.'

CQC has a statutory duty to monitor the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw there were policies and procedures in place and training had been provided for staff in relation to the Mental Capacity Act and DoLS Codes of Practice.

We spoke with support staff who showed an awareness of the process and were able to identify when an application might be required. There had been no applications made to deprive people living in the home of their liberty.

We spent time observing how support staff interacted with people who lived at the home. We saw staff approached people with respect and worked to maintain people's privacy and dignity.

We spoke with ten of the people who lived at the home who told us: "The staff ask me what I want to do and help me if I need help.' 'They ask me if it is alright to help." "I can decide what I want to do." 'I like it here.'

We saw risk assessments had been carried out in relation to the environment and this included a general emergency evacuation plan (GEEP).

There were policies and procedures in place to help minimise risks. The support staff we spoke with were aware of the safeguarding and whistleblowing policies and procedures and their responsibility to report poor practice.

Is the service effective?

We looked at a sample of people's support plans and saw evidence to show people had been involved in planning their support. This meant people received support in the way they wanted. We saw support plans had a social history and a life map that gave detailed information about the person.

The people we spoke with told us there were forums in place for them to express their views and opinions about the service they received. People told us they had regular 'residents meetings' and an annual questionnaire. We saw minutes were taken during residents meetings and we saw topics such as; changes, activities, new staff and menus. We looked at the most recently completed quality assurance survey and saw comments were positive.

During our inspection we saw people were able to speak to the manager if they wanted to. People told us the manager spoke with them on a daily basis.

Support staff demonstrated a good understanding of people's care and support needs. We spoke with people who lived at the home and their comments included: 'They explain what they are doing.' 'They ask me what I want.' 'They know what I like and I am happy here.' 'We are like one big happy family here.' 'The staff are nice.' 'I get the help I need.' 'It's alright here, I am happy.'

Staff training records showed staff received relevant training to improve their skills and knowledge.

Is the service caring?

We spent time observing the interactions between people who lived at the home and staff. We saw support staff were patient and support was provided in a patient and sensitive manner.

We looked at a sample of people's support plans and found they contained information about preferences and interests. This meant care and support was provided in the way the person wanted.

We spoke with people who lived at the home. Comments included: "They know what I like." "The staff show respect.' 'They ask me what I need.' 'They know how I like things done."

Is the service responsive?

People's needs had been assessed before they moved into the home. We saw support plans were reviewed on a regular basis. Where there had been changes to a person's support needs; support plans were amended to ensure the person's needs were met.

We saw there was a complaint policy and procedure in place and people were given a copy in their information pack.

The people we spoke with told us there were a variety of activities arranged. One person told us: "There's always something going on." 'We go out to the shops or to the pub.'

The lifestyle coordinator showed us the activities plan that included; bingo, gardening group, art therapy, cinema and trips out for coffee or lunch.

People told us: "We have meetings to talk about changes and activities."

Is the service well led?

The people we spoke with told us they liked the manager. Comments included: 'The manager is nice she listens.' 'I can talk to her (manager) anytime.'

There were systems in place to monitor the quality of the service they provided. These included surveys, audits and resident and staff meetings.

Comments made by people who lived at the home and their representatives were used to improve the service. This showed the provider took people's views into account.

We spoke with care staff who told us they were well supported by the management team. Comments included: "We have trained staff meetings as well as general staff meetings.' 'This manager has been supportive.' 'I have supervision about every three months but can raise any issues with the manager as they arise.'

One person told us: 'We are treated like kings in this home. I have nothing to complain about we are well cared for.'

Another person said: 'Staff here are nice they treat you nice.'

We found that people were supported to take part in activities of their choice in their local community and at times which best suited them.

We found that each person had a care plan which detailed their care needs and how these were to be met. We found that care plans were reviewed on a regular basis and that nursing staff and care staff had access to up to date information about people's presenting care needs.

People told us they had no complaints but if they did they felt comfortable about raising issues with staff and they felt listened to.

We found measures were in place which ensured that people lived in a clean and hygienic environment.

We found that staff were not employed at the home until all pre-employment checks were in place.

We found that the home was sufficiently staffed to meet the needs of people who lived there.

We found that people were not fully protected against the risk of abuse because incidents were not always recorded and there wasn't a full audit trail of events and actions taken by staff in response to events.

One person told us; 'I like living here. If you don't feel well they look after you. They got me better'.

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People were consulted about their care; how they preferred to spend their time and people were asked for their opinions of how the home was run. For example people had requested that the garden area was improved and as a consequence of this a garden group was set up which included a number of people who lived at the home.

We found that all care plans and other care records had been reviewed and updated since our last inspection and this meant that peoples care needs were being fully met.

We found that the way in which the registered provider and care staff responded to safeguarding concerns had improved and staff were managing risks in a proactive way.

We found improvement in the quality and standard of the environment with many areas having been redecorated and there were plans in place to improve other areas of the home.

It was alleged that care planning arrangements did not ensure that the needs of people who use the service were fully met and because of this people were not safeguarded from abuse.

It was alleged that people's dietary and cultural needs were not being met, that staff were not properly recruited and that there was a high turnover in staff employed at the service.

We were told that equipment used by staff was not safe or fit for purpose.

People told us that they liked living at Chataway nursing home and one person said, 'The staff here are great'.

People told us that they were provided with Halal food and they liked this because it was important to them because of their religious beliefs.

We visited the service in September 2012 and made three compliance actions in respect of standards of care provided at the service. We did not look at these areas of non compliance during this inspectio and we have plans to follow these up at a later date.

We found some of the day to day routines of at the home were inflexible and did not promote peoples autonomy and independence.

We found that staff were appropriately recruited with all pre employment checks in place and we found that staff were trained but would benefit from additional training in how to provide person centred care.