The Care Quality Commission
  • Care Home
  • Care home

The Chestnuts

Overall: Requires improvement read more about inspection ratings

Lavric Road, Aylesbury, Buckinghamshire, HP21 8JN (01296) 414980

Provided and run by:
Ambient Support Limited

All Inspections

29 April 2019

During a routine inspection

About the service.

The Chestnuts is a purpose-built care home set in its own grounds and provides care and accommodation for up to 64 people including those living with dementia. At the time of our inspection 42 people were using the service.

People’s experience of using this service.

Medicines were not managed effectively. We found several people had not received their medicines as the prescriber intended.

Staff did not always receive regular supervisions to support them in their role.

We found two people were being deprived of their liberty. The provider had not re-applied to renew these applications until two months after the expiry date.

Audits were undertaken by the provider. However, the audits had not identified the issues we found in relation to medicines, supervisions and DoLS applications.

People reported they felt safe and were treated in a dignified manner.

People told us they enjoyed the food at the service. Where people were at risk of malnutrition appropriate steps were taken.

Activities were available for people to avoid social isolation. Complaints were recorded and responded to appropriately. CQC notifications were sent where appropriate.

Rating at last inspection.

At the last inspection the service was rated Good (the report was published on 16 September 2016).

Why we inspected.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up.

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

13 September 2016

During a routine inspection

The Chestnuts is a modern purpose-built home in Aylesbury for 64 older people. The home is able to accommodate and support up to 32 people with a higher level of support needs, specifically those living with dementia.

The inspection took place on 13 and 14 September and was unannounced. The service was previously inspected in February 2014when it was found to be fully compliant with the regulations. At the time of our inspection there were 49 people who used the service. The service had a registered manager.

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’s feedback about the home was mainly positive. One person commented, “They are all very kind and caring, sometimes I can be awkward and they never shout.” Another person told us, “They are all local girls, it’s a family environment we all know each other”. One visiting relative told us, “Some staff are better than others.” Another relative said, “Its early days, but generally staff seem caring”.

People told us they felt safe living at The Chestnuts. People were safe from abuse and neglect. Staff we spoke with demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider had reported incidents to the local authority where this had occurred.

Care plans and risk assessments were in place to ensure high quality care was provided. Where some risks were identified during the inspection and not in place, the deputy manager ensured this was rectified during our inspection. Some relatives told us they had never seen their family members’ care plan.

Staff had received training in safe handling of medicines and were competency-assessed to support them in their role. However, medicines were not always managed effectively. We found some people were without their prescribed medicines for several days. These were mainly creams for fragile skin. One person did not receive their anti-fungal cream for three days as staff documented that they could not find the cream.

We have made a recommendations in relation to the ordering of medicines and the involvement of people and if appropriate their relatives in the development and review of care plans.

Regular supervisions and appraisals took place to ensure staff felt supported in their role.

People’s privacy and dignity was not always maintained.

People had a range of activities they could be involved in. In addition to group activities people were able to maintain hobbies and interests.

The atmosphere within the home was warm, friendly and inviting. People told us, “It’s obviously not the same as your own home, but it’s very good.”

17, 18 February 2014

During a routine inspection

When we inspected there were 54 people living in the home. We spoke with 11 people who use the service, three visitors and eight staff. We also made our own observations during the visit.

People who use the service told us they were satisfied with the service they received. People felt the staff supported them and met their needs. One person using the service said "it's very good here. I like it."

People told us that staff treated them with dignity and respect. One person said 'I get on well with the staff.' We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

The staffing rosters showed that the service provided a range of suitable staff to meet peoples' needs. Staffing at night would benefit from being reassessed. The home trained their staff and had procedures which protected people from abuse. People told us they did not have any complaints but would speak to the manager or staff if they had concerns. One person said 'it's a nice place, if it wasn't I would make a fuss.'

The service and the building were monitored and risk assessed to ensure they were suitable for the people using them.

The evidence we collected showed us the service kept people safe and met their care needs.

During a check to make sure that the improvements required had been made

At our review of the service on 17 July 2012 we found there were not enough staff to meet people's needs in a timely manner. This meant that people people's medication was delayed while staff were carrying out personal and other care. This had the potential to impact on people's health and well being. The provider has sent us an action plan telling us what they have done to achieve compliance.

The provider has informed us that since our visit in July 2012 it has agreed to increase the number of housekeeper hours in the service. This has provided additional support to care staff. The provider has also informed us that in consultation with GPs and pharmacists, it has made changes to the times it administers medicines to people. This has led to a clear separation of staff activity with regard to the administration of medicines and other work.

The provider has informed us that staffing levels have been increased on 'respite days'. This means that there is one additional member of staff on duty in the morning and afternoon to provide assistance to people on 'respite' care going home after a stay in the home and to new people arriving for a 'respite' stay. The provider has also informed us that the registered manager has discretion to increase staffing on a temporary basis in response to any short term increase in demand.

The implementation of the above means that staffing levels in the service are now considered sufficient to meet people's needs.

17 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector joined by a practicing professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person that we spoke with said it was important that they had been given a single room. They said they liked being able to spend time in their room alone if they wanted some quiet time. The person told us that all staff treated them with dignity and respect. They said there were no issues for them if they were assisted by male staff. This was because the care was always carried out in a dignified way. Another person told us they liked the fact that a hairdresser visited the service. This was because they liked to look well groomed. One person said there were activities on offer and they joined in the ones they liked.

People that we spoke with said they had enjoyed their lunch. They said they had been given enough to eat and drink. One person told us they particularly liked puddings at the service. We heard one person say to staff that it was a ''nice meal''.

People that we spoke with confirmed that the food preferences recorded on their care plans were correct. Two people said the food was too spicy for their liking and that there was too much cheese. They also said they would like more than two options at meal times. They said they had not been given opportunity for alternative meals if they did not like the two options.

The majority of people that we spoke with did not raise any concerns about their care or safety. One person was worried that they had not been given their morning medication. Their comment was dismissed by a member of staff and not checked out to see if any corrective action was needed.

One person said staff were ''good'' and that they were around when they needed support. Another told us mornings were rushed because there were not enough staff on duty.