Welcome House - 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 Inadequate. At this assessment the rating has changed to 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 safe and care treatment

This service scored 59 (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 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. Lessons were learnt to continually identify and embed good practice.

Incidents at The Chestnuts were infrequent, however when they happened, they were investigated and reported appropriately. An investigation was undertaken to identify any contributory factors and learning that could be taken. We saw this was shared with staff, who had an up-to-date knowledge of how people should be supported safely in line with their current needs.

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.

There was appropriate guidance and monitoring in place to support people with their complex health needs, and we saw that referrals were made in a timely way when people’s health and wellbeing changed. For example, we saw staff had identified concerns about one person losing weight and had made a referral to the dietician. They were prescribed supplements and regular snacks as a result and had now returned to a stable and healthy weight.

There were systems in place to assess the needs of any people moving into the service to ensure they could be safely met; however nobody had moved into The Chestnuts since our previous inspection.

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.

Staff were knowledgeable about their responsibilities to safeguard those in their care from the risk of abuse and neglect. They could confidently describe what signs of concern they may look out for, and what they would do if they were worried that a person was at risk of harm. One staff member told us “I would look out for any bruises, evidence of money being stolen, note changes in behaviour such as people not eating. I would report to my manager and take action to remove the person from danger if needed. If appropriate I could also speak to the local authority, police or CQC to share my concerns”. There had been no safeguarding incidents recently which required reporting to the local authority. People felt safe and one person told us “Yes, I do feel safe. The staff are kind and treat me well”.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in locked accommodation were needed, to ensure their safety, appropriate authorisations were sought and recorded.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were not always managed safely or effectively. The people living at the service had diagnosis of complex mental health conditions. Although people’s emotional needs were largely stable, there was a continued lack of clear guidance on how staff should respond in a person-centred way if they were to become anxious or distressed to ensure their wellbeing and safety. For example, signs that a person might be struggling with their emotions were recorded but not how staff should respond if they were to observe these signs.

However, risks posed to people’s physical health were more consistently managed, for example around management of diabetes and risks posed to people with reduced mobility. There was clearer guidance and monitoring in these areas to ensure people’s safety.

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.

We identified evidence of people smoking with the building which was not being adequately controlled. The homes most recent independent fire risk assessment stated that people did not smoke within the building, which we identified was not accurate. Although there were controls agreed with people on access to cigarettes, these were not providing effective as it was still happening. There was an outdoor smoking area however this was located outside people’s bedroom windows, which did not reflect consideration to impact this might have on people in these rooms.

The environment was generally in a good state of maintenance, with regular checks taking place around utilities such as electricity, water, gas and fire safety. There were some remaining hazards such as a bathroom where the light was not functioning, and an unlocked boiler cupboard which was very hot to the touch. These were addressed following the inspection.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were sufficient staff to support people’s needs safely, who were generally knowledgeable about each person and the care they received. There were robust recruitment systems in place to ensure all staff were suitable to work at The Chestnuts. This included the use of Disclosure and Barring Service (DBS) checks, which are checks against the police national computer to help providers make safer recruitment decisions. Staff received regular supervisions to monitor their knowledge, abilities and welfare. Where more complex tasks were performed such as administering medications, staff had their competency assessed to ensure they were able to do so safely.

There were a small minority of staff who had not completed specific training around mental health. However we found in all other areas, staff had training that reflected the needs of the people they supported. Staff we spoke with could describe how they would support the physical and mental needs of people in their care.

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.

Although cleanliness had improved since our last inspection, it still remained inconsistent and people were not always supported in an environment that was clean or safeguarded them from the risk of infection. Kitchen surfaces such as cupboards and worktops were sticky to the touch, as were surfaces in certain people’s bedrooms. Some people had cobwebs and dust in their rooms indicating further work was needed to implement the improved standard of cleanliness throughout all parts of the building. However, staff worked alongside people to support them in manage their own personal hygiene to reduce the risk of infections. There was clear guidance in place of how this could be supported for each person, and people were supported to take pride in their appearance.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medication management systems were not effective at ensuring people would receive the medication they needed, when they needed it. The service was using multi-compartment compliance aids (MCA’s) in the form of blister bags for all people. These are not recommended by National Institute for Health and Care Excellence (NICE) due to the increased risk of medication errors, and that medication does not come with crucial safety information such as side effects. This meant we could not be assured staff would have this information available to refer to. During our inspection we identified some concerns about the temperature medications were being stored at meaning they would be less effective. This had been identified at our previous inspection and remained a concern.