Chipstead Lake - Care Home Physical Disabilities

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff understood how to support people to make decisions and people’s right to make informed decisions even if they are unwise. However, records did not follow best practice guidance, people’s capacity assessments were poor and best interest decisions were not recorded. Decisions made at people’s previous care home had not been reviewed or reapplied for as required. People’s needs had been assessed using nationally recognised tools. However, these assessments had not been reviewed when people had been identified as high risk, such as skin damage or weight loss. Some people required their food and fluid intake to be monitored. Records were not accurate, these records were used to make decisions about people’s care. There was a risk people would not receive appropriate care. People were supported to live as healthier lives as possible. Staff worked well with other healthcare professionals.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not have feedback about how their needs were assessed and how this was done. We found assessments had not always taken place before people moved into the service and there was no evidence people’s needs were regularly assessed as individual’s information was not dated and not always reviewed.

A staff member told us 2 people had moved from other homes the provider managed. People's needs had not been assessed to check if the service could meet their needs.

Assessments had not been undertaken before people moved into the service, to check if the staff could meet their needs and to commence developing initial care plans before people arrived to ensure a safe transition. We asked the management team for the initial assessments for the 2 most recent admissions to the service as they were not in their care files. We were told assessments had not been completed before their admission. When people had not been assessed before moving into the service, there was a risk they may not have their needs met or be living in the most appropriate service. Some people’s needs assessments contained detailed guidance on important aspects of their support, such as communication or modified diets, but we could not be assured these were up to date and reflected people’s current needs as records were not dated. Needs assessments were not updated with important information for staff. For example following an incident the registered manager told us staff were not to attend to a person by themselves. This information was not present in the person's assessment.

Relatives told us they thought staff provided good support to people. A relative told us, “This week I got a call from staff, (person) had a fit and she gave her medicines and was letting her sleep it off, I said to her ‘thank you so much’.

Staff told us, they were required to complete daily logs of bowels movements and food and fluids. They would raise any concerns at handover and to team leaders and managers. For example, it is known that if one person has not opened their bowels for three days the DN and GP are to be called and increase the person’s laxatives as a first measure. However, daily records were not always kept up to date, so the safety measures in place were reliant on staff knowledge.

Assessment tools such as Waterlow, to assess people's skin and nutritional tool MUST had not always been completed monthly people were at very high/high risk as directed for the assessment tool to be effective. There were systems in place to make sure people received food and drink appropriate to their needs. People’s dietary needs were communicated to the kitchen staff and staff were clear on what support people required with eating and drinking.

People were invited to vote for who they considered employee of the month, at each monthly residents meeting. People were asked for their vote and then a member of support staff is named as the employee of the month. Residents' meetings also seek feedback on what is working in the service and where staff teams could focus their improvements.

Activities staff as well as care staff, helped support people at breakfast or through parts of the day if required. The registered manager and deputy manager also work supporting people when required.

Feedback from partners was positive about the new registered manager. They told us they felt the registered manager was responsive and confident corrective action would be taken where necessary.

People had been assessed by healthcare professionals such as speech and language therapists (SaLT) and dieticians. However, where people had moved into the service from another home, they were not re-referred to the local team to check the assessments were still relevant and up to date. One person had a SaLT assessment dated 2022, when they lived in a previous care home. They were assessed as requiring a modified diet. Staff had not referred them to the SaLT team again to check if the guidance they were continuing to follow was still safe and relevant to their current needs.

People were supported to attend appointments with healthcare professionals to help to prevent health issues. We saw evidence people had been to the opticians, and for diabetic eye screen appointments, mental health care, chiropody. The service had a good relationship with the GP who checked people’s health every week and visited when needed.

The provider employed an in-house physiotherapist and assistant who supported all the people living in the service.

Staff reported any concerns at handover and in the daily records so these could be raised quickly with the health professionals, to reduce the risk of people becoming unwell.

A relative told us their loved one was not always supported in the way they preferred and their care had not been evaluated. They told us, staff did not always take the same action when their loved one became unwell. Some staff supported the person within the service and other staff sent them to hospital. We reviewed the person's care plan and there were no guidelines for staff about how to support the person when they were unwell, leaving them at risk of not receiving appropriate care.

Staff told us that they provide care to people in a way that encourages people to get the most from their support. We saw staff knew people very well and knew if they had a particular goal they wished to achieve.

Although care plans had sections where people’s goals were recorded, not all people had them, there was no evidence if they had been achieved or were making progress towards them. Some goals recorded were inappropriate, such as my goal 'Epilepsy'. One person had very in-depth goals they wished to achieve however there was no evidence these had been reviewed or achieved in line with the persons wishes and aspirations. Care plans held details in how to support people emotionally and physically, to make decisions and choices. These were sometime very detailed however we cannot be assured that these are accurate or up to date. Staff had not provided a date when the goal had been written.

People were not being supported following the Mental Capacity Act 2005 (MCA). People's capacity had not been assessed following guidance, there were blanket statements such as ‘x does not have capacity to consent due to him having a severe learning disability, there was no information about which decision this related to. Some people's capacity had not been assessed and there was no evidence best interest decisions had been recorded or completed following the guidance.

We observed staff asking for consent from people before providing support to them. Staff told us they always respected people’s choice, even when it may be unwise, if they understand those risks it's their choice. Staff told us, “I treat residents with as much respect as possible, I ask them their choice of wash or shower, help with their choice of clothes, brushing their teeth and not forcing them, if they say no, I document that”

The provider had processes in place but these had not been adhered to by staff. Although documents such as risk assessments and care plans recorded that a person did not have capacity to make decisions, mental capacity assessments had not been undertaken to determine which decisions people lacked capacity for. Records were not always in place to evidence best interest decision making. A choking risk assessment for one person recorded in one part that the person did not have capacity. In a different part of the risk assessment, staff recorded the person was ‘happy with it’. Provider policy required additional forms to be completed if people did not have capacity. These records had not been completed and were not attached as directed. The name at the bottom of each page on one person's risk assessment was not the name of the person who it referred to on the front or whose care file it was in. Staff had not always recorded best interest decisions when they had been made, for example, when equipment was being used to monitor people, in the least restrictive way. A Deprivation of Liberty Safeguard (Dols) application had been made but this was 03/04/2023, staff had not followed up the application. People's DoLs applications are only relevant when they are living in that care home, staff had not completed applications when people moved from other care homes to Chipstead Lake. There was a risk people may have restrictions in place, without the relevant decisions being made. Some people had signed themselves to give consent to their care and treatment but many care plans did not contain any signatures for the person or their representatives.