Chestnut Grange

We found the following examples of good practice.

There was a restriction on visiting the service at the time of the inspection. However, family were kept fully informed through email and phone calls. A visitor and staff sanitising station with appropriate PPE, sanitiser and check lists were made available at the main entrance. Signage in picture format and written instructions for what visitor should do was also at the main entrance.

The provider ensured people-maintained contact with relatives by staff supporting them with facetime, telephone calls and letter writing. The deputy manager told us they had accommodated garden visits during the summer and was reviewing visits for the winter once they had reviewed current guidance on accepting visitors.

There was a clear regular programme for staff and people living in the home to be tested for COVID-19. This meant swift action could be taken if or when positive tests were received.

Staff followed procedures for don and doffing PPE and how to dispose of it safely, in line with government guidelines. All staff wore appropriate PPE, which was in good supply. Posters and information about COVID-19 were visible throughout the service. The provider was working closely with Public Health England and local infection control teams to ensure they had appropriate safety measures in place.

A robust contingency plan was in place and used for when positive testing or isolation for staff or people arose. Agency staff were used to cover shortfalls in staffing, due to staff testing positive for COVID-19.

Handover meetings were completed in line with safe distancing guidelines.

A robust individual risk assessment was in place for people in high risk groups. The provider considered and reduced any impact to people/staff who may be disproportionately at risk of COVID-19. The registered manager gave an example of vulnerability for people and they had assessed if any staff were at risk and how they managed those risks safely.

People using the service had tested positive and were self-isolating in their own rooms or communal areas when appropriate. Arrangements were in place to reduce the spread of infection. People’s individual needs were considered to ensure everyone was kept safe.

The home was very clean and tidy with easy wipe surfaces and floors. The provider had increased the cleaning regime. The cleaning schedules had been consistently completed for the weekly and monthly tasks around the home environment and touch point cleaning.

Further information is in the detailed findings below.

Chestnut Grange is a care home that offers care and support for up to 10 people with learning disabilities or autistic spectrum disorder. There were nine people using the service at the time of our visit.

The care service was designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People were given choices and participation within the local community was encouraged.

People’s experience of using this service

• People were supported to be safe. Staff understood their responsibilities to protect people from abuse and avoidable harm. Risk was assessed and managed. People’s human rights and freedoms were respected within the risk management plan.

• Routine checks and maintenance were carried out on the premises and equipment. There provider had a health and safety team available to provide additional support and training to people and staff.

• There were enough staff to meet people’s needs and to spend time with them. Staff were recruited in a safe way.

• People’s medicines were managed in a safe way and were reviewed by the prescribing doctor to make sure they remained effective. People had access to the healthcare services they required. Staff referred people promptly and followed the advice and guidance provided by the professional.

• People had enough to eat and drink and were encouraged to follow a healthy diet and maintain a healthy weight.

• The service was spacious and met the needs of people who lived there. People’s rooms were personalised. The service was clean and tidy throughout. Staff knew how to reduce risk of cross infection. They had access to the protective equipment and cleaning products they required to achieve this.

• Staff had the training and support required to meet people’s needs. Care and support followed best practice up to date guidelines and legislation. Staff had opportunities to learn and develop their skills and qualifications.

• Consent to care and support was always sought in line with legislation and guidance. People were encouraged to make choices and decisions about their care and support and the things they did each day.

• Staff were kind and compassionate. People and staff had developed positive relationships. Staff were passionate and motivated about improving outcomes for people and increasing people’s skills and independence. Privacy and dignity was promoted by all staff.

• Staff knew people extremely well. They knew about the things that were important to people and the things that may cause distress. Staff knew the best way to communicate with people and how to offer support and reassurance when this was required. People led active lives and took part in culturally relevant activities in and outside of the home.

• There was a complaints procedure and any issues were responded to quickly and used as an opportunity to learn and improve. People, relatives and staff were asked for their feedback and their views and opinions were listened to and acted on accordingly.

• There was a clear organisational structure. Staff understood their roles and responsibilities. There was strong leadership and support structures in place. Managers were open, inclusive and accessible. Staff and managers shared a vision based on providing person centred care and support and improving outcomes for people. There were effective systems in place to monitor the quality of the service and to drive improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service Good (report published on 23 July 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Chestnut Grange is situated in the village of Weston, between the market towns of Retford and Newark. The service provides care and support for up to ten people with a learning disability, and accompanying complex needs. At the time of inspection seven people were using the service.

At the time of our inspection, the registered manager had recently left and the provider was making arrangements for their replacement. The registered manager from another nearby service had been asked by the provider to oversee the service while these arrangements were made. A registered manager is a person who has registered with the Care Quality Commission 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 person referred to in this report as the manager is the person who has applied to CQC to become the registered manager for the service.

People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There were enough staff with the right skills and experience to meet people’s needs. Medicines were stored, administered and handled safely so that people had their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. Staff received supervision of their work. People were enabled to make decisions and staff knew how to act if people did not have the capacity to make decisions. People spoke positively about the food and were supported to maintain a healthy diet. Staff monitored and responded to people’s health conditions, with people having access to their GP and other health care professionals as and when they required.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Where people showed signs of distress or discomfort, staff responded to them quickly. People were supported to access an independent advocate if they wanted to. There were no restrictions on friends and relatives visiting their family members. People could have privacy when needed.

People and their relatives were involved with the planning of the care and support provided. Care plans were written in a way that focused on people’s choices and preferences. Regular monitoring of people’s assessed needs was conducted to ensure staff responded appropriately. People were able to access the activities and hobbies that interested them. A complaints procedure was in place and people felt comfortable in making a complaint.

People were involved in giving their views on how the service was run. There was a positive atmosphere within the home and people were encouraged to contribute to decisions to improve and develop the service. Robust auditing and quality monitoring processes were in place. The service continually strived to improve the quality of the service that people received.