Background to this inspection
Updated
14 October 2016
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.
This inspection took place on 21, 22 June and 31 August 2016 and was unannounced on 21 June and 31 August. The inspection team consisted of one inspector and a specialist advisor who was experienced in nursing care. As part of this inspection, a pharmacist inspector also carried out an inspection of medicine management on 27 June 2016.
At our previous inspection in September 2014, the service was compliant with the regulations we inspected.
Before our inspection, we reviewed the information we held about the service which included notifications of incidents that the registered persons had sent us since the service was registered. These are events that the registered persons are required to tell us about. We also reviewed information from local commissioners of the service and healthcare professionals. This enabled us to obtain their views about how well the service was meeting people’s needs. We also looked at the report of a visit carried out by Redbridge Health watch in May 2016.
During the inspection we spoke with 12 people who use the service and three people’s relatives. We spoke with three nurses, ten staff, the registered manager and the operations manager. We looked at six people’s care records and other records relating to the management of the home. This included five staff recruitment records, duty rosters, accident and incidents, complaints, health and safety, maintenance, quality monitoring and medicine records.
Updated
14 October 2016
This inspection took place on 21, 22 June and 31 August 2016 and was unannounced on 21 June and 31 August.
The Chestnuts Nursing Home is registered to provide accommodation, nursing and personal care for up to 45 older people. At the time of the inspection there were 43 people living at the home some of whom were living with dementia.
The home had a registered manager in place. 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 found that not all care plans were personalised for people who used the service, and did not contain all of the necessary information to enable staff to support them safely.
People did not receive their medicines safely because robust systems were not in place to manage prescribed medicines consistently and safely.
Staff supported people to make choices about their care. However, people did not always have their legal rights respected because sufficient systems were not in place to ensure that they received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People in the dementia unit were accommodated on the top floor. We saw that the environment was not suitably adapted to meet their needs and we have made a recommendation about this.
People told us they felt safe in the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Staff had received safeguarding adults training and were aware of the actions they needed to take if they had concerns regarding people's safety. Risks to people’s health and wellbeing were identified, recorded, reviewed and managed. The provider's recruitment process ensured that staff were suitable to work with people who needed support.
Staffing levels were sufficient to meet people's needs. Systems were in place to review staffing levels in line with people's needs.
Staff received regular training and supervision that provided them with the knowledge and skills to meet people's needs.
People told us that they were happy with the food and drink and were provided with appropriate food of their choice so that their nutritional needs were met.
The registered manager was aware of the requirements of their registration with us and notified us of significant events related to care provision. A variety of audits were carried out by the provider and used to drive improvements in the service.
We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.