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Inspection carried out on 7 December 2018

During a routine inspection

What life is like for people using this service:

The provider and registered manager continued to provide a ‘good’ service. People were safe at the home and staff knew how to protect them from harm. The home was well-staffed and people were supported to go out and take part in activities. All areas of the home were clean and tidy and the premises were being continually improved. People’s bedrooms were personalised in the way they wanted.

Staff were trained to provide effective care and knew how to support people with learning disabilities. Staff encouraged people to eat wholesome food and maintain a healthy weight. The home catered for people’s preferred diets including vegan. Staff worked with healthcare professionals to ensure people’s healthcare needs were met. Staff were trained in the Mental Capacity Act 2005 and understood the importance of seeking consent before supporting people.

Staff treated people with kindness and compassion and we saw many caring interactions during our inspection visit. People and staff got on well. Relatives were made welcome at the home. People were encouraged to make choices about all aspects of their daily lives and their cultural and religious preferences were recognised and met. Staff reassured people when they needed this. People were encouraged and supported to be independent and staff were supporting one person with their goal of getting their own place to live.

People appeared happy and comfortable at the home. They told us staff supported them to take part in group activities and to pursue their own individual hobbies and interests. Information at the home was presented to people in an accessible way, for example the home used pictorial menus and charts to support people to make choices about meals and activities. The home had a user-friendly complaints procedure and people were reminded of their right to complain at residents' meetings and in one-to-one sessions with staff.

The registered manager knew all the people using the service well and was involved in supporting them. The home had a friendly and open culture and people were involved in how it was run. Staff told us they were well-supported by the registered manager and had regular meetings and supervision sessions. The provider and registered manager had quality assurance systems in place that enabled them to monitor the quality of the care provided and make improvements where needed.

More information is in the detailed findings below.

About the service: The Chestnuts provides care and support for up to 14 people who have mental health needs, learning difficulties and/or autistic spectrum disorders. On the day of our inspection there were 12 people living at the service.

Rating at last inspection: Good (report published on 21 September 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

Inspection carried out on 23 August 2016

During a routine inspection

This inspection took place on the 23 August 2016 and was unannounced.

At our last inspection carried out on 19 March 2015 the provider was not meeting the requirements of the law in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, good governance and notification of incidents.

Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that they had.

The Chestnuts provides care and support for up to 14 people who have mental health needs, learning difficulties or autistic spectrum disorders. On the day of our inspection there were nine people living at the service.

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.

People who were able to talk with us told us they felt safe living at The Chestnuts. Relatives we spoke with agreed. The staff members we spoke with had received training in the safeguarding of adults and knew what to do if they were concerned that someone was at risk of harm.

Risks associated with people’s care and support had been assessed when they had first moved into the service. These assessments provided the registered manager with the opportunity to properly manage the risks presented to both the people using the service and the staff team.

People’s care and support needs had been identified before they had moved into the service. This was so that the registered manager could be sure that their individual needs could be met. From the initial checks, plans of care had been developed. These plans provided the staff team with the information they needed in order to support the people using the service in a way they preferred.

Checks had been carried out when new members of the staff team had started work. This was to check that they were suitable to work at the service. An induction into the service had been provided for all new staff members and ongoing training was being delivered. This provided the staff team with the knowledge they needed in order to meet the needs of those in their care.

We asked the people using the service if they felt that there were enough staff on duty to meet their needs. Whilst the majority of the people thought there were, some felt that more staff would enable them to get out more. The registered manager told us that they would monitor the staffing levels so that appropriate numbers of staff were deployed on each shift.

People received their medicines as prescribed and in a safe way. Medicines were being appropriately stored and the necessary records were being kept, though there were minor inconsistencies when recording if a person had been assisted with the application of their cream.

People's nutritional and dietary requirements had been assessed. People had been fully involved in the development of the menus that were in place and these catered for their individual needs and preferences.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors, dentists and opticians and they received ongoing healthcare support.

The staff team involved people in making day to day decisions about their care and support and understood their responsibilities within the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

The people using the service told us that the staff team knew them well and knew what help and support they needed. They told us that they were friendly and caring and observations during our visit confirmed this.

Meetings for the people using the service and for the staff team h

Inspection carried out on 19 March 2015

During a routine inspection

An unannounced inspection took place on 19 March 2015. Our previous inspection of 19 February 2014 found the provider was not meeting one regulation at that time. This was in relation to care and welfare of people who used the service. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. Although action had been taken to improve we identified additional breaches in relation to safeguarding, risk assessing, assessing and monitoring the quality of service provision and notification of incidents.

The Chestnuts provides care and support for up to 14 people with learning disabilities with a range of support needs. The service is situated in Coalville and is a converted two floor property with a number of communal areas and garden available for people to use. There were seven people using the service at the time of our inspection.

There was no registered manager in post at the home. 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 and associated Regulations about how the service is run. A new manager had been recruited and was in post for a matter of weeks at the time of our inspection. They intend to apply for registered manager status but an application had not been received at the time of writing this report. The home had had a number of different managers in a relatively short space of time.

People using the service were complimentary about the staff team and satisfied with the care and support they received. People’s independence had been promoted and people’s privacy was respected. We found that people had been asked for their consent and staff had acted in accordance with their wishes. Some people told us they had not felt safe living at The Chestnuts. This was because of the behaviour other residents had exhibited. People were able to spend their time as they chose but encouragement and support to engage in meaningful occupations was lacking.

People had not been protected from abuse or the risk of abuse because the service had not always informed the appropriate authorities of incidents where people had been harmed by other people’s behaviour. Incidents and accidents had been recorded but these had not been analysed to prevent future occurrences. Risk assessments and care plans provided insufficient guidance for staff about how to manage and respond to such behaviours and staff were often inconsistent or inappropriate in their responses. This exacerbated the problems and risks that people experienced.

Staff had received training and felt supported by the new manager but we were concerned about their ability to manage challenging behaviour effectively. Wehave made a recommendation about staff training in positive behaviour support.

Risk assessments and care plans had been reviewed and updated but care was not always provided in accordance with these. This had placed them and others at risk. Medicines were stored and handled appropriately by trained staff but medicines that were given ‘as required’ had not been managed safely. There was one occasion where someone had not received their prescribed medicine and appropriate action had not been taken.

Support to access healthcare services had been provided and people were able to make their own choices about eating and drinking. However, staff had not always promoted a nutritious, balanced diet.

People’s likes, dislikes, preferences and individual needs had been recorded by the service and we found staff encouraged people to make their own decisions and respected their choices on a day to day basis. Staff supported people in a calm and professional manner and had developed positive relationships with people living at the home. They respected people’s privacy.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. There were sufficient numbers of staff available to meet the needs of the people who lived there.

Systems were in place to gather the views of people living at the home but action was not always taken as a result. There was a complaints procedure in place but it had not always been used appropriately.

There were systems in place to assess and monitor the quality of the service but these were ineffective. They had not identified shortfalls in service provision or foreseeable risks to people’s health and welfare or provided the information that the provider needed to ensure that people were safe or improve the service. This had placed people at risk of receiving inappropriate or unsafe care.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 were known and understood by the new manager.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

Inspection carried out on 19 February 2014

During an inspection looking at part of the service

This inspection was carried out to see if improvements had been made to The Chestnuts following our inspection of 15 November 2013. Additionally, we had recently received concerning information about The Chestnuts.

We spoke with five people using the service and with six members of staff. One person told us: �I love living here and when I go out I always have a helper [a member of staff] with me."

We were told each person�s care record was currently being reviewed. We looked at the care records of two people who were using the service. We found that people�s care and treatment was not always appropriately assessed, planned or delivered to meet their individual needs, safety and welfare.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that there were sufficient numbers of staff on duty to ensure people were safe and found that their health and welfare needs were met at all times.

We found the notifications of incidents, for example, safeguarding notifications, were being reported to us without delay.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still identified as a registered manager on our register at the time.

Inspection carried out on 15 November 2013

During a routine inspection

We spoke with six people who lived at The Chestnuts and asked them for their views on the care that they received. We also spoke with two members of staff.

We found people were able to make informed decisions about their care and support. One person told us: �It�s a good team, they do a good job, I am never bossed around.� We found that people using the service had been actively involved in planning and reviewing their care, and had signed their care plans.

We found people experienced care and support that met their needs and protected their rights. One person told us: �I am happy here, I like it. There are plenty of activities. I like playing dominoes and pool, and going to Leicester." Care and support was delivered in a way that met people�s needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found that people received the right medication at the right time.

Although there was a recruitment and selection process in place, we found that gaps in a staff�s employment history were not fully explained.

People using the service we spoke with told us they were aware of the provider�s complaints policy and how to make a complaint.

We found the notifications of incidents, for example, safeguarding notifications, were not being reported to the Care Quality Commission without delay.

Inspection carried out on 17 October 2012

During a routine inspection

People we spoke to told us they felt safe and supported by the provider. They told us the provider encouraged their independence but they knew they could ask for assistance and support if they required it.

We found the provider met the needs of all the people who used the service and looked to improve the quality of care whenever possible. The staff were encouraged to develop their professionals skills and undertake relevant professional development.

The provider worked cooperatively with commissioners to improve the quality of service and whenever necessary they asked for advice and assistance from commissioners and other stakeholders.