Archived: The Chestnuts

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to management of risk and governance at the service.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The manager had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.We found many examples of how and where lessons learnt had been shared with staff. Actions taken to prevent a re-occurrence included staff training, greater involvement from the manager to work alongside staff as a role model, better communication and revised processes.However, improvements were required to ensure lessons were learnt to continually identify and embed good practice. For instance, we found ongoing improvements were required in risk management which we had been previously identified at the last inspection.

Feedback from relatives confirmed they were kept up to date with their family member’s accidents and incidents. Some relatives acknowledged previous safeguarding concerns but expressed confidence in the way they were handled under current management. They told us “There was a safeguarding issue, but that has been resolved. Safety measures and equipment have now been put in place.”

Other relatives reported transparency regarding incidents. One relative told us “I was told that my [family member] missed a dose of medication, they were very honest about it.”

People, their relatives and external parties described management at The Chestnuts as a significant strength. The current manager was consistently praised by family members and healthcare professionals for being “visible” and deeply involved in the day-to-day running of the home. Their leadership style was credited with transforming the atmosphere and operational stability of the home. Comments included “[family member’s] care has improved so much" and “The new manager has been absolutely amazing and has turned this place around."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

We received positive feedback about how people were supported when their needs change or they needed to attend appointments away from the home.

The local community district nursing team visited the home to provide nursing services to people. They advised us they have a good working relationship with the staff. The district nursing team were positive about the way staff supported them.

Relatives were complementary about end of life care at The Chestnuts and the support staff provided.

Systems were in place to ensure information was available for staff to send with people when they were admitted to hospital. The introduction of regular risk and weight monitoring meetings meant this information was up to date when needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Since our last inspection there was a greater understanding from the management about what abuse was, how to recognise and report it. The management team had worked closely with the local authority when concerns about potential abuse had been raised.

People and their relatives told us they were safe living in the home. Comments included “My [family member] feels safe at the care home”, “I do feel [family member] is safe now”, “I feel that my [family member] is in a safe pair of hands” and “I think my [family member] is safe for sure.”

Staff told us they knew how to raise concerns about people. We observed posters were displayed in the building about how to raise concerns. We noted the manager had arranged for staff to receive refresher training on recognising abuse. Feedback from staff confirmed this had been beneficial.

People were not always protected from risks associated with their health and environment. We found records relating to risk needed to improve to ensure there was clear guidance for staff on how to mitigate and manage risk.

We found risk assessments did not always have enough information or had contradictory information on what actions staff needed to take. For instance, it was not clear from a person’s care plan what modifications were needed to their drinks to ensure the risk of choking was reduced. One person had fallen, the risk assessment had not been updated to ensure staff knew what to do to prevent a reoccurrence.

We found staff did not always have the detailed information they needed to ensure people’s care was delivered in a safe and individual way. We saw care plans where more information was needed about how to protect people who were susceptible to developing pressure ulcers and other skin problems.

People who were distressed at times were supported by staff who lacked clear direction in care plans on how to manage those episodes. We discussed this with the manager to ensure improvements were made.

People at risk of malnutrition or weight increase were monitored. The manager had a monthly overview meeting of people’s weights. We could see action was taken when concerns were raised. One person commented about their weight gain and how unhappy they were. We noted staff were supportive towards her about choosing healthier options.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Since our last inspection improvements had been achieved to promote a safer environment for people living at the home. However, we found systems in place to protect people from the risk of fire were not sufficiently robust. Although regular fire drills took place, the management had not taken urgent action to address a problem with the two-way radio equipment (walkie talkies) used for staff communication in the event of a fire. The management responded promptly to our feedback about this and confirmed action had been taken to ensure staff could communicate with each other in the event of a fire.

Staff showed us how they correctly used equipment such as sensors and pressure relieving mattresses to promote people’s safety.

The Personal Emergency Evacuation Plans (PEEPs) were now written in a more concise style with relevant information about people’s individual mobility and healthcare needs.

The provider did not always make sure there were enough permanent qualified, skilled and experienced staff.

People were being supported by a service which ensured the staffing levels were satisfactory to maintain safe cover within the home. However, the provider currently used a significant number of agency staff on day and night shifts. Relative's told us they felt this had a negative impact on their family member's care, comments included “There are too many agency staff, so continuity of care is not so good” and “There are a lot of agency staff, but the staff in general are really great.” However, the provider had plans in place to ensure more permanent staff were employed and had systems in place to book agency staff who had worked at the home before.

Staff were now receiving regular supervision which focussed in a supportive manner on enabling staff to improve the standard of care and support for people. Staff were encouraged to complete their mandatory training within the agreed timescales.

There were some positive examples of staff working well together to provide safe care. This included the care given to people who had specific needs due to their health care conditions, for example people who could be resistant to accepting personal care due to dementia.

Staff received training to ensure they had the skills and knowledge to support people. The manager was able to recognise when additional training was needed and supported staff to undertake this.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

There were satisfactory supplies of Personal Protective Equipment (PPE). Staff had recently received refresher training in how to protect people from the risk of infection and how to safely apply their PPE. However, one senior member of staff was wearing nail coverings which had the potential to harbour infections and prevent good hand hygiene.

There was a cleaning schedule in place; however, on the day of our visit we found carpets in communal rooms used by people had not been hoovered. We were informed equipment to deep clean carpet was broken and not yet replaced. We discussed this the management team for them to action.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines were safely managed. There were systems for ordering, administering and monitoring of medicines. Staff were trained and deemed competent before they administered medicines. Medicines were safely secured, and records were appropriately kept. We found that room and fridge temperatures were appropriately monitored.

The provider had a system to monitor and audit people’s medicines on a regular basis and we found that improvements had been made as a result of this. For example, a monthly audit by the provider found that opening dates should be written on liquid medicines and on assessment, we found this to be the case.

We were assured that medicines-related incidents were investigated properly with appropriate action plans and there were processes in place to ensure staff learned from these incidents to prevent them occurring again.

People received their medicines as prescribed.We looked at 10 people’s medicines and found minimal discrepancies in the recording of medicines administered. Overall, this provided a level of assurance that clients received their medicines safely, consistently and as prescribed.

There were separate charts for people who had medicines such as patches, ointments and creams prescribed to them (such as pain relief patches) and there was an appropriate medicines policy in place. Furthermore, medicines for waste were disposed of regularly and appropriate records were made.

During the inspection, we saw several instances of where residents were prescribed PRN (as required) medicines and there were associated PRN protocols in place. This meant we had overall assurance that staff were able to administer these types of medicines effectively to people, within appropriate clinical guidance.

There were 3 people who received their medicines in a covert manner and appropriate authorisations had been sought. There were appropriate medicines administration procedures in place, including the use of hand hygiene prior to each administration. Both sets of first aid and hypoglycaemia boxes were checked weekly by the manager and appropriate actions taken if needed.