Chalkhill Road

Chalkhill Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Chalkhill Road is registered to provide personal care and accommodation for up to 20 people with complex mental health needs making a transition from psychiatric wards, into the community. At the time of this inspection there were 14 people in residence.

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

People did not receive person centred care. Although there were measures to promote person-centred care, these were not implemented effectively. This was evident in several practice areas, including medicines management, management of violence and aggression, nutritional support and monitoring compliance with treatment orders. The cumulative effect of shortfalls in all these areas meant people did not receive care that met their needs.

People were not always protected from potential harm. Although there were safeguarding procedures, which were followed by sufficient qualified staff, risk assessments had not always addressed potential risks or included sufficient guidance for staff to mitigate potential risks to people. This included arrangements for medicines management, which were not satisfactory. People were at risk of not receiving correct medicines.

Quality assurance systems had not been used effectively to identify shortfalls. Although audits had been carried out in relevant areas, the service had not identified the shortfalls we found during this inspection. We also judged there was limited organisational learning. Action to tackle findings from our last inspection had not yet led to fundamental changes in practice. We found improvements were still required in medicines management and quality monitoring systems.

We observed kind and caring interactions between people and staff. However, the concerns we found at this inspection did not demonstrate a caring approach.

In as much as the key role for staff was to help people to regain independence, creative and flexible approaches needed to be adopted to motivate people, keeping in mind the variable degrees of support people required. In particular, the service needed to be mindful about this in relation to people’s medicines, nutrition and self-care, including keeping their living space clean.

We have made three recommendations about the management of complaints, person-centred care and end of life care.

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.

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 requires improvement (published 19 February 2019). At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Well-led, Responsive, Effective and Caring sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chalkhill Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and relevant authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chalkhill Road is registered to provide accommodation and personal care for a maximum of 20 people with complex mental health needs. At the time of our inspection 18 people were living at the home.

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.

We found that there were shortfalls in the systems to ensure people received their medicines in a safe way. We saw a few examples, where medicines were not administered as prescribed. We also found that some risk assessments were not as detailed. The lack of detail meant that staff may not have been able to support the respective individuals fully.

There was a system to ensure that people were safe and protected from abuse. Staff knew how to recognise abuse and how to report allegations and incidents of abuse. Safe recruitment procedures were in place. We saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. We also saw there were systems in place to protect people and staff from infection.

Staff received regular supervision and appraisal. They had also received relevant training. People’s care records showed relevant health and social care professionals were involved in their care. The home was working within the principles of the Mental Capacity Act 2005 (MCA). There were concerns that people’s nutritional needs may not always have been met. This was due to a long-standing provider’s policy, which was intended to promote people’s independence. This policy has since been changed following our inspection. It is now the provider’s policy that people receive cooked breakfast and meals every day if they choose to.

Staff understood the need to protect and respect people's human rights. People’s privacy and dignity were respected. People's rights to confidentiality were also respected. Staff had completed training in the new General Data Protection Regulation (GDPR) law. Staff had received training in equality and diversity. People’s spiritual or cultural wishes were respected. People were supported with their religious observances. People were supported to be as independent as possible, and where possible, staff assisted people to increase their independence skills. Staff had built positive relationships with people. Each person had a key worker who had special responsibilities for working with the person.

People’s needs were largely met. The service’s purpose was to provide a good start for people transitioning from hospitals to independent living. People’s support plans were based on an evidence-based model for supporting people who are stepping down from secure hospitals, prisons and mental health services. Each person had their needs assessed before moving into the service and the findings of the assessments formed the basis of their care plans. We saw evidence that the service had helped people to achieve their own goals and aspirations. Between 2017 and 2018, the service had helped at least 10 people to move on to independent living.

Although the service monitored the quality of the service, this had failed to identify the shortfalls we found. People had expressed dissatisfaction regarding the preparation of meals. This was not resolved satisfactorily until we pointed it out.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. 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.

Chalkhill Road is registered to provide personal care and accommodation for up to 19 people with complex mental health needs.

The home did not have a registered manager in place at the time of this 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.

At this inspection an existing deputy manager had been assigned to temporarily manage the service. A new manager had been appointed and was due to commence work in April 2016.

People receiving care confirmed they felt safe and secure around the staff and with each other. Risks to people were assessed and well managed. There were procedures in place for monitoring and managing risks to people. When there were changes in the level of risk, the risk management strategies changed to reflect this.

Safeguarding procedures were in place to keep people safe from harm. People felt safe living at the home. The staff understood their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. They had received training on how to identify abuse and understood both the providers and local authorities' procedures for safeguarding people.

The service took an effective approach in managing risks, accidents and incidents. Risk assessments for the environment had been drawn up and were regularly reviewed with the changing needs of the people who lived at the home in mind. There was a comprehensive business continuity plan. Robust arrangements were in place to respond to emergencies and major incidents. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

People were protected from the risks associated with the recruitment of new staff. There were robust recruitment procedures in place. New staff had induction training until they were competent to work on their own.

People were safe because staffing levels were assessed and monitored to ensure they were sufficient to meet people’s identified needs at all times. There was a rota system in place to ensure that enough staff were on duty. Staffing levels were flexible so that if people needed extra support due to illness or to take part in their particular interests there were staff available for this.

There were appropriate arrangements for obtaining medicines. The acting manager and senior staff regularly reviewed and audited medicines to ensure they met people’s current needs.

People were supported by staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices. The deputy manager and her staff team knew people well and understood their specific care needs.

People were supported to maintain good health. They were referred to relevant health professionals when they needed specialist care and treatment. We saw evidence that multi-disciplinary team meetings took place on a regular basis and that care plans were routinely reviewed and updated.

There was a strong emphasis on the importance of good nutrition and hydration. People were supported to eat and drink enough and maintain a balanced diet.

Staff sought people’s’ consent to care and treatment in line with legislation and guidance. They understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

Staff were kind and caring. They had respectful relationships with people. People’s privacy and dignity were respected. The service’s philosophy ensured people were supported and empowered to be as independent as possible in all aspects of their lives.

The management team demonstrated strong values and a desire to implement evidence based practice throughout the service. The philosophy of the service was to support people to recovery and to be as independent as possible. The service’s model of care was consistent with this belief.

The service had a strong quality assurance system in place. Where improvements were needed, plans were put in place to achieve these.

During the inspection we spoke with seven people who used the service. We spent time observing and we spoke with two care workers, and the registered manager and their deputy.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner. The relative of the person who used the service told us that they were confident that people were safe.

Staff understood their role in safeguarding the people whom they supported and they understood the whistleblowing policy.

Staff were clear about their roles and responsibilities and felt well supported by management staff. The management team had systems in place to support workers.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the home included that it was 'nice' and that staff were a 'good team '.

Staff told us that there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment was planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. People who used the service were seen laughing and chatting with staff. There was an obvious rapport between staff and people living in the home

Staff were knowledgeable regarding the specific care needs of people and respected the choices that people made. Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. People's privacy and dignity were respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. People told us that they were listened to and felt involved in decisions about their care. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff. People had the opportunity to provide feedback about the service.

Is the service well-led?

The home had an experienced registered manager who was supported by the regional manager. Monitoring checks of the quality of the service were carried out. These included checks of the care provided to people and the quality of their environment. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

People told us staff supported them, to make decisions about their care, and to develop the skills needed to lead a more independent life. We saw people took turns to cook and did their own shopping.

Staff were respectful and friendly in their interactions with people, and understood people's individual needs. People took their medicines at the times they needed them, and in a safe way.

The provider had effective recruitment and selection procedures in place, which ensured people's health and welfare needs were met by staff who were fit and appropriately qualified.

We saw that people's privacy and dignity was respected and there was evidence they received safe and appropriate care, in a safe and well maintained environment. This was affirmed in the feedback we got from people during the course of our inspection. We asked a number of questions; including 'What do you like about the way staff support you?' which prompted a number of responses. 'They are very polite. They knock on my door before they enter', one person had told us. 'The manager is very good and I get any support l need from her', another person had told us. Positive feedback was consistent for all the other areas we included in the remit of our inspection.