Cheriton Care Home

Cheriton Care Home is a residential care home providing personal care to 56 people aged 65 and over. The service can support up to 71 people across two separate wings known as Badbury and Maumbury. The service does not provide nursing care.

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

Staff spoke knowledgably about how to identify and report potential abuse. Staff were recruited safely with the service ensuring all necessary identity checks were completed before staff commenced their employment at Cheriton Care Home. There were adequate levels of staff available on each shift to ensure people were cared for safely.

Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training and had their competency regularly checked.

The service was compliant with guidance and safe processes relating to COVID-19. Cleaning and infection control procedures followed the relevant COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance regarding COVID-19 testing for people, staff and visitors was being followed.

People and their relatives told us they or their loved one enjoyed living at Cheriton Care Home, they felt safe and received a good level of care and support. People were relaxed and comfortable with staff who knew them well and supported them in ways they preferred.

There was a clear risk assessment system in place. Risks to people’s health, safety and well-being were regularly assessed, reviewed and updated. Where appropriate, people and their families were included and involved in their care and support.

There was an effective governance system in place. There were a variety of action plans, audits, policies, spot checks, systems and procedures to monitor the quality and safety of the service. These ensured a culture of continuous improvement and learning took place and highlighted any potential shortfalls.

People, relatives and staff felt the service was well led. Staff spoke positively regarding the registered manager and the management team and felt well supported within their roles.

The service worked closely with a variety of health and social care professionals to ensure people received timely and effective care and support.

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 16 March 2019).

Why we inspected

We received concerns in relation to the management of risks, the care and support people received and the management culture. As a result we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained at good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

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.

Follow up

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 providing personal care to 56 people aged 65 and over at the time of the inspection. The service can support up to 71 people across two separate wings known as Badbury and Maumbury.

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

We received feedback that indicated a lack of robust systems around ensuring people were eating and drinking enough. People were offered regular drinks and referrals were made to support people who were at risk of not eating sufficient amounts. We found the oversight of people’s fluid intake was not monitored sufficiently. The provider identified an issue that had arisen with the electronic recording system and acknowledged the impact of this on their oversight of fluid intake. They implemented more robust measures immediately. We have made a recommendation about this.

People lived in a home that was kept clean. One person who had worked in health services told us they had high standards and they thought the home was kept clean. We noted that care staff were not doing additional cleaning of touch points after the housekeeping staff had left. The registered manager implemented this straight away. This is important to reduce the chance of cross infection.

People were supported by staff who were kind and knew them well. One person told us “I am very happy. The staff are very kind and welcoming.” Another person said “The staff are kind and helpful. I quite like it here.”

People were supported by staff who understood how to reduce the risk of cross infection. Staff wore personal protective equipment (PPE) and mostly demonstrated good hand hygiene practice. The registered manager addressed issues identified during the inspection immediately and effectively.

People were supported by staff who were clear about their roles and what people needed from them. There were enough staff deployed to meet people’s needs.

People were being supported to see visitors safely, and to go out of the home, in line with current government Covid-19 guidance. At the time of our visit, essential care givers and those whose loved ones were receiving end of life care were able to visit in doors due to a Covid-19 outbreak. Essential Care giver status is given to a relative or friend in order that they can provide enhanced emotional or physical support to a person to ensure their well-being. Essential care givers are subject to the same testing regime as the staff in the care home and can visit more frequently and for longer to provide the identified support. Outdoor visits were risk assessed on an individual basis.

Staff told us they felt supported by each other and the senior team.

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 16 March 2019)

Why we inspected

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.

We inspected and found there was a concern with ensuring people were getting enough to eat and drink so we widened the scope of the targeted inspection to include this question. We were assured by the provider’s actions.

Maumbury Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Following a change in their registration the home no longer provides nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 37 people across two floors, each of which has separate adapted facilities. At the time of our inspection 24 people were living at the home.

The service had 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.

Over the last three years the home has been rated requires improvement on three occasions and inadequate in June 2017 when it was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During the December 2017 inspection the service demonstrated to us that improvements had been made and it was no longer rated as inadequate overall or in any of the key questions. Therefore, this home was taken out of Special Measures. As we required the home to demonstrate that it could sustain the improvements we observed it was rated requires improvement.

Since the June 2017 inspection the provider had, on request, submitted monthly action plans to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during the December 2017 inspection the action plan had been followed and improvements had been made.

People, relatives and staff felt the home was safe and well led.

The home had advised us and the local authority safeguarding team of notifiable events such as serious injury or safeguarding incidents between people living at the home. These notifications are a legal requirement.

Systems and processes were in place to assess, monitor and improve the service, such as audits and daily checks. Required actions had been taken following audits.

The home used a dependency tool to work out how many staff to deploy to meet people’s needs. Although some staff told us they felt rushed in the mornings the dependency tool indicated there were enough staff to meet people’s needs. At the time of the previous inspection staffing levels exceeded people’s needs. Now that numbers of people living at the home had slowly been increasing staffing levels now matched requirements. People, and their relatives, told us they felt their family member’s needs were being met and did not raise any concerns with staffing levels at the home.

People were supported by staff who understood the individual risks they faced and valued their right to live as full lives as possible. People’s personalised risk assessments were updated following accidents or incidents such as falls.

Medicines were managed safely. People received their medicines on time and at the prescribed dose.

Staff knew how to recognise and report signs of potential harm or abuse and had received safeguarding training. They told us that they would feel confident raising concerns internally and, if needed, to external agencies such as CQC, the local authority or police.

Staff received appropriate support through a combination of supervision, training, team meetings and competency checks to help them carry out their duties effectively.

Staff supported people in line with the principles of the Mental Capacity Act 2005 (MCA 2005). Where required mental capacity assessments and best interest decisions had been made.

People were consistently treated with dignity and respect and supported by kind staff who gave them every opportunity to make decisions about the care they received.

People received personalised care that was responsive to their individual needs and reflected their preferences, likes and dislikes.

Care records were detailed and accurate and included people’s end of life care needs.

Fire procedures for visitors and signage were now clearly displayed in the home. This had been addressed since the previous inspection. People had personal emergency evacuation plans (PEEP) in place. These guided staff on how to help people evacuate the home safely in the event of an emergency such as fire or flooding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to people’s needs for example, some people were diabetic or had vulnerable skin and staff had been trained in this area.

People and relatives told us that they were happy with the food offered at the home. We reviewed the menu which showed that people were offered a range of healthy meals.

People were supported to access healthcare appointments as and when required and staff followed professionals’ advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen GPs, district nurses and opticians.

People, professionals and relatives told us that staff were caring. We observed many positive interactions between staff and people.

Staff treated people with kindness and respect. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well and could interact in meaningful ways with them.

People had their care and support needs assessed prior to moving to the service. The care plans were regularly reviewed by the service with people, families and relevant health and social care professionals.

People were encouraged to feedback. We reviewed the resident’s and relatives survey results which contained mainly positive feedback. Improvements had been made in relation to activities provision in relation to people’s feedback.

The home had a system to record complaints. This recorded the detail and actions taken to resolve the identified issues. The registered manager told us that lessons were learnt and shared with staff in meetings and at handovers. Records and our observations confirmed this. This demonstrated that the service acknowledged people’s concerns and looked to resolve and learn from them. The laundry system had been reviewed and improved. Only one complaint had been received since the previous inspection and this had been investigated and resolved.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them. Staff felt recognised and that they were supported to progress.

Maumbury Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 37 people across two floors, each of which has separate adapted facilities. At the time of our inspection 14 people were living at the home.

We have summarised the paragraphs further to now read; At the last inspection on 21, 22 and 23 June 2017, Improvements were needed in relation to people’s care and treatment, medicines, staffing, people’s dignity and respect, care records and the governance of the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during this inspection the action plan had been followed and improvements had been made.

The service had not had a registered manager in place for 537 days. 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. A new manager had been in post for eight weeks and was in the process of registering with us. The provider had employed an interim operations support manager, who had been in post since July 2017 and been based in the service supporting the home and staff team.

Fire procedures for visitors and signage was not clearly displayed in the home. The manager acknowledged this and told us they would address this as a priority. People had personal emergency evacuation plans in place and fire test took place regularly.

People and relatives fed back saying that laundry often went missing. The service told us that they would review the laundry system.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date.

Improvements had been made to staffing levels within the home. Staff and people confirmed that they felt there were suitable numbers of staff to deliver care to people. Staff confirmed that improvements had been made around staff support. For example, better communication, supervision and organisation.

People, relatives, a health professionals and staff told us that the service was safe. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Improvements had been made to ensure medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were diabetic and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment of capacity assessments and best interest decisions.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People, professionals and relatives told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People were encouraged to feedback. We reviewed the resident’s and relatives survey results which contained mainly positive feedback. Improvements had been made in relation to visitors accessing the home in response to people’s feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. The registered manager told us that lessons were learnt and shared with staff in meetings. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them. Staff felt recognised and that team moral was good.

People and staff felt that the service was well led. The registered and service manager both encouraged an open working environment.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Improvements had been made to quality monitoring systems within the home. Audits and additional daily checks were completed by the manager and quality lead. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate.

The home is registered to provide accommodation and residential or nursing care for up to 37 people. At the time of our inspection there were 32 people living at the home, some of whom were living with a dementia. The home is set out over two floors.

When the service was last inspected in February 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not consistently being managed sufficiently to ensure people always received safe care and treatment, and the systems in place to monitor the quality and safety of the care people received were not fully effective. As a result of the findings of the inspection in February 2017, we served a notice of decision to vary the conditions of the provider’s registration . We required the provider to report to the Care Quality Commission about the safety of people's care and how this was being monitored.

This inspection was brought forward because serious concerns had been raised by the local authority safeguarding team, health care proffessionals such as GP’s and people’s families. These included concerns about the safety and welfare of people. During this inspection, we found serious concerns about the care and treatment for some people living at the home consistent with the concerns raised by the local authority.

The home did not have a registered manager at the time of our 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. The previous registered manager left in June 2016. There was an acting manager in post who was also responsible for managing one of the provider’s other homes.

The systems in place to assess, manage and mitigate risk had not identified the concerns CQC identified during this inspection. The provider had identified some concerns relating to the service and they had put plans in place to mitigate risks. These included providing additional management support, However, these actions were not sufficient to ensure people received a safe, effective, caring, responsive and well led service.

People did not always receive their medicines when they needed them, risks to people were not always identified and where people had fallen staff did not always respond to ensure people’s safety. There were serious shortfalls in one person’s end of life care provision.

There were not enough staff or activities available to meet people’s social, emotional and wellbeing needs. Staff did not always follow health professional advice. Staff did not receive support and training required to support them in their role.

People’s rights were not protected because staff had not acted in accordance with the Mental Capacity Act 2005 (MCA). People’s mealtime experience was mixed. People generally commented positively about the food, and food was prepared to meet their individual needs.

People were not always treated with dignity and respect and their privacy was not always respected.

People’s care needs were not fully assessed and planned for. Care plans included contradictory and inaccurate information. Care records did not always reflect the care detailed within the care plan.

Quality assurance systems were ineffective at identifying and addressing shortfalls in the service provided. The provider had not always notified us of significant events which had occurred in line with their legal responsibilities.

Staff were aware of the procedures to follow if they suspected someone was being abused. The provider followed safe recruitment procedures.

People and their relatives told us they mostly liked the staff that helped or supported them. Some staff were caring in their approach and smiled when they interacted with people.

People and their relatives knew how to raise a concern or make a complaint. There were systems in place for people, staff and visiting professionals to give their feedback on the service.

Staff felt able to approach their managers and raise any concerns.

We have made recommendations to the provider relating to follows national guidance in relation to ensuring the environment fully meets the needs of people living with dementia and reviewing how they support people to experience a positive meal time experience.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 two of these were repeated breaches. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. We are considering the action we are taking and will produce a further report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection took place on the 16 and 20 February 2017 and was unannounced.

The service is registered to provide accommodation and residential or nursing care for up to 37 people. At the time of our inspection the service was providing residential care to 35 older people some of whom were living with a dementia.

The service did not have a registered manager at the time of our inspection. The last registered manager of the service had left in May 2016 and the current manager had applied to take on this role. 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.

We inspected Maumbury Care and Nursing Home in November 2015 and there were breaches of regulation related to how people were supported in a personalised way and their dignity respected, how risks were managed and how the quality of care people received was monitored and improved. We rated the home as requires improvement in all areas we looked at. At our recent inspection we found that improvements had been made and people now received care that was personalised and upheld their dignity. There had also been improvements in how risks were managed but these were not sufficient to ensure people always received safe care and treatment. We also found that improvements to how the quality and safety of the care people received were monitored were not sufficient.

Staff understood the plans people had in place to eat and drink safely. The menu offered a variety of main meals and snacks and catered for individual likes, dislikes, allergies and special diets. However, the risks people faced related to eating and drinking enough had not been consistently managed or actions taken in order to minimise the risks. For example: referrals hadn’t been followed up, food and drink charts were not being completed consistently and people who had their food pureed did not consistently receive snacks between meals. Staff did not always have accurate information about changes to people’s risks.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified actions had been taken to improve outcomes for people.

People were supported by staff who felt supported in their roles. Staff received an induction and on-going training that enabled them to carry out their roles effectively. Some training was not current at the time of our inspection the manager shared plans about ensuring this was rectified.

People were supported by enough staff that had been recruited safely and understood their role in identifying and reporting unsafe practice or potential abuse.

People’s medicines were ordered, stored and administered safely. Peoples prescribed creams were being administered but not always recorded correctly. People had access to healthcare when it was needed.

People were supported to make choice and determine how they spent their days. Staff supported people to make choices about their day to day care and obtained consent in line with the principles of the Mental Capacity Act.

Care staff were kind, patient and friendly and respected people’s privacy and dignity. They had a good understanding of what mattered to people and used this information to support meaningful interactions.

People were supported by staff who understood the information held in their care plans. People and their families were involved in decisions related to their care.

People enjoyed the activities available to them. Some relatives felt that more activity was a priority and the manager told us that they were addressing how best to meet people’s needs for meaningful activity.

People, their families, staff and visiting professionals all described the manager and staff approachable. They knew how to make a complaint and felt they would be listened to and any actions needed would be taken. Staff felt appreciated and understood their roles and responsibilities.

We had concerns about risk management and quality assurance in the home. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.