We carried out an unannounced inspection of Chamwood on 21 November 2014. An unannounced inspection is when we enter and inspect the service without giving prior notice to the provider, people who use the service or the staff.
Chamwood is an eight bedded home that provides accommodation for people who require personal care. It has single bedrooms with en-suite accommodation. It is located in the Grimesthorpe area of Sheffield with good access to public services and amenities. Accommodation is on two floors. The home has two communal lounges and a kitchen/dining room. There is car parking to the side of the service.
There has not been a registered manager at the service since 2011. There was an acting manager who has been in charge of the service for the past 18 months. They told us that they had applied to CQC to become 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. The present acting manager covered two services. The provider had not made appropriate arrangements for sufficient cover of the day to day management of the service, which had resulted in the acting manager being unable to fulfil the full range of their duties and responsibilities satisfactorily.
During our inspection we saw insufficient action had been taken to maintain the building and the surrounding grounds belonging to the service. We saw that there was outstanding maintenance work with no written plans for completion. The service did not have a maintenance programme with timescales for action to show how and when the work was going to be completed. This meant there was no identification of the work which needed to be completed by the provider. You can see what action we told the provider to take at the back of the full version of the report.
We were informed by the acting manager that the fire risk assessment had been updated and all staff including the people who lived at the service were involved in the weekly fire drills.
We observed that the management of medication by staff was carried out in a safe manner. Staff were trained in the protection of vulnerable adults and there were systems in place to protect people from any abuse, bullying or harassment.
People commented that staff understood their needs and knew who they should go to seek additional help if they needed. One person said, “Staff give us the best support they can. I trust them”. They said there was plenty of staff and they were happy with the support.
Staff on duty said they had been supervised and supported by the acting manager and the deputy. They were very positive about the arrangements for training and development in place.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict them. DoLS is part of this legislation and in place so that where someone is deprived of their liberty they are not subjected to excessive restrictions. We found staff were knowledgeable about protecting the rights of people and making sure people gave consent to care. The staff members we spoke with had attended training in MCA and DoLS and demonstrated a good understanding of the legislation and how this impacted on their role.
We looked at the food and nutrition arrangements at the service. From the care files we noted people’s likes and dislikes had been identified and each person had an eating and drinking plan to meet their needs.
Three people told us they were involved in decisions about their wellbeing. They explained that staff gave them information in the way they understood and gave them time to digest and think about it. One person said, “They don’t get fed up when I ask them over again”. The deputy manager said that all the people at the service had a named next of kin and the acting manager told us they had access to an advocacy service if people needed assistance when making decisions.
We found people had contributed to their initial assessment and planning of their care. The documents identified people’s views about their strengths, levels of independence, their health status and aspirations. There was a lack of evidence of people being involved in care programme approach (CPA) meetings. CPA improves the delivery of service to people with mental illness and minimises the risk of them losing contact with mental health services. This meant there was a lack of evidence that people were in receipt of care that was specific to their mental health needs.
We found people had not been offered appropriate opportunities, encouragement and support to promote their autonomy, independence and community involvement through activities. There was an assumption by staff that people spend the day how they choose and they were there to help with people’s decisions. This had resulted in people spending their day without any structure, no routine or any organised opportunities for activities. We found the care plans on activities or working and playing needed revision as there was a lack of information about people’s activities or interactions and the daily notes did not capture how people spent the day.
People said they knew how to make a complaint and they had been given information on who they should complain to. People had access to written information about making a complaint. We found people knew how to share their experiences or raise a concern or complaint.
We saw some reports from the provider visits. They were not informative and did not have comments on action needed or the progress on the actions required. The system did not demonstrate that the provider continued to monitor the quality of service provided. This is due to the lack of evidence that assessment of quality and identification and management of risks had taken place during the provider monitoring. The acting manager told us that they did not have a system in place to supervise and check the home manager’s performance by the registered provider. This meant the manager was left to carry out their duties without any oversight by the provider.
You can see what action we have told the provider to take at the back of the full version of the report.