The Chadwick

The Chadwick is a care home providing accommodation for up to 67 people older people, some of whom are living with dementia. At the time of the inspection there were 47 people living at the home.

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

At the last inspection, the service was failing to ensure people’s safety was promoted, did not have effective governance systems and did not comply with duty of candour or send the required notifications. As a result, there were found to be multiple breaches of regulations and the home was put into special measures.

At this inspection we found that the required improvements had been completed and systems implemented to address the shortfalls had been effective.

People felt safe and told us the staff were kind and friendly. Relatives felt the staff team were very good and the new registered manager had made a difference to the home. People’s safety and welfare was monitored. If an incident or concern arose, the management team identified and resolved it. Incident, events and unexplained injuries were recorded and investigated. Where needed, incidents were reported appropriately.

People were treated with dignity and respect. People and staff had developed positive relationships and staff knew people well. Care plans were detailed, giving staff the appropriate information to meet people’s needs.

Records were reviewed to help ensure people’s needs had been met. Staffing was monitored and call bells audited to ensure staffing numbers were effective. Some people living on the first floor told us they thought more staff were needed as at times they had to wait, and activities were not frequent enough. However, they said staff worked hard and were always helpful.

Staff felt they had enough training and support to do their role and found the leadership of the management team to be good. Training relating to infection control and COVID-19 had been delivered. Staff knew how to reduce the risk of transmission of COVID-19. Staff worked safely in relation to COVID-19.

The recruitment process was robust, including all required checks to help ensure staff employed were fit to work in a care setting. Medicines were now managed safety and these were checked through an audit system.

Governance systems needed to monitor and identify concerns had been developed and these had been effective as the number of incidents since the last inspection had reduced.

Rating at last inspection

The last rating for this service was Inadequate (published 28 February 2020) and there were multiple breaches of regulation. The provider sent us an action plan stating how they would make the required improvements. We imposed a condition on the service meaning that they could not admit new people to the home without our permission.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 January 2020 and 06 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection, to show what they would do and by when, to improve governance, safe care and treatment, duty of candour, notifications of other incidents and safeguarding service users from abuse and improper treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chadwick 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

The Chadwick is a residential care home providing personal care to 58 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 67 people. The Chadwick is a bespoke built new residential home set over three floors, with a range of communal areas, private bedrooms with en-suite and access to a local town.

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

People and staff told us there were not enough staff especially during the evenings, nights and weekends to provide safe care which met people’s needs in a timely way. People told us they often had to wait long periods of time to go to bed in the evenings or for staff to answer their call bells. Risk assessment tools were used by staff to establish if people were at risk of falls or at risk of developing pressure ulcers. However, actions to prevent falls or pressure ulcers developing were not always taken in an effective way. On 06 February 2020 we returned at the home to check what actions were taken by the registered manager to mitigate risk for people who were at high risk of falls. The actions taken were not effective and people continued to sustain falls and injuries as a result.

Systems and processes to safeguard people from the risk of harm were not used effectively. Staff were knowledgeable about safeguarding procedures and their responsibilities to report and record any concerns they may have had. However, when people sustained unexplained injuries, the occurrence of these were not investigated by the registered manager and were not reported to the relevant safeguarding authorities to consider how people could be safeguarded from further harm.

Evacuation procedures in case of an emergency, like fire, were not practiced with staff, although this was a required action in the fire risk assessment carried out by the provider in May 2018 and November 2019.

The laundry room presented an infection control and fire risk. There was no separation between clean and dirty laundry and there were large piles of clothing and bedding on surfaces and the floor.

The provider’s governance systems were ineffectively used by the registered manager to improve people’s experience about the care they received and to address concerns we reported in the previous inspection.

The registered manager carried out various audits and analysis of falls, accidents and incidents. However, they had not fully considered what actions were needed to ensure people were safe. Before the inspection we requested information from the provider and the registered manager. The data we received was conflicting and we could not rely on the accuracy of it.

On 06 February 2020 when we returned to the home we were informed by staff that there was an outbreak of infection in the home. CQC had not been notified about this outbreak.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvements had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to people waiting long periods of time for their needs to be met, lack of staffing and lack of action from the management team in the home when concerns were reported to them. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

We have identified breaches in relation to safe care and treatment, safeguarding, governance systems and duty of candour at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 Chadwick is a residential care home providing personal care to 54 people aged 65 and over at the time of the inspection, some of who were living with dementia. The service can support up to 67 people. The Chadwick is a bespoke built new residential home set over three floors, with a range of communal areas, private bedrooms with en-suite and access to a local town.

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

Sufficient numbers of staff not consistently deployed to support people when needed. People spent excessive periods of time waiting for staff to assist them.

Risks assessments about people’s safety and welfare did not always explicitly describe how to manage the risk and were not always updated as people’s needs changed. Equipment was used for people before being assessed as safe to do so. Safeguarding incidents were not robustly reviewed and reported.

Staff did not all receive effective supervision. Staff training had not been provided in key areas to ensure they were competent in carrying out their role. People’s nutritional needs were met, although some improvement was required around the mealtime experience provided to people.

People’s care records were not comprehensive and did not take into account people’s personal choices or preferences. The planning and provision of meaningful activities for people needed to improve and we have made a recommendation about this.

People told us they were happy with the care provided. Assessments were carried out prior to care being provided and people told us staff were caring and respectful and they understood the pressures on staff. Medicines were given to people when required.

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.

People said they were able to raise concerns and complaints which were responded to, and were kept up to date in regular meetings.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 26 October 2018 and this is their first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff training, poor staff culture, unsafe use of equipment and a lack of effective governance systems to keep people safe. A decision was made for us to inspect and examine those risks.

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

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

The overall rating for the service is Requires Improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection 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 local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.