Background to this inspection
Updated
18 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
Chestnut House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. At this inspection the manager had cancelled their registration as they were retiring. A new manager had been appointed and was due to start at the service in February 2022.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, including the provider’s action plan. We received feedback from the local authority and commissioners who work with the service. We used all of this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We met with all of the people living at the service, spoke with four people in detail and four visiting relatives. Not all people could speak with us about their experience of living at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with eight staff including the manager, deputy manager, care staff, an agency nurse, the activities co-ordinator and maintenance person. We held a video conference with the manager, nominated individual and two of the provider’s quality assurance and governance team. This was to discuss the governance arrangements at the service.
We reviewed a range of records. This included three people's care records and five people's medication records. We looked at a variety of records relating to the oversight and management of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found and receive updates as to actions taken. We looked at training data, policies and quality assurance records. We sought feedback from professionals who work with the service and received feedback from one. We received feedback from one relative in response to the inspection poster displayed in the service.
We continued to review the information we received from the service and feedback from relatives and professionals until 28 January 2022.
Updated
18 March 2022
About the service
Chestnut House Nursing Home is a care home providing personal and nursing care for up to 85 people. At the time of the inspection there were thirteen people living at the service, some of whom were older people living with dementia. People were all accommodated on the ground floor of the home.
People’s experience of using this service and what we found
The provider’s governance systems had not ensured that actions were taken in response to environmental shortfalls. We found no evidence people had been harmed but these shortfalls placed people at risk of harm or injury. They were identified in both the provider’s own audits and our last inspection report. We made a referral to the fire service who arranged a fire safety inspection visit. They identified there were actions that were needed to ensure the fire safety of the service and these works were required to be addressed within two months.
People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and very well cared for. Throughout the inspection we saw kind and caring interactions between people and staff.
There were enough staff to meet people’s needs and there was a stable staff team who knew people well.
Risks to people were identified and recorded, and staff knew how to respond to these risks in order to keep people safe. Medicines were managed safely and effectively by staff who were trained and competent to do so. A consistent system was not used to record people’s as needed medicines. The provider agreed to ensure this was implemented.
Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Overall, staff followed recommended IPC practices. Safe visiting was supported.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People benefited from a manager, deputy manager and staff team who promoted a positive culture. They focused on people being treated as individuals and staff had continued to make improvements in the personalised care that people received. Relatives spoke highly of the manager and staff and the communication between them.
Rating at last inspection
The last rating for this service was requires improvement (published 5 August 2021) .The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the provider remained in breach of one regulation.
The service remains rated requires improvement. This service has been rated inadequate or requires improvement for the last seven consecutive inspections since 2017.
Why we inspected
We undertook this focused inspection as part of our public commitment to rerate services. This was to release capacity in the adult social care sector during the pandemic. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.
The provider has taken action to mitigate the risks identified and has worked with the fire service to ensure people’s safety.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chestnut House Nursing Home on our website at www.cqc.org.uk.
Enforcement
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 have identified a repeated breach of regulations in relation to the provider’s oversight and not acting in response to their own and CQC’s previous findings in relation to fire safety issues and hot water temperatures.
We have issued a warning notice that the provider must be compliant with the regulations by 1 April 2022.
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.