Archived: Chipstead Lodge Residential Care Home

This inspection site visit took place on 31 July 2018 and was unannounced.

There was a registered manager in post 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 last inspections in July 2017 we asked the provider to make improvements in relation to the safety of care to people, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), activities for people, lack of detailed care plans, staff training and supervisions and quality assurance at the service. At the focused inspection in September 2017 we asked the provider to make improvements in relation to the safety of people. We issued a warning notice to the provider in relation to this. We found that actions from these inspections had not be sufficiently addressed.

The premises and equipment was not maintained to a safe standard. In the event of an emergency there was not up to date information on the support people required to evacuate the building. There were areas around the service that smelled strongly of urine and furniture did not feel clean. Audits were not effective in identifying these shortfalls.

Risks to people were not managed safely. There was a lack of detailed guidance for staff to assist them to manage people and their behaviour due to their mental health or dementia. Monitoring tools were not used effectively where people were at risk of malnutrition and dehydration. After the inspection the provider sent in evidence that they had addressed the most urgent concerns.

The management of medicine was not always safe which put people at risk. Accidents and incidents were not always recorded and appropriate analysis was not undertaken to look for trends to try to prevent future accidents.

Staff were not always working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Information about people’s care was not always being communicated effectively between staff.

The premises adaptation did not meet the needs of people that were living with dementia.

Care plans were difficult to navigate which meant that new staff and agency staff may not easily find the most up to date information on people’s care needs. Staff had received training in relation to their role and had the opportunity to meet with their manager. However, as staff were not always practicing safe care this training and supervision was not always effective.

There were varied responses from people about the caring nature of staff. At times people felt ignored. We found that people were not always involved in the planning of their care and did not have choices in their day to day care. People were not always supported with their independence.

Activities were not always person centred and people did not have appropriate opportunities to go out. Care plans were not always detailed and lacked guidance around people’s diagnosis.

Records of complaints were not kept and people did not always feel that their complaints were responded to. Quality checks that were taking place were not effective and audits did not always identify the shortfalls that we identified. Improvements were not always made as a result of feedback. Records at the service were disorganised and therefore difficult to navigate.

There were aspects to people’s care that was safe including a robust recruitment processes, safe levels of staff that were always maintained, staff protected people from the risk of abuse and there was a business continuity plan in place in the event of an emergency.

There were mixed responses from people about the quality of the food. People were offered choices of meals and drinks. People were supported to maintain their health and had access to health care professionals. Before people moved in to the service a full assessment of their needs took place.

We did see examples of people being treated in a caring and respectful way by staff. People were supported to practice their faith and visitors were always welcome to the service.

Staff told us that they felt supported and listened to by the manager. Where appropriate, notifications regarding significant events were sent to the CQC.

The overall rating for this service is ‘Inadequate’ and has been placed into ‘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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The registered manager was on annual leave 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. Instead we were supported by a senior carer and a director of the service.

We carried out a comprehensive inspection of this service on 21 July 2017. After that inspection we received concerns in relation to the safety of people that lived at the service. We received information from the provider that there had been a fire at the service and that one person had left the service without staff being aware. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chipstead Lodge Residential Care Home on our website at www.cqc.org.uk”

People were not always safe as the provider had not ensured that all identified risks were mitigated. There were people that had left the service unnoticed by staff. Despite the risk of this happening being known by the provider appropriate steps had not been taken to ensure that people were protected. One person left the home for six days until they were found by Police. We are making further enquiries about this incident with the provider.. There had been another two incidents since June 2017 where people have left the service without support.

In the event of an emergency information that related to people’s whereabouts and what support they needed was not up to date or accurate. Handover sheets and the service fire risk register were not completed accurately and did not always account for people that were not at the service.

Personal evacuation plans (PEEPs) had not been updated to reflect that one person had passed away, two people were not at the service and one person that was at the service did not have a PEEP. The PEEPs did not contain information around the risks of the people that may leave the service without staff being aware.

The provider notified us after the inspection that actions had been put in place to ensure that people were regularly checked to ensure that they were present in the service.

All appropriate actions had been taken by staff in relation to the fire that was started at the service. The provider informed us that the fire service had commended staff on their swift action to ensure that people were evacuated safely.

The service was last inspected on the 21July 2017 where breaches of regulations were identified in relation to the overall environment and the lack of person centred care, lack of mental capacity assessments, lack of robust governance, lack of training for staff and the lack of supervisions for staff. At the inspection on the 21 July 2017 the service was rated as requires improvement.

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.

People felt they were safe, that staff gave them the care they needed and that they felt cared for. People did say more activities were needed.

The safety of the premises and equipment was not well maintained. and staff were not always following good practice in relation to infection control.

There was not sufficient detailed information in people's care plans around the support they needed with their mental health. However, other aspects of the care needed was detailed and provided staff with the appropriate guidance. There were not sufficient activities on offer specific to the needs of people.

People's rights were not always protected under 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 always been completed specific to the decision that needed to be made around people's capacity. DoLS applications had been submitted to the local authority but these were not accompanied with the MCA specific to this.

Staff were not always sufficiently competent, skilled and experienced in relation to people’s mental health. However, other aspects of training were provided to staff that met people’s needs. Staff competencies were not assessed as one to one supervisions were not taking place regularly.

Records were not always maintained with the most appropriate and up to date information about people’s care. Systems in place to assess and monitor the quality of the service were not always effective. Audits had been undertaken but not always used to improve the quality of care for people.

There were sufficient staff deployed in the service to provide appropriate care to people. Risk assessments for people were up to date. There was information to guide staff in how to reduce the risks to people. Incidents and accidents were recorded and followed up and detailed actions put in place to reduce the risk of incidents occurring. Staff that worked at the service had appropriate recruitment checks before they started work.

Medicines were managed, stored and disposed of safely.

Personal emergency evacuation plans were in place for people who lived at the service and staff had received fire safety training. There was a service contingency place in the event the building had to be evacuated. Staff had knowledge of safeguarding adult's procedures and there was a safeguarding adult's policy in place. People said that they felt safe.

People were provided choices that met their preferences including at meal times and what care they wanted. People at risk of dehydration or malnutrition were receiving enough food and drink and being supported to maintain nutrition. People had access to health care professionals to support them with their health needs. People told us that they felt well looked after.

Staff were caring and considerate to people. People told us that staff were kind towards them and treated them dignity and respect.

People and staff felt the registered manager was supportive and approachable. Staff said they felt valued and supported.

People and relatives were given opportunities to provide feedback to improve the quality of care; however this had not always led to improvements. There was a complaints procedure in place and complaints were investigated. People said they knew how to make a complaint.

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.

The service was last inspected on the 17 July 2015 where no concerns were identified.

At this inspection we found the provider had taken appropriate steps to ensure that people who used the service had their privacy dignity and independence respected. The practice of locking bedroom doors during the day had stopped which allowed people to move about the home independently.

At this inspection we found the provider had produced management guidelines for people with challenging behaviour. This was to ensure staff had appropriate guidance to follow when caring for people with aggressive or challenging behaviour. This is still ongoing.

At this inspection we found the provider had taken reasonable steps to ensure that people were being cared for in an environment that maintained their health and wellbeing. We found the home was now adequately heated with the provision of a new plumbing system to the radiators in the new extension.

We also noted at this inspection the provider was now informing CQC of significant events that affected people's health and wellbeing. The provider was also raising these events to the multi agency safeguarding team when appropriate for investigation.

People's needs were assessed and generally care and treatment was planned and delivered in line with individual plans. We found not all challenging behaviour was assessed and monitored appropriately.

The safeguarding procedures in place did not protect people as incidents and accidents were not being referred to the local authority for investigation and action.

The home was clean and people were being cared for in a hygienic environment. However people told us they were cold and we saw additional heaters were provided in some rooms.

The staff we spoke with told us they liked working in the home and said they had undertaken ample training and development that enabled them to undertake their roles.

The provider had systems in place to monitor the quality of service provision.

Records were not maintained appropriately and care plans did not include guidance for staff on the management of aggressive behaviour.

Not all accidents and incidents in the home were being recorded or notified to the Care Quality Commission.

Some people told us that they had been living there for many years and that it was now their home. We were told that the staff were kind and caring and treated them with respect.

One person told us that they liked to be independent and that staff helped them to go out as much as possible.

Some people had less communication skills than others and we saw staff take time to communicate with people through gestures and signs.

We got very positive comments regarding the food and people were generally positive about the meals and the quality of the food provided.

Staff told us that they liked working in the home and that they had the training to undertake their roles and responsibilities.

Visiting health care professionals also spoke highly of the home and the care provided.