Archived: Chestnut View

Updated 17 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The team consisted of one inspector and one inspection manager onsite and an assistant inspector offsite who made phone calls to staff and relatives.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from partner agencies and professionals including the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service. We spoke with two people who used the service and two relatives of people who use the service. We spoke with nine members of staff including the manager, deputy manager, senior care workers, care workers, cook, activities coordinator. We spoke with the nominated individual offsite. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included the relevant parts of six people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 17 July 2021

About the service

Chestnut View is a residential care home that can accommodate up to 18 people. At the time of the inspection there were 17 people living in the home. The home is made up of two floors and can support older people and those living with dementia.

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

Systems did not always safeguard people from abuse. People were not always protected from avoidable harm and lessons were not always learnt when things went wrong. Medicines were not always managed in line with good practice. Staff training was not up to date and no assessments of competence were undertaken by the registered manager. Procedures were not always in place to ensure risks from infection were reduced.

Policies and procedures were in place to help ensure the quality and safety of services however, these had not always been effective. Audits had not always identified shortfalls and led to improvements in the quality and safety being provided by the service. Records were not always accurate and up to date. Opportunities for continuous learning and improvement had been missed. Working in partnership with others had not always been effective.

Staff had regular supervisions, however staffs’ knowledge and understanding on training and people’s healthcare needs was not regularly checked on. Some staff lacked knowledge in areas of people’s healthcare needs and had poor understanding of completed training such as MCA and DoLS. Referrals to other healthcare services were made but not always reviewed when needed. Peoples care needs were regularly assessed and reviewed but the reviews were not always accurate.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

Care plans were not always reflection of people’s current needs and it was not clear how people were involved in reviewing these. People’s independence was promoted, and people felt respected by staff. People liked the staff team and felt they were kind and caring.

The building was suitable for people living at the service, however there was no accurate risk assessments for people using the steep stair case in leading to first floor . People had varied mealtime experiences. People’s weights were monitored for any weight loss.

The provider understood and demonstrated a duty of candour in their approach to complaints management. Checks on equipment and premises were in place however they have not always identified the shortfalls we found on inspection. The management team had acknowledged staff morale and were focussing on achieving good outcomes for people.

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 14 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about cleanness of the service, medication management, mealtimes experience, management’s knowledge of people’s needs, not following up referrals to health professionals. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, 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.

Following our inspection, the provider began to implement a range of actions designed to mitigate the risks found.

The overall rating for the service has changed from Good to Inadequate. 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 Chestnut View on our website at www.cqc.org.uk.

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 and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four breaches in relation to need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.