Chester House Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The provider was in breach of the legal regulation in relation to person-centred care.

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 were at the centre of their care and treatment choices, and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

There was no activity co-ordinator employed and we were not assured that regular activities took place at the home, other than an entertainer visiting once every few weeks. We saw no evidence that activities were designed and delivered for people with dementia or other cognitive impairments. Despite 3 people being cared for in their bedroom, there was no provision for 1:1 interactions/activities and we observed they did not receive meaningful person-centred interactions from staff during our three days of visits. Most people were observed spending the day in the lounge in front of the television or sleeping and daily records confirmed this practice. We saw no evidence that people were supported, on a regular basis, to access the outside space, other than to go for a cigarette. People confirmed that they do not access the garden area very often. The management told us they have events on at the home such as a coffee morning; however, these were not regular occurrences.

Despite the home being registered with a service specialism of dementia care, we found the environment experienced by people was not always appropriate to promote good experiences for people with dementia and other cognitive impairments. We found improvements were needed as the environment was often noisy and busy and this may cause overstimulation and distress in those people with dementia and other cognitive impairments. People did not have access to any quieter areas to sit and relax in, other than their bedroom. We observed several times where a person was experiencing distress or people were having verbal altercations.

People confirmed with us there was a lack of any activities at the home. One person told us, “Staff don’t really do any activities with us." Another person told us, “They don't really do activities, they put a singer on about every six weeks or so."

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

A stable staff team who knew people’s care needs were in place which helped promote people’s continuity of care. Some people living at the home had mental health needs and other physical health needs; however, we were not assured that staff had received appropriate training in the needs of people they were caring for. There is a regulatory requirement for staff to have completed training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. The training matrix supplied to us indicated all staff had previously completed this training; however, when asked for evidence completion and course content, we were supplied with training dates after our inspection. The training information demonstrated only 1 of the 2 parts of the course had been completed and the training was given at tier 1; however, care staff working with people with a learning disability and autistic people require training at tier 2.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The management was not aware of the Accessible Information Standard (AIS), the AIS is a legal requirement for health and social care providers to ensure information for people with disabilities, impairments or sensory loss receive accessible information and communication support. However, they told us staff had completed training in communication. Our observations around staff communication were mixed and we saw some lovely interactions but also observed instances where there appeared to be a language barrier. The management told us they have spoken with staff about the need for them to speak slowly to people to ensure they understand.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The management told us they had not received any complaints from people or their relatives.

We saw that resident meetings and relative meetings were taking place regularly.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We were not fully assured that people’s environment was conducive to enabling people to easily navigate their way around the home. Some modifications had been made to make the home dementia friendly, for example, some signs denoting specific rooms such as the bathroom. However, improvements were required to make access around the home easier for people with dementia and other cognitive impairments, for example, we found people could not always access some areas of their home or bedroom due to keypad locks.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Feedback from people and relatives was mainly positive, describing kind and compassionate care. However, our evidence showed variation in people’s experiences. People were not meaningfully engaged, and specific improvements were need in the provision of 1:1 person-centred care for people in their bedrooms. This meant people who could not, or did not, wish to join in communal areas did not always have the same opportunities to access the television, or conversations, as other people using the service.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of our inspection, there was no-one at the home receiving end of life care. The management told us staff had received end of life training. People had an end of life care plan section, and we found this to be generic and not person-centred. This meant there was limited information demonstrating how people and their families had been involved in discussions about their wishes and preferences, and we were not assured staff were aware of any end of life wishes they may have. We did not see people’s future goals and aspirations were recorded in care plans.