Chipstead Lake - Care Home Physical Disabilities

We found the following examples of good practice.

¿ The registered manager had implemented procedures to minimise the risk of infection from visitors. Visiting was by appointment only. A visitor pod had been created in the conservatory with floor to ceiling screens to support safe visiting. Visitors were able to access the conservatory directly without coming into the home.

¿ The service had procedures in place to enable new people to move into the service safely. A requirement for a negative test for Covid-19 and a 14-day isolation period were in place. One to one support was provided where required which minimised exposure to unnecessary risk and provided reassurance.

¿ The service had up to date infection control policies including those specific to Covid-19 and infection outbreaks. The home looked clean and there were cleaning schedules in place which were monitored by the infection control lead. Regular infection control audits were done by the registered manager and actions were monitored to ensure completion.

Chipstead Lake – Care Home Physical Disabilities is registered to provide accommodation and personal care for 24 younger adults and older people who have physical adaptive needs. There were 24 people living in the service at the time of our inspection visit. Some of them also had special communication needs and used signed assisted language to express themselves.

The service was part of a larger site that contained an activity centre used by people who had physical adaptive needs and who lived in the community. In the residential service each person had their own bedroom and private bathroom. Two people had their own self-contained flats.

The service was run by a charitable body who was the registered provider. There was 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. In this report when we speak about both the charitable body and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safeguarded from situations in which they may experience abuse including financial mistreatment. People had been helped to avoid preventable accidents while their freedom was respected. Medicines were managed safely. There were enough care staff on duty and background checks had been completed before new care staff had been appointed. Suitable arrangements were in place to prevent and control infection. Lessons had been learned when things had gone wrong.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. People were supported to eat and drink enough to have a balanced diet to promote their good health. Suitable steps had been taken to ensure that people received coordinated care when they used or moved between different services and people had been supported to access any healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness, respect and compassion and they had been given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. Confidential information was kept private.

People received personalised care that was responsive to their needs and which promoted their independence. People had been offered opportunities to pursue their hobbies and interests. The registered manager and care staff recognised the importance of promoting equality and diversity. There were suitable arrangements for managing complaints and provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who had promoted a person-centred culture in the service and had made the arrangements necessary to ensure that regulatory requirements were met. People who lived in the service and members of staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

This inspection was carried out on 18 January 2016 by three inspectors. It was an unannounced inspection. There were 22 people using the service at the time of the inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to reduce the risks to people’s safety.

There were sufficient staff to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were suitable to work with people.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The service was clean, well maintained and designed to meet the needs of the people that used it.

Staff were knowledgeable and skilled in meeting people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and had an annual appraisal of their performance. Staff felt supported in their roles and were clear about their responsibilities. This ensured they were supported to work to the expected standards.

Staff worked creatively to enable people to overcome difficulties and to achieve their goals. Staff provided a caring service that treated people with kindness and compassion and recognised their individuality. They knew each person well and understood how to meet their support and communication needs. People’s privacy was respected and people were assisted in a way that respected their dignity.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted where needed and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. Staff sought and obtained people’s consent before they provided care.

People were provided with meals that were in sufficient quantity and met their needs and choices. People were happy with the quality of the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. The service provided an effective physiotherapy service that maintained and increased people’s mobility and wellbeing.

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend reviews with people’s consent. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. Clear information about the home, the facilities, and how to complain was provided to people and visitors.

People were involved in the planning of activities that responded to their individual needs and interests. A broad range of activities and outings were available for people to choose from. People were supported to use IT equipment and internet services and adaptions were made to the equipment to meet their needs.

Staff told us they felt valued by the registered manager and supported to provide a high quality service. The registered manager was open and transparent in their approach. Emphasis was placed on continuous improvement of the service. The registered manager kept up to date with any changes in legislation that might affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

At this inspection we reviewed the actions the provider had taken in response to the compliance action. The building was still in the process of being refurbished or rebuilt in places but there had been significantly risk assessed with risk prioritised progression evident since the last inspection. We found that the provider was responsive and had taken prompt action to address the shortfalls that we had identified at the last inspection to make the building and environment safer. The compliance action was therefore closed and the service was then found compliant with outcome 10 (regulation 15).

We therefore found that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

One person told us they had lived at the home for many years and the home had become a bit drab and the heating had become less effective over time. Another told us the home could be cold in winter but their room was warm enough.

People told us they liked the home and their rooms but the hot water was not working.

People said they had no complaints but knew how to make one if they did.

We saw that people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that people who used the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises.

We saw that people were given support to make a comment or complaint where they needed assistance. They had their comments or complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

People told us, or indicated that they liked living in the home. Comments included 'I love it here, I feel like one of the family here' and 'I am happy here, I get to choose what I want to do'. They told us that they were happy with the care and support that was provided by the service. People spoke highly of the staff and described them as 'Very Nice' and 'Respectful'.

We found that relatives and people who used the service had been kept involved in their care. People we spoke with told us that they were involved in decisions about their care and with the running of the service.

People we spoke with said there was plenty to do both inside and outside the home. Some people we spoke with told us that they attended the nearby Activity Centre where they took part in various activities such as exercise and computer classes. One person told us that they had recently been supported to attend a sailing holiday, which they had really enjoyed.

Some of the people in the home had complex needs which meant that they were not able to tell us their experiences of using the service; we therefore used our observations to help inform some of our judgements. We saw that people were being supported around the home by staff in a kind and sensitive manner, in a way that promoted individual independence.