Archived: The Chestnuts

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had their needs assessed prior to moving into the home. We found a variety of assessments were completed. However, these were completed to a varying degree, some were fully completed whilst others had sections left blank. The provider had systems in place to ensure staff had time to update each person’s records. The care home operated a ‘resident of the day’ process. We found this process needed to be fully embedded to be successful and to ensure people’s records were updated with any changes.

The provider did not always plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice and standards.

People’s needs were assessed with them and relevant people. However, we found mixed understanding of nationally recognised tools to assess risks to people. Staff had recently received training on modified diets, as one person’s dietary needs had changed. We found staff were knowledgeable about this and the care plan had been updated. However, other tools used to assess malnutrition risk were not routinely completed accurately. People who were at risk of dehydration did not always have a full record of drinks offered and consumed. The provider was aware of this and had plans in place to support staff with improving record keeping.

The provider did not always work well across teams and services to support people.

People were supported by staff who had opportunities to keep up to date with any changes in their needs. However, some staff told us it was sometimes difficult to keep up to date with all the changes which occurred when they had been off work for a few days.

Staff told us they attended handover meetings. The provider had also introduced a daily catch-up meeting, we found some improvements were needed to ensure the meeting was routinely held and agreed actions were put in place.

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We received feedback from a number of relatives who commented their family member had put on weight since moving into the home. We found little evidence of healthy eating options for people. One relative told us “The only issue has been [persons] weight, initially [person] put on two stone when [person] went there… they hasn’t lost the weight since…it is our greatest issue that [person] is allowed to eat so much”. Another relative told us “[Person] has put on weight since they have been there, they do eat biscuits a lot.” We found staff were slow to identify weight gain and take action.

Staff told us they did have processes in place to monitor people’s health. We noted there was good communication between the home and community nursing staff.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found mixed evidence on how staff supported and monitored people’s care and treatment to continuously improve it.

Staff told us how they would monitor food and fluid intake and how they undertook regular checks on people’s wellbeing. However, the records did not always support this. We were not confident outcomes were always positive and consistent.

Staff told us and we saw evidence of people being referred to a 24hour virtual clinical assessment service. This supported people to remain at the home rather than visiting an acute hospital.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People were not routinely supported in line with the Mental Capacity Act 2005, to ensure decisions were made either by them, their legal representative or in people’s best interests.

People’s care plans contained a statement the person had “Read and agreed my care plan”, however, this section had often been signed by a member of staff. In addition, people’s care plans also included mental capacity assessments stating the person did not understand their care needs. It was not clear if people had really understood what they were being asked to consent to.

Where capacity assessments had been undertaken for specific decisions which confirmed the person was unable to make a specific decision, the service did not always ensure a best interest decision was recorded.

People were not routinely consulted about changes and decisions about the environment. For instance, one area had a key code to enter and a button to exit, however, people living in the unit had not been consulted. This was rectified by the provider after we discussed it with staff.

Staff told us they had received training about the Mental Capacity Act 2005, and we observed staff asking people to make decisions about what they wanted to do.