We carried out a review of the data available to us about Chestnut House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Chestnut House, you can give feedback on this service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured people who lived at the home can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People living at the home received planned and co-ordinated person-centred support that was appropriate and inclusive for them. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found.
People, their relative and professionals told us people were very safe living at the home. One relative told us their relative received safe care and this was down to the level of detail and attention staff paid to their loved one. Detailed risk assessments were in place to help staff keep people safe, whilst encouraging people to be as independent as they could. Regular safety checks of the building were completed. Only suitable staff were employed. The registered manager used all incidents as a learning opportunity to improve various aspects of the service and care provided.
People’s needs were fully assessed before they came to live at the home. People were also encouraged to visit prior to coming to live at the home, to ensure they and other people living there, were happy with arrangements. Staff had appropriate skills to care for people. Staff received regular refresher training. People enjoyed a healthy, fresh and varied diet. People attended regular healthcare appointments. People’s bedrooms were unique to each person and had been decorated to reflect each person’s individual tastes.
People received care from staff who were caring and committed in their role. Staff were very aware of the importance of maintaining people’s dignity and were very keen to support and promote people’s independence.
Regular reviews of people’s care was completed with emphasis placed upon people achieving their individually set goals. A complaints policy was in place, but no complaints had been received. People had access to documents in a variety of formats to support their understanding and communication. End of life wishes were included in people’s care plans.
The service had a registered manager. They managed the service very well and promoted an atmosphere and culture in the home which was both inclusive and empowering for people and staff. The registered manager ensured information was shared with the appropriate authorities. When things had happened, immediate action was taken to address any issues. A service improvement plan was in place which was reviewed regularly at both local and regional level, and this was used to drive further improvements and outcomes for people and the home. The registered manager and staff worked very closely with various healthcare professionals. People, their relative, staff and visiting professionals were very complimentary about the registered manager.
The service applied the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 3 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection in January 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.
Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people’s safety had been assessed and plans put in place to minimise or prevent the identified risk. This enabled staff to have the guidance they needed to help people to remain safe
There were sufficient staff on duty to meet the needs of people who used the service. Staff were available to provide one to one support and assist with visits out in the community. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.
People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and all staff had completed up to date training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were able to their choose meals and staff supported people to maintain their health and attend routine health care appointments.
Care plans detailed people’s needs and preferences and were person-centred. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. People who used the service had access to a wide range of activities and leisure opportunities. The service had a clear process for handling complaints.
Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager and operations manager, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met. Feedback was sought from people who used the service through regular meetings’. This information was analysed and action plans produced when needed.
The inspection visit took place on the 23rd January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
We last inspected the service on 20th November 2013 and found the service was not in breach of any regulations at that time.
Chestnut House provides care and support for up to six people who live with a learning disability. There were four people living at the service at the time of our inspection. The home does not provide nursing care. The detached house is situated in Thornaby, close to all amenities and transport links.
There is 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. On the day of our inspection the registered manager was not at the service.
We spoke with three people who lived at the home who had a range of communication skills. We were told they were happy with the service the home provided. Comments we received included; “I like it here” and “I like all the staff.”
We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw staff spent time with one person discussing a visit by a friend and how they wanted to prepare for this. We also saw people were asked if they wanted to visit the day centre and if they declined, their wishes were respected.
We found there were policies in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) but staff were not fully aware of what these meant or the implications for people living at the service. Although there were applications for authorisations for two people, we did not know if these had been authorised by the local safeguarding authority and there was no information in people’s care files to reflect if they were subject to the DoLS process. After the inspection we were informed by the authorising body that it was not their procedure at the time to acknowledge applications received.
We found the dining room carpet was a trip hazard and staff had been reporting this issue since February 2014. There were also safety issues with the downstairs bathroom in relation to exposed radiator valves. We were told the registered manager had been requesting support from the housing landlord for the bathroom for some time. A manager from a neighbouring service of the provider’s spent time at the service on the day of the inspection and actioned for a flooring company to address the carpet issue straight away.
We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as epilepsy and Makaton (the use of signs to help people communicate). There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the manager and of each other. Medicines were also stored and administered in a safe manner.
There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify and support their personal and professional development.
We saw people’s care plans were person centred and had been well assessed. The home had developed easy read care plans and communication aids to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from going to day services to helping to make the evening meal. One person had very recently transitioned into the home and we saw this had been planned and assessed so it was as smooth as possible.
The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible and were supported to independently use public transport and accessing regular facilities such as the local G.P, shops and leisure facilities.
We also saw a regular programme of staff meetings where issues where shared and raised. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.
The provider cared for four people with learning disabilities. We found that people were benefitting from good standards of care and that their consent was sought through sophisticated methods of non verbal communication. Staff told us that care was totally individualised and we saw evidence of this from the care records.
The home was comfortable and staff aimed to ensure that all people lived as independently as possible. We found that there was a good standard of nutrition and efforts were made to involve service users in shopping and preparing a high standard of nutritious tasty food which people enjoyed.
There were appropriate arrangements in place to manage medicines safely and staff were trained and supervised to undertake administration of medicines.
We observed kind and supportive interactions between staff and service users and wellbeing of service users was ensured through a system of personal support to maintain as much independence and choice as possible.
We saw that staff treated this person with dignity and respect. Staff were attentive, gave reassurance and interacted well with the person who used the service. We saw that staff communicated well and explained everything in a way that could be easily understood. Staff encouraged and supported the person to be independent.
We found the premises that people, staff and visitors used were safe and suitable.
We found that appropriate recruitment procedures were in place.
We found there was an effective complaints system in place at the home.
Other people told us about going out to work/day services and the outings that had taken place this year.
One person we spoke to was extremely positive about the care and support being provided. They said, "The staff are smashing, excellent, they are there when you need them".
People told us they were safe living at Chestnut House. One person said if they had any concerns they would speak to the staff about it.
People spoken to confirmed they are involved in regular meetings within the service. They said, "We definitely have a say about what happens in the house".