Archived: Chestnut Court

The service had a registered manager. 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.

We inspected Chestnut Court on 27 and 28 April 2016. This was an unannounced inspection. At this inspection we found four breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 regarding, medicines management, staffing levels and supporting staff. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were not safe at the service. There were poor arrangements for managing medicines and there were not enough staff available to meet people’s needs and keep them safe. Risk assessments did not always cover all areas of risk relating to people to ensure their risks were minimised and managed.

Staff did not always receive up to date training, supervision and appraisal. Staff did not always treat people with respect and dignity. Peoples care plans were not always regularly reviewed. There was a lack of activities at the service for people to take part in. There was poor record keeping and quality monitoring tools used by the service did not identify issues of safety and quality. Staff had mixed views about the staff culture and management team.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. There were effective and up to date systems in place to maintain the safety of the premises and equipment. We found recruitment checks were in place to ensure new staff were suitable to work at the service.

Appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. People using the service had access to healthcare professionals as required to meet their needs.

Staff knew people they were supporting. People using the service and their relatives told us the service was caring. Staff respected people’s privacy and encouraged independence. People and their relatives knew how to make a complaint. The service enabled people to maintain links with their culture and religious practices.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

We spent time in all three units and observed how people were supported by the staff. We saw that staff treated people with respect and dignity. Relatives told us that they felt people were safe. One relative told us '[my relative] likes it here. Its friendly and she feels safe.'

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had made the necessary DoLS applications when decisions needed to be made in a person's best interest or they needed to be deprived of their liberty in some respect.

The systems for the administration of medication had improved since the last inspection and people received their prescribed medicines safely.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that a healthcare professional had written in a monitoring report 'service user needs are catered for and there was evidence that the service is working to meet Care Quality Commission shortfalls.'

People were supported to receive the healthcare that they needed. One healthcare professional told us 'there has been a marked improvement and any issues are taken on board and addressed.'

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and preferences.

Is the service caring?

Relatives we spoke with were very positive about the care provided by the staff team. One relative told us 'the girls are lovely with [my relative]. They see to all her needs.' We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do. A person who used the service said 'it's nice here. The girls are very good. They always help you and will do anything for you.'

Is the service responsive?

Care staff were able to tell us about people's needs and how they supported and cared for them. The service was responsive to people's changing needs. We saw that care plans were reviewed monthly and updated when needed. This meant that staff were made aware of people's current needs and how to meet these as safely as possible. A member of staff told us 'one person's needs changed after they had an operation. We were all made aware and all the care plans were updated.'

Is the service well led?

A new manager had been appointed since the last inspection. All those we spoke with were very positive about the management of the home. They told us that the manager was approachable and 'got things done.' Staff we spoke with said they felt the home was well managed and that they received the support and guidance they needed to carry out their duties and to meet people's needs. People said that the quality of the service had greatly improved and that they had every confidence in the manager.

On this visit we found that people were treated with respect and that they were asked for their consent before care was provided.

People who used the service and their relatives told us that the staff worked very hard, were kind, caring and gentle. One relative said 'the carers are fantastic in general.'

However we found that people's care and welfare needs were not being met. For example, not checking that people had passed sufficient urine and not adequately addressing significant weight loss.

The systems for the administration of medicines were not robust and did not support people to receive their prescribed medication safely. Although the provider had a quality monitoring system in place it was not effective. For example, the manager informed us that that one person's pressure sores had not increased in number or severity but this was not the case. This issue and the other concerns highlighted during the inspection had not been identified via the provider's quality monitoring of the service.

However, we found that the provider's system for managing an infectious outbreak, arranging the effective cleaning of the service, and managing laundry were not effective. Records had not been kept of who had received treatment for scabies and carpets were not thoroughly cleaned. The service was not safely dealing with laundry and there was a risk that clean items could be contaminated by dirty items. Audits of the cleaning arrangements were not sufficiently detailed to demonstrate that cleaning of the home had been checked to the required standard. This meant the provider had not complied with Department of Health guidance (the Code of Practice for health and adult social care on the prevention and control of infections and related guidance) and was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Effective systems were in place to reduce the risk and spread of infection. We examined all of the communal areas and 15 of the bedrooms and found that all the areas were clean. We spoke to the manager of the home who told us that an effective monitoring regime had now been put in place to ensure that the home remained clean and properly maintained at all times.

We examined the records for the home and found that they showed rooms and communal areas were being cleaned on a daily basis. In addition two bedrooms are 'deep cleaned' every day. The home has brought in an external training company that has delivered infection control training to 95% of the staff. The manager told us that since the beginning of January 2013 there have been no further outbreaks of illness at the home.

People told us they were disappointed that there were very few activities to keep them occupied during the day. The home arranged special events from time to time such as an owl display, occasional professional singers and other entertainers that had all visited. However, the home did not have a regular programme of activities or a system that ensured people had time for one to one interactions with staff.

We inspected between 11am and Noon and found that food from breakfast had not been cleared away in two of the lounges. We found dirty equipment such as slings, bedpans and toilet booster seats. The home did not have an effective system in place to ensure good housekeeping and the prevention of outbreaks of infection.

At the time of our inspection we found that building work was being undertaken to improve cleanliness at the home. The provider had developed a proposed action plan to establish effective systems around cleanliness and infection control.

We found that medications were stored and administered safely, and that staff had undertaken training and competence assessments on the administration of medications.

We observed staff interacting well with people, and people told us that staff treated them with respect and dignity.

We found that during the day time staffing levels had increased since our last visit in June 2012, but that staffing levels remained unchanged during the night. Staff and people using the service told us more staff at night would be helpful. One person told us "we have an extra person to help in the day, but at night it does take them a while to come sometimes."

We found that monitoring systems have being introduced since our last visit, and that the service has made plans to issue surveys to people, their relatives and relevant professionals to gain their views about the service.

You can see our judgements on the front page of this report.