About the service:

Chandos Lodge Nursing Home is a service registered to provide accommodation and personal or nursing care to older people. The service can provide accommodation and care to up to 31 people and there were 27 people living there at the time of the inspection.

People’s experience of using this service:

People told us they were safe at the service. There were a sufficient number of staff to keep people safe. However, people were not always protected from risks around unsafe recruitment as there was not always evidence available the provider sought evidence of staff conduct prior to the staff working with adults at risk. People received their medicines in a timely manner and the medicines were stored safely. However, we found where people received their medicines covertly (in food or drink) the provider did not adhere to the good practice guidance therefore we could not be reassured medicines remained effective. Risks to people’s well-being and individual conditions were assessed and recorded. Risks surrounding infection control were managed appropriately and the service was clean. Individual people’s accidents and incidents were recorded but there was no overview to monitor the accidents for any trends and lessons learnt. Arrangements around planning for emergencies, such as in an event of evacuation needed improving.

People were supported to make their own choices and staff were aware of principles of the Mental Capacity Act. However, we found there was not always written evidence available that people’s capacity to make specific decisions had been assessed. People were supported to access health professionals and any advice received was incorporated into the care planning process. People were encouraged to maintain a good diet and nutrition. Staff received ongoing training and told us they felt supported.

People continued to receive caring and kind support. We observed kind and caring interactions. Staff respected people’s privacy, dignity and their individual needs including people’s individual communication needs. People told us they built positive working relationships with the staff.

People received support that met their assessed needs. The feedback received from people, relatives as well as the records demonstrated people did not always receive meaningful activities in line with their choices, preferences and assessed needs. People knew how to raise any concerns, we saw complaints were managed in line with the policy. No people were receiving end of life support at the time of our inspection, people’s end of life wishes where appropriate, had been recorded.

There was a registered manager in post who was supported by a team of staff. The provider’s quality assurance processes were not always effective as they did not identify concerns we found during our inspection. This included the requirement to display the rating and to inform the Care Quality Commission about reportable occurrences. People and staff were involved and their views were sought. The team at Chandos Lodge worked well in partnership with other agencies and the local social and health professionals.

At this inspection we found improvements were required as the evidence gathered for Safe, Effective, Responsive and Well-Led domains demonstrated the service met the Requires Improvement characteristics. We found three breaches of Regulations 17 and 19 of the Health and Social Care Act 2008 (Regulations) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We also made one recommendation to improve the quality and safety of the service.

Rating at last inspection:

Good (report published 15 April 2016).

Why we inspected:

This was our scheduled, planned inspection based on previous rating.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

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This inspection took place on the 15 March 2016 and was unannounced. This was a focussed inspection carried out following the receipt of information of concern.

Chandos Lodge Nursing Home is registered to provide residential personal and nursing care for up to 31 older people. At the time of this inspection there were 29 people living there.

Chandos Lodge Nursing Home had a registered manager 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.

We previously inspected the service in December 2015. When assessing whether the service was; safe, effective, caring, responsive and well-led we found safe required improvement with effective, caring, responsive and well-led rated as good and the overall rating of the service as “Good”.

The areas assessed under safe at the previous inspection which required improvement were; inconsistent monitoring and recording of medicines and inconsistent recruitment checks. During this inspection, we followed up on progress by the home in improving these areas of its operation.

We also followed up concerns raised with CQC since the inspection of December 2015 about issues affecting the safety of people who used the service and staff. These were in summary; medicine administration, training for new staff to ensure they could provide safe care, problems with the heating and hot water system and the unsafe use of extension leads in conjunction with auxiliary electric heaters. Concerns also included staff recruitment and unreasonable restrictions placed on the use of personal protective equipment (PPE) by staff and of incontinence products by people who required them.

Staffing levels on the day of our unannounced inspection agreed with the staffing rota. During this inspection we observed people received care and support from an appropriate number of staff to do so safely.

In the staff recruitment records we saw, there was no evidence of staff working outside of their approved immigration status. Training records for the three most recently recruited staff included a basic induction into their role and the required initial training in, for example, moving and handling and safeguarding. This meant staff had the basic level of skills and competence to provide people with a safe standard of care.

Those staff we spoke with confirmed there were no unreasonable restriction placed upon the use of incontinence products for people’s use. The incontinence pads had a visual indicator to show when they required changing and were provided free of charge to the home.

The provider did monitor the use of, for example, protective gloves. They agreed they did try and avoid waste through inappropriate use or unnecessary changes of PPE during the provision of care. We have made a recommendation about this in the report.

Medicines were managed safely and people received their medicines, regularly and as prescribed. Whilst the times of morning medicines administration could vary, there was no indication that people were having their medicines at inappropriate or unsafe intervals. The covert administration of medicines was covered by appropriate safeguards and records.

Records for medicines administered only as and when required had improved since the previous inspection and in most cases now recorded the actual amount given. In one case, the variable dosage was not recorded. We were told by staff this was because there was not room to record it on the medicines administration record. We have made a recommendation about this in the report.

The provider accepted there had been problems experienced with the heating and hot water systems with the boiler failing for part of one day. They told us this had now been addres

This inspection took place on 9 and 10 December 2015 and was unannounced on the first day.

We previously inspected the service in June 2013 when we found the service was meeting the requirements of the regulations in place at that time.

Chandos Lodge Nursing Home is registered to provide residential personal and nursing care for up to 31 older people. At the time of our inspection there were 30 people living there.

Chandos Lodge Nursing Home 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.

We received very positive feedback about the service from people who lived there. “They couldn’t do any better than they already are doing” and “Very welcoming and good communication” were some of the comments made.

Healthcare professionals told us the home referred people appropriately and staff were responsive to any advice or recommendations they made. They were positive about the standard of care records they saw.

Staff were provided with the skills and knowledge they needed to recognise and respond to any safeguarding concerns. Risk to people’s health, welfare and safety were appropriately and effectively managed. Risks to individuals were identified and risk assessments were in place which set out the action to be taken to reduce the likelihood of injury or harm to people during the provision of their care. There was a training programme in place for staff to provide and update them with the necessary skills and practical knowledge to meet people’s needs effectively and safely.

Staff recruitment was essentially satisfactory, although recruitment records did not always include evidence that applicants’ physical and mental health was satisfactory. We have made a recommendation about this in the report.

Medicines were managed safely and people received their medicines, regularly, on time and as prescribed. However, the records for medicines administered only as and when required did not always record the actual amount given. We have made a recommendation about this in the report.

Relatives were generally satisfied that there were sufficient staff to meet people’s needs.

Care plans were in place which set out people’s needs and how they were to be met. Care plans included details of people’s preferences for how they wanted to be supported. Care plans were reviewed and kept up to date to take account of changes in people’s needs.

The service was effectively managed. Staff told us they worked together well as a team. Several of the staff we spoke with had worked at Chandos Lodge Nursing Home for a number of years. This consistency of staff was something people who received care and support, their relatives and visiting health and social care professionals commented on positively.

The provider/registered manager constantly monitored the quality of care being provided, was active throughout the home and had a very high profile within the service as they provided support to the administrator and staff.

The people we spoke with expressed a high level of satisfaction with the care they received at Chandos Lodge. They told us staff were kind and friendly, and they had confidence in their abilities to do their job well. They said they were given choice in their daily activities, and full explanations prior to any support being provided. Care was always delivered in rooms, where privacy and dignity were maintained.

The nurse said that one member of staff was allocated to the lounge area to ensure people had their needs met whilst there. This staff member ensured people were comfortable, had drinks or nutritious snacks, and helped them with activities. Two people told us what a valuable service this gave to the people in the home.

We saw that the medications were stored and delivered safely, in accordance with good practice. Staff who gave medications were qualified and were trained to do so.

We read staff files and saw that good recruitment practices were in place. Their format and content ensured that staff had the knowledge and skills to meet the needs of people using the service.

The manager told us of checks undertaken to ensure the safety and quality of the home. They included care plan audits, medication checks and an infection control audit. These provided a monthly assurance scheme.

We examined staff and care records. We noted they were usually well written, and nearly always audited within the home's guidelines. We saw that storage of files was adequate.

People told us that they and/or their family had been given the opportunity to visit the home before they moved in to ensure it met with their needs and expectations. They said that the staff treated them as individuals and respected their views and choices. They said they were provided with opportunities to take part in activities and were happy with the care and support they received. One person said ‘’they are extremely kind…I think they meet my needs well.’’ Another told us ‘’the staff are very good here, they couldn’t be better, very well trained.’’

People told us that they liked the staff, felt they met their needs well and the care provided was very good. They said there was enough staff available to help and assist them, both in the day time and during the night.

They said they were able to make decisions about their day to day care and were involved in the reviews of their care. Their wishes were taken into account.

People told us they had the opportunity to visit the home, meet the staff and residents and view the facilities before moving into the home

People told us that they had no concerns but if they did they would either tell their relatives or the manager of the home. They said they felt safe and well looked after.

People told us that they liked the staff, felt they met their needs well and the care provided was very good. They said there was enough staff available to help and assist them, both in the day time and during the night.

They said they were able to make decisions about their day to day care and were involved in the reviews of their care. Their wishes were taken into account.

People told us they had the opportunity to visit the home, meet the staff and residents and view the facilities before moving into the home

People told us that they had no concerns but if they did they would either tell their relatives or the manager of the home. They said they felt safe and well looked after.