Archived: The Chestnuts Nursing and Dementia Care Home

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.

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Effective safeguarding procedures were in place. Staff understood how to identify abuse and who they would report safeguarding concerns to. Risk assessments were completed for each person who used the service to identify potential risks and what actions should be taken to minimise risks such as falls and pressure sores. Accidents and incidents were reported and recorded. Medicines were safely managed, stored and audited. Staff competency was assessed to ensure safe administration of medicines. There was sufficient staff to meet the needs of people using the service. Relatives we spoke with said, ''there are always plenty of staff around.'' There were systems and equipment in place to respond to medical emergencies; however staff were unclear about the level of life support they would provide once the emergency services had been called. People's mental capacity to make informed choices had been assessed and we saw where appropriate that people's relatives were involved to ensure people's best interests were considered.

Is the service effective?

Records showed that people's health and care needs were assessed with their involvement where possible. Care plans were developed which reflected the level and type of support each person required to be safe and receive care appropriate to their needs. People told us they felt safe and their personal needs were met and staff ensured any changes they requested were acted upon. Staff we spoke with felt supported by their manager to meet people's needs effectively.

Is the service caring?

We observed people using the service had their privacy and dignity respected. A relative told us, 'the place is professionally run and the staff genuinely care.'

People were involved in the planning of their care and steps were taken to identify people's preferences. Staff demonstrated a good understanding of each person's needs and how to effectively communicate with them. This ensured people were supported and involved in decisions about their treatment and care. We observed staff took time to answer people's questions and provide suitable explanations in a respectful manner.

Is the service responsive?

People were involved in activities and their wishes were respected when they did not wish to participate. People's healthcare needs were met and appropriate referrals were made to specialists and other professionals when needed. We observed peoples wishes about their care and daily activities were respected and responded to appropriately by staff. People and their relatives had access to information about how to raise a concern or make a complaint.

Is the service well led?

The registered manager had completed care plan audits and had ensured recommended actions were completed. People who used the service had been supported by their families to participate in a satisfaction survey. The registered manager had responded to people's feedback to improve the service through the development of a quality assurance plan. People and relatives we spoke with were able to name and identify the registered manager. One relative told us, 'we often see her whatever time of day we come, she is always around. If we need anything she sorts it out immediately.'

The home was clean and warm. People's rooms were personalised and reflected their individual interests. The provider had plans to refurbish the home and improve the layout and decoration later in the year. We saw that people and their relatives had been involved in discussions about these plans.

We found there were enough staff to meet the needs of the people living in the home at the time of our inspection. Staff had access to training and supervision and were able to obtain further relevant qualifications.