Archived: Chaldon Rise Nursing Care Home

There was a registered manager in post and present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the previous inspection we identified a breach in regulation 11. People’s consent was not always being gained before care was delivered. The provider sent us an action planned to say that this had been addressed however on this inspection we still found concerns.

People's consent was not always being gained in relation to the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm. Assessments had not been completed specific to the decision that needed to be made around people's capacity. DoLS applications had been submitted to the local authority where it may have been appropriate however people’s capacity had not been assessed before they were submitted.

There were not always enough staff deployed in the service provide safe care to people. There was not enough information to guide staff in how to reduce the risks to people. Incidents and accidents were not always followed up and actions were not always put in place to reduce the risk of incidents. Despite people stating that they felt safe they were not always protected from the risk of abuse. Safe recruitment practices were not always followed. The cleanliness of the premises and equipment was not well maintained which put people at risk.

People were not always receiving care from staff that were competent, skilled and experienced. There was a risk that people were receiving care from staff who were had not had training to meet the needs of people living with dementia, mental health and other health care needs. Staff competencies were not assessed as they did not always have appropriate supervision or appraisals.

People were not always provided with choices that met their reasonable preferences at meal times. People were not always treated with dignity and respect in relation to the care that they received. We did see times when staff were caring and considerate to people. People told us that staff were kind towards them.

The provider was not always responsive to people's needs. There was a lack of pre-admission assessments before people moved in which should have identified that the service could not meet their needs. There were also other people at the service whose needs could not be met. There was a lack of detailed information in some people's care plans around the support they needed. However in other care plans there was guidance for staff and staff received the appropriate care in relation to this.

There were not enough activities on offer specific to the needs of people. There were periods of time where people had no meaningful engagement with staff. People did not always have the opportunity to go out.

There were not effective systems in place to assess and monitor the quality of the service. Although an audit had been undertaken this had not been used to improve the quality of care for people. People were not given opportunities to be involved the in the running of the service or provide feedback to improve the quality of care.

People's medicines were being managed in a safe way however staff had not always been competency assessed in medicine management.

Personal evacuation plans were in place for every person who lived at the service and staff had received fire safety training. People at risk of dehydration or malnutrition had systems in place to support them however records that related to recording what people had eaten and drunk were not always maintained. People had access to health care professionals to support them with their health needs.

There was a complaints procedure in place. Where complaints had been received these were investigated thoroughly.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The provider had informed the CQC of significant events.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service therefore has been placed 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 time frame. 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.

We saw people who used the service were well cared for and were treated with dignity and respect. People told us they enjoyed living in the home and that the staff treated them with care and consideration.

We saw some people had less commentation skills than others. Staff had a good understanding of people's needs and were able to communicate with people using signs and gestures.

People told us they felt safe and could talk to staff if they felt uneasy about anything. We spoke with staff regarding safeguarding vulnerable adults, and they demonstrated to us a good understanding of these procedures.

There were sufficient staff on duty and they told us they had been provided with the training necessary to undertake their roles and responsibilities.

We saw that people were given their medication safely and as prescribed.

Effective systems were in place to measure the quality of service provision. People were asked for their views about the home and comments and suggestions were acted upon.

Not all people were able to tell us their views due to their individual care needs and difficulties with communication.

We observed staff interacted with some people through signs and gestures while other people were able to communicate normally.

We also saw that staff explained to people what procedures they were about to undertake and saw people agree with gestures.

We heard staff were polite and addressed people in an appropriate manner.

Staff told us that they enjoyed working in the home and felt that they had received all the required training that enabled them to undertake their roles effectively.