Were the people using this service safe and was the service well-led?

Since our last inspection the provider and registered manager had worked hard to address the concerns in our last inspection. As a result of the improvements we found there were no longer any breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The new registered manager had settled in well and had developed positive relationships with people, staff and families. They worked effectively with the provider to promote a culture which was focused on the needs of the people living at the service. Although the registered manager was still stretched as they were managing two other services, the provider was addressing this issue. A new deputy manager had been appointed to support the registered manager.

Some of the processes and records at the service needed streamlining to ensure systems worked effectively. New quality audits had been introduced and were effective at supporting the improvements at the property. The provider met with the registered manager and senior staff to implement any actions from the audits. There was open discussion about mistakes and any lessons learnt were used to improve the service.

Communication had improved across the service and staff felt supported to speak out about any concerns they had. The provider and registered manager communicated well with families and people and had consulted with them about the proposed building work.

Staff worked well with external professionals to meet people’s needs. There was scope for the registered manager to develop positive networks outside the service for support and to lean and share about best practice.

The registered manager had significantly enhanced the administration of medicine. There was improved training and guidance about the support each person needed. The registered manager observed staff competency and carried out detailed checks to ensure people received their medication as prescribed.

There were enough safely recruited staff to meet people’s needs. The registered manager recognised the importance of people receiving support from staff who knew them well.

Staff supported people to remain safe. The quality of the risk assessments had improved. Staff had the necessary guidance to support people to minimise risk, while ensuring they enjoyed their lives and were not overly restricted. Staff knew what to do if they were concerned for people’s safety. People were protected from the risk of infection. The property was clean and homely. The building work was not impacting on their quality of life.

See more information in Detailed Findings below.

Rating at last inspection: Requires Improvement overall, with caring and responsive rated as good (report published 22 May 2018)

About the service:

Chignal House is a residential care that provides personal care and accommodation to up to three people with learning disabilities. At the time of the inspection there were three people living at the service. The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live lie as any citizen ‘Registering the Right Support’ CQC policy.

Why we inspected:

We carried out this focused inspection because the provider was carrying out building work at the property and had applied to increase the numbers of people living at the service. We wanted to check whether the existing people living at Chignal House were receiving safe care during the application process. At the time of writing this report, the provider had withdrawn their application to increase the service while they completed the building work.

Follow up:

We will continue monitoring the service to ensure people receive care which meets their needs.

We inspected all three Paradise Lodge Care Home Limited services, known as Chignal House, Paradise Lodge and Willow Tree Lodge, over a period of three days, 07, 08 and 12 March 2018 as these services are all in close proximity.

The inspection of Chignal House took place on 08 March 2018 and was unannounced.

When we completed our previous inspection on 26 January 2017, we found there was a lack of good governance systems in place to monitor the quality of the care provided at the service. This was a breach of regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found care plans were not always person centred or regularly reviewed to ensure they reflected people’s current needs. Medications were not always stored safely and their recruitment process needed reviewing to ensure people were safe. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. The provider did not send this action plan within the set timescales. The inspector contacted the provider to request a copy of this via email; however, at this inspection the provider told us they had not received these emails.

At this inspection, we found that, there continued to be a breach of regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to information not being analysed to identify an overall picture of how well the organisation was meeting people’s needs and performing. Although the provider spent a lot time working across all three services, we found a lack consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning management of risk and regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty.

We recommend the provider review their building risks assessment to ensure risks to people are assessed in line with recognised guidance on managing health and safety in care homes.

The manager and staff had not understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm and / or abuse.

Improvements had been made to the storage of medicines, however the medicines audit had not identified inconsistencies in the amount of a person’s medicines held, resulting in medicine being unavailable when they needed it to help manage a period of distress and anxiety.

Following this inspection, the provider sent us a plan to address the issues we raised during our inspections of all three of Paradise Lodge Care Homes Limited services. This showed they had taken seriously the issues we raised and had taken steps to address these, including but not limited to carrying out an investigation into missing medicines, health and safety concerns and identifying a different training provider to deliver a robust MCA and DOLS training programme for all staff.

Chignal House 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. Chignal House accommodates three people in one adapted building.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence an

The provider ensured that the environment was kept clean and maintained to a safe standard, and that people living at the service had been enabled to furnish their bedrooms with their own furniture and tastes. However, some general maintenance was needed in a few places, and the registered manager took this forward during the inspection.

People at the service told us they felt safe and supported by staff working there, and we saw risk assessments and care plans that promoted their independence whilst managing well any potential risks.

Medication was provided by staff that were trained, and supported people’s safe involvement. However, it was not safely stored. The registered manager took immediate action to remedy these concerns.

Whilst we saw that staff received good supervision, oversight, and support by the registered manager, recruitment processes were not robust and we fed back to the registered manager that the provider should review these processes urgently.

Once employed, staff received training and support to carry out their care duties to a good standard. We saw that staff received regular training updates and attended regular staff meetings to keep up to date with changes in the service and to review the care they provided to people.

People at the service told us that staff treated them with dignity and respect. We saw that staff were caring and supported people with a compassionate and caring approach. However, some wording in care plans was condescending and did not represent the care that people told us staff provided and that we observed. We requested that the registered manager review these urgently.

Care provided was inclusive and supported people to remain independent, learn new skills, and lead fulfilling lives. We saw that the provider and registered manager, supported staff to meet people’s individual communication, physical and mental health needs in a manner that supported people’s preferences and involved other relevant agencies and resources to ensure that these could be met.

Governance systems in place were not robust and did not reflect the good standard of care that people received. However, the registered manager had already identified that systems needed a thorough review to be more effective and at the time of inspection was already in discussions with external organisation to review these processes. It was evident however, that staff felt they were supported by a management team who were visible, and approachable to both staff, and people living at the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the end of the report.

Chignal House provides accommodation and personal care for three people who have a learning disability and require 24 hour support and care. This was an unannounced inspection.

A registered manager was in post. 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS) and to report on what we find. Staff were aware of their responsibilities in relation to DOLs and had received training. They told us that there were at the time of our inspection no DOLs in place.

People who used the service told us that the service was a safe place to live. There were procedures in place which advised staff about how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to and how to report any concerns.

There were procedures and processes in place to guide staff on how to ensure the safety of the people who used the service. These included risk assessments which identified how risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. Staff told us that the provider visited daily and often stayed to have lunch with people.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service identified shortfalls in the service provision and took actions to address them.

Chignal House provides accommodation and personal care for three people who have a learning disability and require 24 hour support and care. This was an unannounced inspection.

A registered manager was in post. 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS) and to report on what we find. Staff were aware of their responsibilities in relation to DOLs and had received training. They told us that there were at the time of our inspection no DOLs in place.

People who used the service told us that the service was a safe place to live. There were procedures in place which advised staff about how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to and how to report any concerns.

There were procedures and processes in place to guide staff on how to ensure the safety of the people who used the service. These included risk assessments which identified how risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. Staff told us that the provider visited daily and often stayed to have lunch with people.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service identified shortfalls in the service provision and took actions to address them.

We spoke with staff and reviewed care records as well as staff records.

People received care and support that met their needs and which took into account their individual preferences. Staff were able to demonstrate that they understood people's specific needs and that the care provided was person-centred.

We reviewed the provision of food and drink, and people told us they liked the food provided.

We examined recruitment processes and found these were providing staff suitable to perform their role.

We reviewed how records were maintained and stored and saw records were in good order.

During our inspection on 22 March 2013 we met two out of three of the people who live at Chignal House and spoke with one of them. Both people were about to go out and the third person was already out, doing whatever they had chosen to do that morning.

We observed that people were comfortable with the staff who were on duty and that people had made choices about what they wanted to do that day. The person we spoke with said they made all their own decisions, which included that they did not wish to help with the housework. Care records showed that published guidance relating to the Mental Capacity Act 2005 had been followed to record people’s ability to make decisions about their lives.

Care and support plans gave staff detailed guidance on the ways in which each person preferred to be supported. Assessments of any risks to people were carried out so that people were supported to be independent but kept as safe as possible. Each person’s healthcare needs were met. Medicines were managed safely and given as prescribed.

Staff undertook a range of training so that they were equipped for their role. Staff told us they felt well supported by the manager. One staff member said, “I enjoy working here. I love working with people.”

The provider had a complaints procedure in place that was in easy read language and pictures so that people could understand it better. Staff said they knew people well enough to know if anything was not right.

People living at Chignal house gave positive feedback at both our last key inspection and at our recent site visit. People told us that they were treated with respect and dignity by the staff at Chignal house.

People with whom we spoke told us that their care needs were discussed with them and explained to them before they took place.