Welcome House - The Chestnuts

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to treating people with dignity and respect.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although staff demonstrated a kind and caring approach, people were not treated with respect, privacy or dignity.

The garden at the service had unsuitable items in it which demonstrated a lack of dignity to people’s home environment. Staff had not considered whether people wanted these unsightly items in their garden and how it may impact them on a day-to-day basis. Staff said, “People are not interested in the garden. We have tried to get them involved, but instead the staff just cut down the weeds.” However, staff had not considered that people may not wish to be involved in the garden because it was uninviting and uncared for. When we visited on the second day, we found the garden had been tidied up and the items removed.

In addition, a ‘smoking’ area has been established to the side of the premises. This was used regularly throughout the day as many people living at the service smoked. But staff had not considered one person whose bedroom was adjacent to this smoking area. They told us, “The smell of smoke doesn’t always bother me, but I don’t like the noise. I can’t read my book because it is too noisy (with staff and people chatting in the smoking area). It's not all day, but it is often.” The person confirmed they had not been consulted on the location of the smoking area.However, the registered manager told us that the smoking area had been established prior to this person moving in and they had been given a choice of rooms at the time.

At other times of the day we heard staff interacting with people in a kind way and people told us staff were caring towards them. One person said, “Staff are kind to me.” A second told us, “The staff are kind and generally everyone is nice here.” It was one person’s birthday on the first day of our visit and staff had organised a cake, everyone sang happy birthday and cake was passed around to people.

Staff respected people’s privacy. They told us some people locked their bedroom doors when they were not in their rooms. At these times staff would respect the person’s choice to do this and only enter a person’s room after asking for permission. A staff member said, “If people are out they lock their doors and we don’t go into their rooms.”

Staff did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences.

Staff were not able to tell us about people goals and aspirations. We spoke to one staff member about a person asking how the person was supported with their addiction. We were told, “Staff make sure she’s engaged so her mind does not have time to wander.” When we asked if there was any structured approach or if the person had any independence, goals or ambitions, we were told there was nothing in place. The staff member said, “We sit and we talk to her. I am not sure (about independence, etc). She has made breakfast before.”

Staff did not always consider people’s cultural and unique backgrounds or protected characteristics. Although there was information about a person’s religious beliefs in their care plan, there was nothing else around their sexuality, cultural or ethnicity needs and preferences. Some people were from a distinct ethnic group however this had not been identified in their care plan. Staff did however accompany one person to a temple so they could pray which met their religious preferences.

The registered manager and staff did not promote people’s independence. One person said, “I can retain some independence where I can, but I would like to think I could do some cooking.”

Although people were involved in their care plans, due to the staffing arrangements at the service some people did not have the choice of when they could go out, and they could not go out spontaneously. There were no opportunities for people to take part in social activities during the evening. One person mentioned they would have liked to visit the restaurant down the road, but said they were unable to go out at night.

Staff said people had keyworkers (a designated member of the staff team who advocates for the person and works towards goals with them). They told us, “We have keyworkers for people. They have chats with people to find out what they like or don’t like (for example, meal choices). They sit with the person and speak to them about what should be in their care plan.” But there was no evidence that these key workers supported people to have choice and control over their lives.

There was a lack of consistent approach to support people to retain or regain their independence. Staff did the ironing and supported people to clean their rooms, rather than encouraging them to do this themselves. A staff member said, “We encourage service users to wash up. If there are vegetables to be peeled they can join in.” But this was the extent of independent daily living skills that staff involved people in. In addition when we asked staff how people were supported to achieve their independence, they were unsure how to answer this other than to say, “By meeting their care needs.”

Although the kitchen door remained open throughout the day, we did not observe anyone assisting with lunch preparation or making their own drinks. Lunch, despite being a simple dish, was prepared entirely by staff and afterwards the tables and kitchen were cleared by the provider’s quality assurance manager who was visiting on the day. One person told us, “I don’t believe I am allowed in the kitchen. I would like to make my own drink as sometimes they forget to put milk in it and I don’t like it.”

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We read of the numerous incidents which occurred in the service, some of which resulted in people being harmed or feeling unsafe. Despite this, the registered manager had not considered these as potential safeguarding concerns and as such reported them to the local authority safeguarding team to enable them to take any appropriate action. This meant people experienced unnecessary distress.

Yet there were some examples where people’s needs had been responded to. For example, where one person was accompanied to the local temple to pray, and another person who wished to go out on the afternoon of our second visit and the registered manager ensured they were able to do this immediately they mentioned it.

The registered manager did not always care about and promote the wellbeing of their staff or themselves.

We reviewed the rotas over a 4-week period as the registered manager explained that they and the deputy manager took responsibility for being on-call on alternate weeks. Due to the registered manager’s annual leave, the deputy manager worked 3 consecutive weeks Monday to Friday at the service (completing 53, 50 and 47 hours respectively) while also being on call for the full 7 days each week. As a result, during this 3-week period the deputy manager had no time fully away from work for rest or relaxation. Additionally, at the end of July the registered manager worked 55 hours in the service Monday to Friday while also being on call for 7 consecutive days. Extended working weeks with no full rest days greatly increases the risk of exhaustion and also the risk of mistakes occurring.

Staff however told us they felt supported. One staff member said, “The manager does support me. She encourages me to be involved in the care plans which is good development for me.” A second staff member told us, “The manager’s door is always open. They gave me time to speak about a recent incident and suggested I take time out if I needed it. I felt very supported. If I needed more structured support such as counselling, I am certain it would be available for me.”