Alderwood L.L.A. Limited - The Chestnuts

About the service

Alderwood L.L.A. Limited - The Chestnuts is a residential care home providing personal care to up to six autistic people with mental ill health and learning disabilities, in one detached building. At the time of the inspection six people lived in the service.

People’s experience of using this service and what we found

The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture.

Right Support

People were not always being supported by staff who had received enough training to meet their needs. Care plans were not always personalised. We have made a recommendation about improving how people’s care plans are written.

Systems were in place to support those who lacked verbal communication to make choices.

Staff supported people to develop strategies to manage emotional distress and anxiety, when encountering a new situation or dealing with a change. Periods of anxiety or emotional distress were recorded, which included the action taken by staff to support people.

Staff supported people to access health and social care support. Staff supported people with their medicines safely. Positive relationships had developed with local health care providers, who provided support, taking into account people’s emotional needs for planned appointments.

Right Care

People were not always cared for by staff they knew. The provider relied on a high use of agency staff and was not always meeting people's assessed needs. This had the potential to put people at risk due to lack of knowledge of the service, people and systems.

People’s needs had not always been fully assessed, which meant people were at risk of experiencing sensory overload, which could then lead them to experiencing emotional and physical distress.

The service was impersonal. We have made a recommendation about improving the environment for the benefit of the people who use the service.

Many of the staff team provided kind and compassionate care and wanted to see improvements for the benefit of people receiving support.

People had detailed care records, which were regularly reviewed. Risks associated to people's care and choices were set out in their care records, however, due to the volume of documents, there was a risk that new staff may not quickly and easily identify the most up to date information in order to support people effectively.

Right Culture

We found negative language being used in some people’s care records which was not dignified.

Staff told us they were concerned about the high use of agency staff at the service as they did not always have the same drive for improvement or focus on quality within the service compared to permanent staff.

People were supported to have choice and control of their lives.

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

Rating at last inspection

The last rating for this service was good (published 21 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about allegations that abusive practices were used at the care home. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alderwood – The Chestnuts on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

The 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 and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Appropriate policies and procedures were in place for the safe handling of medicines. However, the provider needed to ensure that staff consistently followed safe practice in relation to the storage and recording of medicines.

Some aspects of environmental safety management had not been followed by staff and areas that should be locked were accessible to people. Immediate action was taken to rectify this and the high staffing levels in the service reduced some of the risk this had posed to people.

People were comfortable living at the Chestnuts. Relatives told us their family members were supported in a safe way by staff. Staff understood their responsibilities to keep people safe from harm and to report potential risks to their safety.

People's needs were assessed prior to them receiving the service to ensure that staff were able to fully meet their needs.

People were supported to choose their meals and staff encouraged people to have a healthy balanced diet.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, best interest decisions were not always completed where people were found to lack mental capacity. People were encouraged to make decisions about their care, daily routines and preferences and staff worked within the principles of the Mental Capacity Act.

Staff induction training and mentoring was comprehensive and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to complete their roles to a high standard. All staff said that they were well supported by the provider.

The culture of the service was caring, person centred and inclusive. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff encouraged people to follow their interests and people were supported to access many varied activities.

People who used the service and their relatives had the opportunity to feedback on the quality of the support and care that was provided. Any required improvements were undertaken in response to people's suggestions.

Care planning and risk assessments were personalised and mentioned the specific care each person required, including their likes and dislikes. Staff were aware of people's preferences, and supported people in a person-centred manner.

People were involved in their own care planning as much as they could be and were able to contribute to the way in which they were supported. People were listened to by staff.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staffing levels ensured that people's care and support needs were safely met.

Staff had the appropriate personal protective equipment to perform their roles safely. Staff supported people in a way which prevented the spread of infection. The service was clean and tidy and had a maintenance staff member to carry out any works required.

There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Rating at last inspection:

Good (report published 20 July 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection was unannounced and took place on 14 June 2016.

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.

The service was led by a dedicated and passionate registered manager, who was well supported by a strong and positive management structure within the provider organisation. Alongside the registered manager, the service was led by a general manager who led by example and was equally driven, committed and passionate about making sure people were provided with care which fulfilled their needs and made them happy. There was an established culture within the service that put people first and at the centre of delivery of care. The culture was open, enthusiastic and uplifting.

Staff were proud to work for the service and wanted it to be the best it could. As a result, they had strong and firm values and a shared vision, and strived to give people really positive care experiences and to provide high quality care. They were aware of, and understood, the high standards of care expected by the provider and registered manager, and worked hard to ensure that they observed this positive philosophy. We found that they were confident and knowledgeable in their ability to support and care for people. Their passion, motivation and dedication to supporting people live a fulfilled life was evident. They faced up to challenges which arose and used these to learn and move forward. The provider philosophy was that people should be able to access the best of everything in life and have ample opportunities to achieve their goals.

Staff had ample opportunity to share ideas for change, and exchange information about possible areas for improvements to the registered manager. Ideas for change were welcomed by the registered manager and provider, and used to drive improvements and make positive and life enhancing changes for people. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement and identify where action needed to be taken. All staff told us they wanted standards of care to remain high and so used the outcome of audit checks, review meetings and questionnaires to enable them to provide excellent quality care.

People were safe and were calm and relaxed in the presence of staff. Staff demonstrated a strong awareness of what constituted abuse and had a positive approach towards keeping people safe. They understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people's freedom and to enable them to live as safely and independently as possible.

Robust recruitment checks took place to ensure that staff were safe to work with people before they commenced employment. There were sufficient numbers of staff available to meet people’s support needs, to keep them safe and to enable them to do the things they enjoyed.

People received their medicines when they needed them. Staff managed medicines in a safe way, and had been trained in the safe administration of medicines.

Staff received regular training, based upon best practice in learning disability and autism, which provided them with the knowledge and skills to meet people’s needs in a really person centred manner. They also received regular supervision and appraisal which enabled them to discuss training requirements and career development needs.

People’s consent was sought by staff before any care or support was provided or activity was engaged in. This was done with the intention of giving people as much control over their lives as possible. Where people were unable to make certain decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them, staff ensured people’s rights to receive care that met their needs was protected, and that any care and treatment was provided in the least restrictive way.

People were supported to access appropriate amounts of good quality, nutritious food and engage in the preparation of this, if this was something they wanted to do. A wide variety of meal options were available for people, which also included any specific nutritional and cultural dietary requirements. People were also supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People's health had improved due to the care and support staff gave.

People were supported by caring and dedicated staff that really enjoyed their work and were passionate and driven to give people the best of everything. They wanted people to receive good quality care that was person centred and specific to their needs and ensured that people’s needs were met in a timely manner. People were considered to be the very heart of the service, the atmosphere was pleasant and there was lots of laughter and good humour, with kind and trusting relationships evident between staff and people.

People had been involved in the planning of their care. It was evident that they felt included in discussions, being able to say what they wanted and how they wanted it to be delivered. We found that care plans were based around the individual needs of people, as well as their healthcare requirements and preferences for activities. People had been supported to develop new life skills and gain independence, using individually created development programmes based upon areas they wanted to work upon. This process enabled people to lead a fulfilled and more enriched live.

Staff worked with people to access a wide range of activities, focused on people’s individual needs. This included on-going support to access the local community, using local facilities to avoid social isolation. A variety of activities, were also available on site for people to engage in at times that suited them.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. No complaints had been received recently. Staff knew how to respond to a complaint should one be received.