Archived: The Chestnuts

Updated 18 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to our visit we also reviewed the information we held about the service. This included any safeguarding alerts and outcomes, complaints, information from the local authority and notifications that the provider had sent to CQC. Notifications are information about important events which the service is required to tell us about by law. We also reviewed previous inspection reports.

This inspection took place on 17, 28 and 30 September 2015. The first visit was unannounced and the inspection was carried out by one inspector. We spoke with one person who used the service, the manager and three members of staff. Not all people were able to communicate verbally with us so we spent time observing their care and interactions with staff. We reviewed records about people’s care, including three files of people who used the service.

We checked four staff files and the records kept for staff allocation, training and supervision. We looked around the premises, external grounds, all of the bedrooms and checked how the premises were cleaned and maintained. We checked records for the management of the service including health and safety records. We reviewed how the provider managed complaints and checked the quality of their service. We also checked how medicines were managed and the records relating to this.

Following our inspection the manager sent us some information about staff training.

Updated 18 December 2015

This inspection took place on 17, 28 and 30 September 2015 and was unannounced. At our last inspection in July 2013 the provider met the regulations we inspected.

The Chestnuts is registered to provide accommodation and personal care for up to five people with learning disabilities. There were four men using the service at the time of our inspection.

At the time of our inspection there was no registered manager and the previous registered manager had left over 12 months ago. Under the Health and Social Care Act 2008, the provider of this service is subject to a registered manager condition under Regulation 5 of the Care Quality Commission (Registration) Regulations 2009. Prior to our inspection we informed the registered provider that a failure to comply with a condition of registration may result in prosecution. When we inspected, a manager had been appointed and been in post for two months. They had made a recent application to register. 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.

Staff were knowledgeable about the risks of abuse and procedures for reporting any concerns. However incidents and accidents were not always reviewed or investigated and those which were reportable to CQC had not been shared. We were therefore not assured that important events which affect individuals’ health, safety and welfare were being appropriately reported to us.

The service did not follow consistent safe practice for the recording and safe administration of people’s medicines. People were not living in a clean environment and parts of the premises were in need of redecoration or repair.

There were adequate numbers of staff who had been safely recruited. Although staff were familiar with people's needs, they had not received regular training to keep their knowledge and practice up to date. We were also not assured that staff had the skills and expertise to support the specialist needs of the people using the service.

The arrangements to monitor service provision were limited and failed to identify shortfalls and ensure that people are well cared for and safe. The provider’s systems were not used effectively to keep checks on standards, develop the service and make improvements.

People using this service experienced responsive care and support that was person centred and appropriate to their needs. For some however, care plans did not always record all the information staff needed to care and support people effectively. We also found that records related to staff and the management of the service were not up to date or consistently maintained.

Staff respected people’s privacy and treated individuals with kindness and patience. Staff made sure people’s dignity was upheld and their rights protected. Staff understood their responsibilities where people lacked capacity to consent or make decisions. This was because they had received training on the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Appropriate DoLS applications had been made where required.

People were supported to maintain good health and had access to healthcare services when they needed them. The service had made timely referrals for health and social care support when they identified concerns in people’s wellbeing. People were encouraged and supported to eat a nutritional diet that met their needs and recognised their choices.

People were able to take part in activities of their choice and were supported to maintain relationships with family and friends who were important to them.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to managing risk for people using the service, the training provided to staff, the systems for monitoring the quality of service provision, notification of reportable events and record keeping. You can see what action we told the provider to take at the back of the full version of this report.