Chapelfields

Chapelfields is a residential care home providing personal and nursing care to 51 people at the time of the inspection. The service can support up to 70 people. Chapelfields is a detached, adapted building spread over 2 floors.

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

There were a range of meetings taking place, which included people, their relatives and the staff team. However, the frequency of these meetings was sporadic at times. We made a recommendation about this. People were invited to complete satisfaction surveys on the service they received, and people spoke positively of the registered manager. Quality monitoring was effective and robust, and the service evidenced continuous improvement.

People felt safe and the registered manager ensured people were safeguarded from abuse. Safeguarding referrals were made where appropriate and staff understood how to identify the potential signs and indicators of abuse. Staff understood the concept of whistleblowing and felt confident in raising concerns should they need to.

Medicines were managed safely, and people received their medicines as prescribed. Records relating to medicines were completed accurately, and people’s needs were met. Infection prevention and control was managed well, and risks relating to people and the environment were assessed and monitored.

Staff were recruited to the service safely, and there were enough staff to support people. People and their relatives praised the staff approach which was described as “Very good” and “Fantastic.”

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.

There was a positive culture in the home and the management team and staff understood the importance of effective team work. People and staff spoke positively of the registered manager who was described as “Approachable” and “Empathetic.” Staff told us they felt supported and valued by the management team.

The registered manager understood and evidenced the importance of continuous learning and development, through quality monitoring, audits and effective partnership working. Visiting professionals spoke highly of the positive culture and staff team at the service.

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 12 November 2018)

Why we inspected

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

focused inspection to review the key questions of Safe and Well-led.

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 good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for

Chapelfields on our website at www.cqc.org.uk.

Recommendations

We made a recommendation regarding the frequency of meetings at the service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The environment was clean and hygienic with an enhanced cleaning schedule in place to minimise the spread of infection. Staff wore appropriate personal protective equipment (PPE) and had their competency to use this assessed on a regular basis.

All visitors to the service have checks on their temperature and were required to complete a questionnaire in line with current COVID-19 guidelines.

Risk assessments had been devised by the service for individuals to take the risk of them being infected into account and new admissions underwent an period of isolation.. All people who use the service are regularly tested and all had received a first does of vaccination. Staff are also subject to testing both prior to their shift and weekly.

Despite restrictions; people who used the service appeared relaxed, comfortable and a home-like atmosphere was sustained. Relatives had the opportunity to visit their relations in a Covid-safe environment

Further information is in the detailed findings below.

Chapelfields 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. Chapelfields is registered to accommodate 70 people. At the time of our visit, 66 people were living there.

Chapelfields provides accommodation and nursing care for people who live with dementia as well as older people with nursing and residential needs.

The last visit to this service was held in August 2016. The service was rated as good on that occasion with no breaches identified.

The service did not have a registered manager. A manager had been in post since June 2018 but had not yet started the process to become registered. 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 initially noted some deficiencies within the safety of the premises. These included a door which required to be locked left open, the presence of a pest control bait that did not initially have a risk assessment associated with it and the presence of boxes in a person’s en suite area that did not appear to have an accompanying risk assessment. The issue with the door security and pest control bait was addressed during our visit. We discussed the presence of boxes in an en suite area with the manager subsequent to our visit. Other risk assessments relating to the environment and the health of people were in place.

While some work had been started in one living area that catered for people living with dementia, the decoration of the interior of the building was not always presented to assist those living with dementia. We have raised a recommendation about this.

Activities were provided for people who used the service but it was not clear about the frequency of activities received by people who could not leave their bedrooms. We have raised a recommendation about this.

The registered provider had systems in place to report any allegations of abuse and had co-operated with the safeguarding authority at the time of our visit following concerns raised. Staff understood the types of abuse that could occur and knew how to report any concerns. They were aware of agencies they could contact to raise concerns about care standards with the service.

The management of medication was safe. Medication was securely locked and associated records maintained appropriately.

Staffing levels were maintained although a recent period had involved the allocation of agency staff to work shifts within the service. While this use was being addressed by recruitment of new staff, the number of agency staff was decreasing and we did not see a negative impact on the wellbeing of people who used the service.

Recruitment process were robust. Appropriate checks were made on the suitability of people to come at work at Chapelfields.

Accidents were recorded and subject to auditing to identify patterns and trends with a view to prevent their re-occurrence.

Staff received the training they needed to perform their role. They also received regular supervision and a structured induction process for new staff was in place.

The registered provider worked within the principles of the Mental Capacity Act.

The nutritional needs of people were taken into account. Staff were attentive to the needs of people during dinner. Food was prepared in a well-equipped and hygienic kitchen.

The health needs of people were promoted. People were provided access to health professionals so that their health could be positively maintained.

People told us that they were treated with kindness and that staff were respectful to them. Our observations noted that this was the case and that people requiring assistance had their privacy promoted and were supported in a patient and unhurried manner.

People’s sensitive information was kept secure. The communication needs of people were taken into account and staff were observed speaking to people in a manner which ensured effective communication between both parties.

Care plans were regularly reviewed and person centred. Assessments were in place capturing the significant health and social needs of people before they came to live at Chapelfields. People told us that they felt staff were knowledgeable about individuals likes and preferences.

An effective process for dealing with complaints was in place.

Staff considered the management team to be supportive and approachable. They told us that the management approach was open and transparent. This view was echoed by people we spoke with.

A range of audits were in place to measure the quality of care provided. Any points for improvement were noted and actioned.

The views of people who used the service were captured through surveys and resident’s meetings.

The registered provider always informed us of any incidents that adversely affected the wellbeing of people and had displayed the ratings from our previous visit prominently.

Chapelfields is a purpose built care home with separate units providing nursing and residential care for 40 frail older people and 30 people who are living with dementia. The home has two storeys and all bedrooms are single rooms with en suite facilities. There are a choice of lounges as well as a communal dining room on the ground floor of the unit for older people. There are lounges and separate dining facilities on both floors of the unit for people living with dementia. At the time of our visit, 65 people were living at Chapelfields.

A registered manager was 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. The registered manager was not present during our visit.

Our last visit to the service on the 7th of July 2014 found that the registered provider had complied with all the regulations that we used to assess the service at that time.

People told us that they felt safe living at Chapelfields. Staff demonstrated a good understanding of how to protect vulnerable adults from harm. The premises were well maintained, clean and hygienic. People were further protected by the way the registered provider recruited new staff. People’s health was promoted through the safe management of medication.

The registered provider demonstrated that staff received up to date training on topics which related to the needs of people living at the service.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and associated safeguards. The registered provider demonstrated that the capacity of individuals was taken into account in their daily lives.

The nutritional needs of people were taken into account. This included the risks faced by people of malnutrition and dehydration. People were offered a choice of meals and regular drinks throughout the day.

People told us that they felt cared for and observations of staff practice confirmed that people were treated in a supportive, patient and respectful manner at all times.

People were able to take part in meaningful activities which included in house activities and trips out to the local community. Activities met the spiritual needs of people.

Care plans were accessible to people, were personal to their health and social needs. Care plans were reviewed and updated as appropriate.

People knew how to make a complaint and any complaints received were investigated in a timely and robust manner.

People told us that they considered the management team to be supportive, approachable and maintained a presence in the service. They stated that the service was well led as a result. The registered provider had a number of ways to measure the quality of the service provided and sought the views of all concerned.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found '

Is the service safe?

People said they were treated with dignity and respect and felt safe. There were the right amount of skilled and experienced staff working at the home to safely meet people's needs.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted recently. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights would be safeguarded as required.

Is the service effective?

People were satisfied with the care provided. Comments included: "It's very good, nice and homely"; "I hope every home's as good as this one"; "It feels like a family".

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Staff had been trained to an appropriate standard to enable them to meet the needs of the people who used the service.

There was a choice of food on offer and people's nutrition and hydration were monitored. People said that they enjoyed the meals and staff knew their likes and dislikes. Comments included "We're offered a choice and they try and accommodate you with whatever you want" and "The food's quite good".

People completed a range of activities in and outside the service regularly. This helped to keep people involved with their local community.

Is the service caring?

People were supported by kind and attentive staff. We saw that nurses and care workers showed patience and gave encouragement when supporting people. People commented: "They're very good"; 'They are very helpful and caring'.

Is the service responsive?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service, their relatives and staff completed regular satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system to help make sure the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and received appropriate supervision.

The people we spoke with said that their needs were met and they were happy with the care provided.

People told us that staff always maintained their dignity when carrying out personal care. One person living at Chapelfields said "It's home from home". One relative said "They always ring me if there are any changes at all in my (relative's) condition". Another relative said how much they appreciated the "little touches" that improved people's dignity, such as making sure the dining tables were nicely set with condiments, flowers and napkins.

Care records gave staff clear instruction on how to meet people's individual needs and showed that people were helped to access other health and social care services when necessary.