We carried out a review of the data available to us about The Chestnuts on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Chestnuts, you can give feedback on this service.
About the service
The Chestnuts is a residential care home providing personal care to five people at the time of the inspection. The service was at full occupancy. People using this service have a learning disability and/or autism.
People’s experience of using this service and what we found
Right Support
¿ Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. One person told us they chose to live at the service and that the support from staff had “given me my life back. I’m very happy here.”
¿ Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
¿ People were supported by staff to pursue their interests.
¿ Staff supported people to take part in activities and pursue their interests in the local area.
¿ Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Right Care
¿ The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.
¿ People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. One person told us, “I’m very able and independent.”
Right culture
¿ People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.
¿ Staff placed people’s wishes, needs and rights at the heart of everything they did.
¿ People and those important to them were involved in planning their care.
¿ Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to check whether they were now meeting legal requirements. We also assessed whether the service was applying the principles of right support, right care, right culture. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chestnuts on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Chestnuts is a residential care home providing personal care to five people who have learning disabilities and/or autism at the time of the inspection. The service was full at the time of the inspection.
People’s experience of using this service and what we found
The provider was working with a new training provider and staff had received refresher training in first aid and fire safety. However, we saw staff still required training in a number of topics including infection prevention and control, medicines management and health and safety. Where staff worked across more than one service, the provider had not obtained evidence of the training staff had completed via their other employer.
The provider continued to not have a registered manager in post as required by their CQC registration. The management team were not always clear about what events required statutory notification to the CQC so that additional action could be taken to monitor these events if and when necessary. The manager undertook regular checks on areas of service provision, however, these did not include a specific infection prevention and control audit. Whilst a business continuity plan was in place this had not been updated to specifically mention their planning and response to the COVID-19 pandemic. The provider had not reviewed their practice in line with the Department of Health and Social Care’s Winter plan for adult social care services which states staff should not be working across more than one service, unless absolutely necessary.
Staff had received regular supervision and felt well supported by the management team. Staff were aware of their responsibilities in relation to care records and care records were accessible to staff. People using the service and their relatives were happy with the care they received and felt comfortable speaking with the staff and management team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 14 November 2019) and there were multiple breaches of regulation. The provider was required to complete an action plan after the last inspection to show what they would do and by when to improve, however this was not received.
At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We undertook this targeted inspection to check whether the breaches of regulation we previously identified in relation to Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also looked at infection prevention and control procedures as part of the CQC thematic inspection programme. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
CQC have introduced targeted inspections to follow up to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to staff training and management of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Chestnuts is a care home which provides personal care. The Chestnuts accommodates up to five adults with a learning disability. Some people also had a physical disability and communication difficulties. At the time of the inspection, there were four people living at The Chestnuts which is located on a residential road in Norbury.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The service did not have a registered manager. Staff were recruited safely. However they were not adequately supported by the provider through supervision and appraisal. There were systems in place to monitor the service and the quality of the care people received. However, when issues were identified they were not always put right promptly.
Staff knew people well and supported people in line with their preferences and wishes. Staff encouraged people to retain their independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
There were enough staff to meet people's needs and support them safely. The deputy manager and staff had worked at the service for many years and enjoyed working there. They communicated effectively with people. Interactions between people and staff were calm and warm. People were given immediate reassurance when they became anxious or distressed.
Medicines were managed and stored safely. People were supported to access healthcare services if needed. People were supported to have enough to eat and drink. People were supported to engage in activities they enjoyed and we saw the service promoted people accessing local community facilities and supporting them to go on trips and holidays. People told us they knew how to make a complaint.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published January 2017).
Why we inspected
The inspection took place on 5 September 2019. This was a planned inspection based on the previous rating. We found that the provider needs to make improvements and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan for the provider to understand what they will do to improve and maintain the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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. People living in the home have both learning and physical disabilities and some people have limited communication abilities.
There was a registered manager at the service. 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 registered manager had taken action to review records about people’s care. Care plans for people accurately reflected their identified needs and the associated risks to their health and welfare. Incidents and accidents had been reviewed or investigated and reported to CQC appropriately.
Since our last inspection essential repairs and redecoration to the environment had been carried out. The home was clean, comfortably furnished and bedrooms were personalised according to people’s needs and interests.
We found that systems for managing medicines had been strengthened and the required records were being accurately maintained. Medicines were managed, stored, given to people as prescribed and disposed of safely. There were systems for checking that people received their medicines correctly and that staff administered medicines safely.
The arrangements for staff training had improved. Staff had updated their training where needed and completed training that was specific to people’s assessed needs. Staff felt well supported by the registered manager and told us she had made positive changes.
We found the systems to monitor the safety and quality of the service had been strengthened. Further audits and checks had been introduced so the manager knew what was working well and what needed improving in the home.
People were supported by adequate numbers of staff who had been safely recruited. Staff knew how to recognise and report any concerns about people’s care and welfare and to protect them from abuse.
People received care which was person centred and responsive to their needs. Risk assessments identified risks associated with individual care needs and staff knew how to manage and minimise risks to people’s health and well-being. People’s needs were regularly monitored and reviewed. Where needs had changed, staff had taken action to ensure people received the care they needed.
Staff worked well with external health and social care professionals to ensure people received the services they needed. People were supported to keep healthy and their nutritional needs and preferences were met.
People were treated as individuals and staff interacted with people in a caring, supportive manner. Staff understood people's preferences and knew how people wanted to spend their time. People's need for independence and privacy was understood and respected by staff.
People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This legislation is intended to ensure people receive the support they need to make their own decisions wherever possible. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.
Mental capacity assessments had been carried out to determine people's level of capacity to make decisions in their day to day lives and for more complex decisions when needed. Appropriate applications had been made to the supervisory body (local authority) to restrict people's liberty where required.
People were offered choices and staff knew how to communicate effectively with each individual according to their needs. People took part in activities that interested them and were supported to maintain social links and relationships with those close to them.