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Welcome House - The Chestnuts Requires improvement

Reports


Inspection carried out on 28 November 2019

During a routine inspection

About the service:

Welcome house – The Chestnuts is a care home which provides accommodation and personal care for up to 15 people with mental health needs. At the time of our inspection, eight people lived in the home. They were fairly independent therefore required minimal support with their personal care needs.

People’s experience of using this service:

The provider failed to always assess and mitigate risks to the health and safety of people. The provider had not always completed incidents and accidents records. The systems and processes to assess, monitor and improve the quality and safety of the service were not wholly effective.

We have made two recommendations about accessible communication and relevant activities for people.

People gave us positive feedback about their safety and told us that staff treated them well. Staff administered prescribed medicines to people safely and protected people from the risk of infection. The provider carried out comprehensive background checks of staff before they started work. The provider had a system to manage accidents and incidents.

Staff received support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach the registered manager at any time for support. The registered manager worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care. 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.

The assessment of people’s needs had been completed to ensure these could be met by staff. The registered manager worked with other external professionals to ensure people were supported to maintain good health. People were involved in making decisions about their care and support. People were treated with dignity, their privacy was respected, and supported to be as independent in their care as possible.

Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People knew how to make a complaint. The registered manager knew if someone required end of life care.

There was a management structure at the service. Staff were aware of the roles of the management team. They told us the registered manager was approachable. People and their relatives commented positively about staff and the registered manager. The registered manager had worked in partnership with a range of professionals.

Rating at last inspection and update

The last rating for this service was good (published 23 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessment and their management and effective quality assurance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 25 April 2017

During a routine inspection

The inspection was carried out on 25 April 2017, and was an unannounced inspection.

Welcome House - The Chestnuts is registered to provide accommodation and personal care for up to 15 people with mental health needs who do not require nursing care. The people who used the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, nine people lived in the home. They were fairly independent therefore required minimal support with their personal care needs.

At the last Care Quality Commission (CQC) inspection in 14 July 2015, the service was rated Good in all domains.

At this inspection, we found the service remained Good.

People continued to be safe at Welcome House - The Chestnuts. People were protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff had extremely good relationships with the people who lived at the home. People understood that staff would support them during difficult times and could rely on staff to always be there for them, providing guidance when needed. People were empowered to make their own decisions and to take responsibility for them. Staff maintained people’s privacy and dignity ensuring that any care or discussions about their care were carried out in private. Interactions between staff and people were caring and respectful, with staff being consistently patient, kind and compassionate.

The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

Inspection carried out on 14 July 2015

During a routine inspection

We inspected this home on 14 July 2015. This was an unannounced inspection.

The Chestnuts is registered to provide accommodation and personal care for up to 15 people with mental health needs who do not require nursing care. The people who used the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 11 people who lived in the home were fairly independent, hence requiring minimal support.

There was a registered manager at the home. 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.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as mental health, and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

Safe medicines management processes were in place and people received their medicines as prescribed.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. People were supported as appropriate to maintain their physical and mental health. People had care plans outlining the goals they wished to achieve whilst at the service and what support they required from staff to achieve them.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.

Inspection carried out on 22 April 2013

During a routine inspection

At our last visit on 30 October 2012 we found that the home was not being maintained to a satisfactory standard of hygiene. Following that visit the provider sent us an action plan telling us about the actions they were taking to make sure standards improved in this area.

During this visit we found that improvements had been made and the home was clean throughout. Damaged flooring, fixtures and fittings had been repaired or renewed and there were procedures in place to make sure that the home was cleaned effectively. This meant that people were being cared for in a clean and hygienic environment.

There were 12 people living in the home at the time of our visit. People told us they were happy living in the home. They said, �The staff are very good, I like living here.� �There is always someone to talk to.� �I can go out whenever I want to. There is always something to do, I don't get bored.� �I would say if I wasn't happy about I anything, they would sort it out.� "There is nothing to complain about."

We found that the care and support that people received was well planned and delivered in a way that protected people from risk of harm. Medication was stored securely and administered safely. There were robust recruitment procedures in place to make sure that staff were suitable. People knew who to talk to if they were unhappy about anything.

Inspection carried out on 30 October 2012

During a routine inspection

There were 12 people living in the home at the time of our visit. There was 24 hour support provided. People told us they were happy living in the home. They said, "I can choose what I want to do and where I want to go." "I read my care plan before I signed it." "Staff help us when we need it." "I like living here, they look after us." "The meals are very nice, we choose what we want to eat." "I like doing the cooking."

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. Staff were given appropriate professional development to enable them to understand people's needs and provide appropriate care and support. Hygiene standards in the home were not adequate to make sure people were protected against risk of infection.

Inspection carried out on 17 November 2011

During a routine inspection

People told us that the care and support they received was very good and they chose to come and go as they liked into the community.