This inspection took place on 13 and 14 August 2018 and was unannounced. This meant the provider was not aware we intended to carry out an inspection. At a previous inspection in July 2017 we rated the service as ‘Good’ overall. We undertook this inspection because we were aware the service had been placed in organisational safeguarding by the local authority and we had received professional and anonymous whistleblowing concerns with regard to the operation of the service.

Chipchase House and Ferndene 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. The service is registered to provide support for up to 51 people. At the time of the inspection there were 48 people using the service. The majority of people who use the service have a physical disability. A small number of people also had mental health issues or a learning disability. The service is separated into two parts. Chipchase is a multi-storey building supporting people who have their own rooms or flats. Ferndene is a separate building where people live in self-contained accommodation but continue to receive regular support from staff. The home is part of the Percy Hedley Foundation which is a registered charity that provides services for disabled people and their families. The home is situated in Forest Hall, North Tyneside.

The care service had regard for the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The service has been established a number of years and so is larger than would now be considered appropriate. However, there remained an awareness of registering the right support and consideration was given to ensuring people with learning disabilities and autism using the service could live as ordinary a life as any citizen.

At the time of the inspection there was a registered manager in post. The registered manager had been formally registered with the Commission since November 2014. A registered manager is a person who has registered with the 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. We were supported on the inspection by the registered manager and the deputy manager.

Prior to the inspection we were aware the service was in organisational safeguarding. Some of the matters related to the organisational safeguarding are still ongoing and we will monitor the outcome of these investigations. Most staff we spoke with were aware of safeguarding issues and told us they felt confident in reporting any concerns around potential abuse. They said, if necessary, they would report any concerns higher up in the organisation, as part of the provider’s whistleblowing policy, or to the local authority safeguarding adults team.

Checks were carried out on the equipment and safety of the home. The majority of checks carried out on systems and equipment were satisfactory. Risk assessments linked to people’s care were available but not always clearly linked to the delivery of day to day care or did not reflect current issues highlighted in daily records or reviews. Risk assessments with regard to moving and handling were in the process of being reviewed and updated. We had received information from visiting professionals that cleanliness and infection control issues were not always being appropriately addressed. We found action had been taken with regard to this matter and equipment and the environment were clean and tidy.

Staff and people who used the service had mixed views on staffing. Some told us basic care was good but there was limited time for more individual

This inspection took place on 3 and 5 July 2017 and was unannounced. We last inspected Chipchase House and Ferndene in March 2016 and found it was meeting all legal requirements we inspected against. Following the March 2016 inspection we rated Chipchase House and Ferndene requires improvement and made recommendations in relation to current guidance on staffing levels and the impact of individual choices on the wider group of people in relation to the mealtime experience. During this inspection we found improvements had been made.

Chipchase House and Ferndene is a care home without nursing operated by The Percy Hedley Foundation. The service is situated within a large site in a quiet, residential area in Forest Hall, North Tyneside. Chipchase House is a two storey residential care home offering single rooms with shared adapted facilities or self-contained bedsit style accommodation with integrated kitchen and private bathroom. Ferndene is a neighbouring row of purpose built one bedroom bungalows.

The service can accommodate 51 people and at the time of the inspection provided care and support to 50 adults who were living with a physical disability. Some people living at the service also live with a learning disability.

A registered manager was registered with the Care Quality Commission at the time of the inspection. The registered manager had not changed since our last 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.

People told us they felt safe living at the service. Staff understood how to identify potential concerns and knew how to respond. Any safeguarding concerns, incidents or accidents were recorded, investigated and responded to appropriately.

Safe recruitment practices were followed and recommendations made at the last inspection in relation to staffing levels had been responded to. Improvements continued to be made in relation to the recruitment of additional staff in response to people’s level of need. A group of bank (as and when needed) staff were available to provide additional staffing as required.

Recommendations made in relation to the meal time experience had also been responded to. There were now two sittings at lunch time to ensure people had plenty of space in the dining room and meals were not rushed. The evening meal was held in a much larger dining area. Medicines were no longer administered in the dining area and people said they were happy to go to the treatment room for their medicines.

Medicines were stored, administered and recorded in a safe way. All necessary documentation was in place and records were accurate.

Risks were appropriately assessed and care plans were in place which provided staff with the details needed to support people appropriately and safely. People told us there were involved in developing and reviewing their care plans and some people directed their own support.

Staff were appropriately trained and supported to ensure they had the skills and confidence to meet peoples' needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported in a kind, caring and compassionate manner and their rights, privacy and dignity were respected.

Staff supported people with all aspects of their lives including nutrition, health and taking positive risks. People told us they were included in decision making about their care and also in relation to the management of Chipchase House and Ferndene.

People knew how to complain and we saw any comments were recorded, investigated and responded to, to people’s satisfaction.

The se

Chipchase House and Ferndene are operated by The Percy Hedley Foundation. The service is situated within a large site in Forest Hall, North Tyneside. Chipchase House is a two storey residential care home. Ferndene is a neighbouring row of purpose built bungalows. The service currently provides accommodation, care and support to 48 adults who have physical and/or learning disabilities.

This inspection took place on the 22, 23 and 24 March 2016 and was unannounced. We last inspected this service in July 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The service had a registered manager 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.

People told us they felt safe living and Chipchase House and Ferndene. Staff understood their responsibilities with regards to protecting people from harm and improper treatment. There was mixed opinions amongst people and staff as to whether there were enough staff employed at the service. We discussed this with the registered manager and the head of residential services who told us they always ensured people’s assessed care needs were met. The service used agency staff most weeks to cover vacant shifts. The registered manager was in the process of recruiting more staff to strengthen their team of permanent care workers. We have made a recommendation about staffing levels.

Policies, procedures and systems were in place to ensure the smooth running of the service. Care needs were thoroughly assessed and plans were person-centred. Risks were regularly assessed and preventative methods were in place to instruct staff on how to deal with a situation.

Accidents and incidents were recorded, investigated and monitored. Action plans were in place to reduce the likelihood of a repeat event. The registered manager reported all incidents to external bodies as necessary.

Routine checks on the safety of the home were carried out by on-site maintenance staff as well as by external professionals where necessary. Personal emergency evacuation plans were in place.

Medicines were managed well and in line with safe working practices. Medicine was administered safely and medicine administration records were well maintained and accurate.

Resident steering groups were held and an annual survey was used to gather feedback and opinions from people and their supporters about the home and the service they received. The service employed their own advocate to ensure people were involved in the development of the service.

The registered manager had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. Only one person who lived at the home was assessed as lacking mental capacity and the registered manager had applied to the local authority for a deprivation of liberty authorisation.

People were supported by staff to maintain a well-balanced, healthy diet, although people’s opinions of the food and their experience at mealtimes were mixed. We have made a recommendation about mealtimes.

We found staff received an induction and were trained; however some formal supervisions and appraisals were overdue within the staff files we examined.

Staff displayed caring attitudes and treated people as individuals. We heard staff gave people choices and encouraged them to make small decisions. People were respected by staff and their privacy and dignity was maintained.

People participated in a variety of activities. The staff supported people to maintain links with their community by encouraging visitors into the home. Individual and group activities were on offer and the service had the use of transport to facilitate day trips and outings further afield.

At the time of our inspection there were 50 people living at the home. Due to their health conditions and needs not all people were able to share their views about the service they received. During our visit we spoke with seven people who used the service and observed their experiences. We spoke with the registered manager, seven members of staff and four relatives.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

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

We saw risk assessments had been completed for people who used the service and that these assessments contained enough detail to minimise risk to people.

We saw people were safe and protected from abuse. Staff demonstrated an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

The provider maintained accurate records and these were available to us on the day of our visit.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and the manager and deputy manager had received training in the Mental Capacity Act 2005 (MCA) and DoLS.

Is the service effective?

People who used the service were asked about the support they received and if they understood their rights. They told us they were given the information they needed to make informed decisions about their care.

People who used the service were asked about the support they received and if they understood their rights. People we spoke to were aware of their rights and what to do if there were any problems.

Is the service caring?

People's preferences, interests and needs were recorded in their care records. Staff were able to give examples of these when we spoke with them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

People's health and care needs were assessed with them and they were involved in this process.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a registered manager in place at the service.

The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service which meant the provider could monitor the service delivered and address any concerns identified promptly.

During our inspection we spoke to three people who used the service, two relatives and three members of staff.

People and their relatives told us, and records confirmed that consent was gained before care was carried out. We saw that people were asked for their consent and the provider acted in accordance with their wishes.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that they were "very happy" with the service. One person told us "I've been here 48 years and seen a lot of changes, but it is still very nice."

We witnessed steps had been taken to provide care in an environment that was suitably designed and adequately maintained to meet the specific needs of people in a way that kept them safe. We noted that staffing was structured in such a way as to promote people's independence and meet their individual needs. Relatives were complimentary about the staff who worked there. One person told us, "All the staff are lovely and let us know what is happening."

We noted that the provider had a complaints system in place and acted on comments and complaints received.

A high proportion of people who used the service were unable to express their views on

the care they received because of the nature of their condition. However, relatives who

we approached were extremely complimentary about the service. We also spoke with staff and observed their practices, in order to determine how this care and support was carried out.

Relatives told us they were happy with the care their family member received. One relative told us, “We’ve got high standards and they reach those standards” and “We’ve had loads of great support. We have nothing but praise for them.” Another relative told us, “X has been there for 44 years and I don’t think I’ve ever had to complain….We find it excellent.” Other comments received from relatives on the day of our visit included, “Percy Hedley is excellent, very caring and professional” and “It’s like an extended family here.”

During our inspection we spoke with 14 people who used the service and seven members of staff. People told us they were happy living at Chipchase House and Ferndene. One person said, “It’s got quite big now but I still love living here.”

We found people were involved in decisions about their care whenever possible and their privacy and dignity was respected.

During the inspection we spoke with people about their experiences of the care and support they received from this service. One person said, “I’ve lived here 50 years next September so that’s got to be a good thing, I like it here.” We found the planning and delivery of care did not always meet individual needs or ensure their welfare and safety.

We saw the premises were well maintained and designed to be accessible to all people.

We noted that not all staff had received an appraisal or had regular supervision and staff training needs were not being met.

The provider did not have an effective system to regularly assess and monitor the quality of the service that people received. We found that where informal comments had been made, appropriate action was not always taken.

There was an effective complaints system available.

We found that care records did not always contain accurate or appropriate information.