17, 28 and 30 September 2015
During a routine inspection
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.