Welcome House - 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 54 (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.

Although people’s needs were assessed, the level of guidance in place did not provide a consistent or clear plan of the care they should receive. The service were supporting people living with complex and enduring mental health conditions, however guidance primarily referred to medication and input from health professionals to manage this, rather than any actions staff could do proactively to promote their emotional wellbeing.

The quality of information in people’s care planning had improved since the last inspection and the provider had recently switched to digital records, but it was still not always clear that these were up to date or reflective of current needs. For example, one person was recorded as not liking meat but their care notes showed them eating this most days indicating that this was not the case.

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The model of care at The Chestnuts did not reflect best practice for a service supporting individuals with complex mental health needs. Guidance in place remained inconsistent about how people’s welfare could be promoted, and there was limited evidence that people had regular opportunities to discuss their wellbeing with staff or that this was proactively offered. The service had not considered wider factors such as promoting independence, meaningful social activity and person-centred goals that could promote people’s mental health, alongside any medical support or medication they received to manage this.

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

We observed that staff treated people with kindness and were generally knowledgeable about how to keep them safe and support their physical health needs. However, there were significant inconsistencies in staff understanding around people’s goals and aspirations, and there was little evidence of staff working collaboratively to support people in achieving them or to improve their independence.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were able to access a range of health services both within and outside of the home. This included visits from services such as opticians and chiropodists on a regular basis, as well as attending appointments with the GP or mental health services which staff supported people to attend. Where people were less comfortable with leaving the building to attend appointments, staff had worked with people to improve their confidence. We identified one person had been reluctant to leave the building, however staff would now ensure they made them aware of the appointment well in advance to provide them with reassurance and they were now attending these in person which was a major step for them. One person told us “I went out this morning to have a blood test. Staff went with me”.

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.

Although people’s physical health outcomes were largely monitored well, there was a lack of consistent monitoring of people’s wider social outcomes and what they wanted to achieve from their time at The Chestnuts. There was a lack of detailed plans of how people would be supported to achieve any goals or aspirations, and no evidence that these were being reviewed alongside people and adjusted accordingly. Keyworker meetings were taking place but the records of these were largely identical from month to month or did not reflect a detailed discussion with each person about their care.

However, where people were at risk through malnutrition or dehydration staff were ensuring that people’s food and drink intake were being monitored, as well as their weight regularly checked. For people who had conditions such as diabetes we saw their blood sugar levels were being monitored regularly, to allow staff to intervene if these were to become unsafe.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed that staff sought consent before performing any care tasks, which was clearly recorded within people’s daily care notes as well being seen in practice during our inspection. Staff were trained and knowledgeable about the principles of consent, and the rights of people to make their own choices. Where people were assessed as lacking mental capacity to make decisions, a best interest meeting was held with people’s representatives to make decisions on their behalf to ensure their welfare.