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Inspection Summary


Overall summary & rating

Good

Updated 3 November 2017

Chestfield House provides nursing care and accommodation for up to 31 older people, some of whom may also be living with dementia. The service is an adapted detached building in Chestfield near Whitstable. The accommodation is provided on two floors, with bedrooms on both the ground floor and first floor, accessed by a lift and a staircase. There are three shared bedrooms and most bedrooms have en-suite bathrooms. At the time of the inspection there were 30 people living at the service.

There was a registered manager employed at the service. A registered manager is a person who has registered with the CQC 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. The registered manager was responsible for the day to day running of the service.

We carried out an unannounced comprehensive inspection of this service in May 2016 the service was rated Requires Improvement. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we asked the provider to make improvements. We issued requirement notices relating to failing to collaboratively carry out an assessment of people’s needs and preferences, failing to mitigate risks to people, failing to assess and monitor the service effectively, failing to complete proper recruitment checks, failing to ensure staff were trained and failing to deploy sufficient numbers of staff. The provider sent us an action plan. We undertook this inspection to check they had followed their plans and to confirm they now met legal requirements. Improvements had been made and the breaches in regulation had been met.

Risks to people were assessed, identified, monitored and reviewed. However we found pressure relieving equipment that was not set correctly. Staff did not have clear guidance on the use of prescribed creams to make sure their skin was kept as healthy as possible. Other medicines were managed safely.

Some care plans had been rewritten and provided staff with more detail to help them provided people with personalised care. Other care plans remained generic and were in the process of being updated

Some audits and checks had not been consistently effective and shortfalls found during the inspection had not been identified. Other checks, such as the environment, had been completed and action taken to address any concerns. The area manager completed a ‘provider visit’ and audited the service The registered manager had taken action to address the shortfalls when they had been identified. We have made a recommendation regarding improving the audits.

People were protected from the risks of abuse, discrimination and avoidable harm. Staff knew how to report any concerns and felt confident that action would be taken. People’s money was safely managed. Staff knew how to keep people safe and understood their responsibilities for reporting accidents and incidents to the registered manager. People’s medicines were managed safely and they received them on time. The premises were maintained to help keep people safe.

People were supported by sufficient numbers of staff who knew them and their preferences well and who had been recruited safely. Staff had completed regular training and one to one supervision to keep them up to date with guidance and best practice.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People’s representatives and health profess

Inspection areas

Safe

Good

Updated 3 November 2017

The service was safe.

Risks to people were assessed, monitored and regularly reviewed to help keep people safe.

People were protected from abuse, discrimination and avoidable harm.

Staff were recruited safely. There were enough staff on duty to keep people safe and meet their needs.

People received their medicines safely and on time.

Effective

Good

Updated 3 November 2017

The service was effective.

People�s needs and preferences were met by trained and knowledgeable staff.

Staff understood their responsibilities under the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported to eat healthily and were involved in making decisions about what they ate and drank.

People were supported to remain as healthy as possible. People were referred to the relevant healthcare professionals when needed.

Caring

Good

Updated 3 November 2017

The service was caring.

People were treated with compassion and kindness.

People were given the information they needed in a way they could understand.

People�s confidentiality, privacy and dignity were promoted and maintained.

Responsive

Good

Updated 3 November 2017

The service was responsive.

People received care and support that was centred on them as an individual; however, care plans were not all personalised and were still in the process of being rewritten.

People�s preferences, likes and dislikes were considered by staff. People were supported to take part in social activities.

People and their relatives were able to share their experiences, raise concerns or complain.

Well-led

Requires improvement

Updated 3 November 2017

The service was not consistently well-led.

Auditing processes were in place to check the quality and safety of the service provided. We have made a recommendation regarding improving the audits.

There was an open and transparent culture where people and their relatives were encouraged to provide feedback.

Notifications had been submitted to CQC in line with guidance. The latest CQC report and rating were displayed in the service and on the provider�s website.