The Chestnuts Care Home

The Chestnuts Care Home is a residential care home providing personal care to up to 41 people. At the time of our inspection there were 36 people using the service. Some people were living with dementia.

People’s experience of using this service and what we found

Risks associated with people’s care were identified and managed safely. Staff were knowledgeable about safeguarding and knew what action to take if they suspected abuse. Accidents and incidents were monitored and evaluated to ensure trends and patterns were identified and actions taken to mitigate risks.

The provider had identified some concerns regarding medicine management and had begun to take action prior to our inspection.

People were protected from the risk and spread of infection and the home was clean and well maintained. The provider recruited staff safely. There were sufficient staff available to respond to people’s needs in a timely way.

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.

Staff were caring and considerate and people told us they liked living at the home.

Audits had been completed and actions identified. On occasions, some actions had not been resolved in a timely way. We have made a recommendation that governance systems are further embedding into practice.

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 28 March 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘The Chestnuts Care Home’ on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were systems and processes in place, in line with guidance, to ensure visitors to the home did not introduce and spread Covid-19.

Staff followed government guidance in relation to personal protective equipment (PPE). All staff were wearing face masks. The home had sufficient supplies of PPE.

All staff and people living at the home were being Covid-19 tested in line with guidance and had received their first vaccination. Appropriate processes were in place should anyone display any symptoms of Covid-19.

The care home was clean, well maintained and odour-free. There were enhanced cleaning schedules in place.

Staff supported people’s social and emotional wellbeing. Alternative forms of maintaining social contact were in place including regular telephone and video calls, and use of closed social media groups. The home had made adaptations to a conservatory to allow partitioned visiting for people.

All staff had undertaken training in infection prevention and control (IPC) and the donning and doffing of PPE.

Policies and audits relating to infection prevention control, including coronavirus, were up-to-date.

The Chestnuts Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post who had been managing the service for a number of years. 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 spoke to the director and registered manager in relation to the importance of window restrictors on first floor windows. A risk assessment had been completed on the first day of inspection for the people who this may be a risk for. On the second day of inspection the window restrictors had been put in place. The director responded by adding this to the environment audit to ensure this was checked appropriately.

Staff understood how to keep people safe, and knew how to report any concerns they may have. Individual risk assessments had improved since the last inspection and were completed in people's care records. However risk assessments had been overlooked for window restrictors. Staff were suitably trained and supported to carry out their work and they were confident and competent in their role.

The provider had systems and processes in place for managing medicines. Where there had been issues these had been identified by the robust audits which were in place and actioned appropriately.

Staff had a good rapport with people and we saw some kind and compassionate interaction. Staff responded well to meet people's needs and they involved people in their care and support. People and their relatives said they felt well cared for. However there were mixed views in relation to staffing levels.

Accidents and incidents were appropriately recorded, analysed and safeguarded where appropriate.

There was good support for people's nutrition and hydration and people really enjoyed their meals. Everyone we spoke with praised the food. Staff liaised appropriately with other professionals as required in relation to meeting people’s care needs.

Care records had improved since the last inspection, however we did discuss with the registered manager to ensure there were no gaps in any people’s records. This had also been picked up through the audit process.

There was visible leadership and clear direction for staff; managers were involved in people's care and knew the needs of the service well. Audits were in place and were regularly discussed in staff meetings.

The Chestnuts Care Home provides care for up to 41 people, mostly who are older people and some of whom are living with dementia. The home is situated in Normanton and is on two floors. At the time of the inspection there was a manager in place whose application to register with the Care Quality Commission was in progress, awaiting completion. 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.

There was a homely, friendly environment in which people said they felt happy and safe. There were clearly noticeable improvements since the last inspection in the overall quality of the provision.

Risk assessments had improved since the last inspection in relation to people's individual safety needs, although checks were not as robust for equipment and premises, such as bedrails and the hot water supply. There was more information available to staff with regard to moving and handling people safely and staff mostly followed safe practice, with the exception of one observed incident. We found there was improved practice around accidents and incidents, with a more proactive approach to preventing falls. There was evidence of ongoing refurbishment and we noted this was in progress, although there were odours in some areas.

Staff training had been completed to improve staff knowledge of the Mental Capacity Act (MCA) and the deprivation of liberty safeguards (DoLS) and there was clear recording where a person may lack capacity, although it was not always evident who had power of attorney to lawfully make decisions on behalf of people who were no longer to make these decisions or consent to care.

People had good opportunities for regular snacks and drinks, with variety and choice available. Where there were gaps in the recording of people's food and fluid intake, this was identified through the management audit process.

Staff engaged positively with people and there were sensitive interactions which showed care was person centred and caring. Care plans were detailed although not always updated promptly. People were purposefully engaged with meaningful activities, although there was more limited interaction fro those people who remained in bed. People in bed could not always make their need for staff attention known and they could not always be heard if they were unable to use their call alarm.

People and relatives knew how to complain and said they found management to be approachable. Complaints and compliments were recorded and there was evidence of action taken where necessary.

Leadership of the home was much more clearly defined than at the last inspection with direction for staff to be supported in their roles and responsibilities. Auditing and monitoring the quality of the provision had improved, although there were some areas that lacked rigour, such as daily checks. There was improved partnership working with other professionals to support people's health and wellbeing. The home was forging links with the Vanguard initiative in Wakefield. This initiative has been drawn up to improve care standards in care homes by a range of measures, one being increased access to the wider multidisciplinary team and enhanced pathways to primary care.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 24th November and 1st December 2015. The Inspection was unannounced.

The Chestnuts Care Home provides care with nursing for up to 41 people. It is situated in Normanton. The home is on two floors. Care is provided mostly for elderly people including those with dementia. At the time of our inspection there were two registered managers in place. One had left the Chestnuts several months before our inspection. There was a new manager in place who was in the process of registering.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.

Relatives of people who used the service told us they felt their relatives were safe at The Chestnuts; staff we spoke with recognised the signs of abuse and how to report this. Risk assessments had been undertaken, but these had not always been updated to reflect people’s current needs. This poses a risk of the provision of inappropriate care, and risks not being identified or managed. Medication was administered appropriately and all staff who administered medication told us they received training and supervision before being deemed competent to administer. However, we were unable to access training we requested at the time of our visit.

The care staff had not received specific training around capacity and did not demonstrate a good knowledge in this area.

People who used the service and staff told us the food was good and we observed people being offered a choice at mealtimes in the form of a picture menu and verbally offering a choice. One of the cooks told us ‘if people don't like the choices we will find something they do like’. The home had a monitoring sheet to note the food and drink intake of people at risk of malnutrition and dehydration. However this had not been inputted into accurately for two people whose care we reviewed, which meant the home had no evidence of what these people had eaten or had to drink. This demonstrated a failure to protect people from the risks of inadequate nutrition and dehydration.

During our inspection we found ten people in bed with their doors wide open meaning anyone who passed by could see in to the room. There was no documentation to ascertain if this was the people’s choice.

Care plans and risk assessments were not person- centred and based around individual needs, this was evident in relation to equipment being used for moving people which could lead to people being put at risk of falls.

There was a lack of meaningful activities for people and in particular people those nursed in bed. This could lead to social isolation and associated complications such as depression.

Audits were not robust and did not have a good analysis; or follow- up plans in place. Policies and procedures for the home were out of date and several made reference to other homes. This meant that there were not effective systems in place for assessing, monitoring and mitigating risks relating to health, safety and welfare of people using

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures”

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well-led?

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

Is the service safe?

We found people were treated with respect and dignity by staff. People told us they felt safe. One person who used the service told us; "I like it here, the staff go out of their way to help you."

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one. The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Training was in place to protect the people who lived at The Chestnuts Care Home such as moving and handling, safeguarding adults and first aid. We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This meant the people who used the service were supported by staff who had the necessary skills and experience.

Is the service effective?

From speaking with people who used the service or their relatives, it was clear people's health and care needs were assessed with them. Assessments had taken place prior to someone being admitted into the home. The assessments formed the basis of the care plan. We found people were involved in writing their plans of care. People also told us they had been consulted during reviews about the changing needs of their relatives who received care. Care plans were reviewed regularly and when people's needs changed.

Family members we spoke with said they were kept informed about their relative's care. They also told us that if they had any concerns they were comfortable with talking to the staff team. People we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the care they received and the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, "Staff are good and all very caring." People we spoke with told us they liked living at the home. Comments included "I like living here."

We observed during our visit that people were treated with respect by the staff team whilst they carried out people's daily care. People told us staff respected their privacy and dignity. Observations during the visit showed staff and people who lived at the home were comfortable in each other's company. During the day we saw some positive interactions taking place and staff responding in a kind manner to people who lived at the home.

People's preferences, interests, aspirations and diverse needs were recorded, and it was clear care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we saw confirmed people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

We saw risk assessments and care plans were in place that reflected the person's care needs to ensure they received appropriate care. The care plans contained information from GPs, district nurses and other health care professional's visits such as dieticians.

Is the service well-led?

We were told by people and families who used the service and the staff team if they had any concerns about the care being provided they would inform the manager. No one we spoke with had ever made a complaint. There was a complaints policy and procedure available.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary.

We saw staff had positive relationships with people. People engaged in friendly banter with staff and they appeared happy and settled. We observed people were supported at an appropriate pace for their needs.

We spoke with three relatives who visited their family members. They said they were mostly happy with the care their family member received.

Staff showed they understood people's human rights and worked in ways to promote these and told us the procedure they followed to ensure people were kept safe from harm. People told us they felt safe in the home and staff helped them to feel safe. One person said: 'the staff keep me safe and sound'.

We saw there were enough staff on duty to meet people's needs. Some staff and relatives said they thought there were not always enough staff. We saw staff engaged in care tasks, although we noticed there were few opportunities to chat with people.

We saw that records were filed in a confidential and orderly manner, located easily and maintained with up to date information. The manager told us records were in the process of being updated to be consistently in line with corporate documentation.