Archived: Chestnut View

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.

As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.

We found the following examples of good practice.

¿ Staff had received training in donning and doffing personal protective equipment (PPE), and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance. Staff had received further training in Covid-19 and infection control.

¿ The registered manager had used a comprehensive competency assessment to ensure that staff were both trained and understood all aspects of infection control, donning and doffing PPE and hand hygiene.

¿ With the building being older it was difficult to zone and cohort individual areas, however, social distancing was maintained by changing handovers to take place in the dining room space.

¿ The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home. There was a Coronavirus Policy and procedure and also national guidance which was kept updated.

¿ There were no visitors allowed in the home. Only essential medical professionals had entered the home during the outbreak. At the time of our inspection people living at the home were coming to the end of their isolation period and there were no new cases of the virus.

¿ The home was clean and although cleaners were only in the home for a few hours each day, care staff continually cleaned touch points. Deep cleaning of rooms were taking place to prevent the spread of the virus.

¿ For staff who were more vulnerable the registered manager had supplied additional items of PPE such as sleeves and shoe covers to ensure that risk is reduced as much as possible and to give them reassurance.

• Chestnut View accommodates 18 people, who may be living with dementia in one adapted building.

•Chestnut View is situated in a residential area in the Chellaston area of Derby.

•At the time of our visit there were 17 people using the service.

People’s experience of using this service:

•People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm.

•People were supported to take their medicines in a safe way.

•Recruitment procedures needed to be more thorough ensuring the all required checked were in place prior to new staff commencing employment with the provider.

•Staff told us they had received training and an induction that had helped them to understand and support people. We have made a recommendation about the induction program ensuring it is in line with the Care Certificate.

•Risks were managed according to individual need ensuring people were supported safely.

•People were protected by the provider's infection control procedures, which helped to maintain a clean and hygienic environment.

•People were supported to have maximum choice and control of their lives. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005.

•People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

•People were cared for by staff who were kind and caring. Staff respected people's privacy, dignity and supported people with their independence. Visitors were welcomed at Chestnut View.

•People were supported to take part in activities of their choice and were supported to access local community facilities to enhance their well-being.

•The provider’s complaints policy and procedure were accessible to people. People knew how to make a complaint and felt the provider would take action to address any concerns.

•The provider monitored the quality of the service people received, to drive improvement. People were asked for their views about the service.

Rating at last inspection:

•At our last inspection, the service was rated "requires improvement". Our last report was published on 29 January 2018.

Why we inspected:

•This was a planned inspection based on the rating of the last inspection. At this inspection visit we saw improvements had been made.

Follow up:

•We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Chestnut View 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.

Chestnut View accommodates 18 people, who may be living with dementia in one adapted building. The home is over two floors, there is an extension which also includes bedrooms and a communal and dining area. The main part of the home has a dining area and two communal lounges. There is a stair lift. There were 10 people living at the service at the time of our inspection. Chestnut View is situated in a residential area in the Chellaston area of Derby.

There was no registered manager in post. 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.’

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

People who were supported with their medicines were not always protected against the risks associated with poor medicines management as their medicines were not always stored safely.

The provider's arrangements for staff recruitment were not thorough and did not ensure suitable people were employed.

People's care records showed risk assessments were completed. However these were not always kept under review. Risk assessments were not always completed for all areas of identified risks and were not always updated following a significant incident regarding one person at the service.

People and relatives we spoke with felt people were safe at Chestnut View. Staff had an understanding of potential abuse and their responsibility in keeping people safe.

People were not always supported to maintain their interests. People were also not supported by the provider in accessing the local community, which did not promote integration with the community.

Staff did not have adequate training to support people's individual needs. Staff told us they enjoyed working at the service. However they raised concerns about the changes in management.

The management and the leadership of the service was not as effective as it needed to be. There have been a number of changes in management since the service registered, which had resulted in a lack of consistency and vision to drive improvement.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required.

People we spoke with all told us that staff were friendly and caring. Our observation showed staff treated people kindly and in a way which respected people's privacy and dignity.

People were not always supported to maintain their interests. People were also not supported by the provider in accessing the local community, which did not promote integration with the community.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint.

We found that the provider’s quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements. The provider was not aware of the changes in current legislation to support the communication needs of people with a disability or sensory loss.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Chestnut view provides residential care for up to 18 older people, who may be living with dementia. The home is over two floors, there is an extension which also includes bedrooms and a communal and dining area. The main part of the home has a dining area and two communal lounges. There is a stair lift. There were 18 people living at the service at the time of our inspection. Chestnut View is situated in a residential area in the Chellaston area of Derby.

There was a registered manager in post. 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.

People and relatives we spoke with felt people were safe at Chestnut View. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe. The provider had procedures in place for the management of medicine, which were not always adhered to by staff. This showed the provider could not be confident that people were always receiving the correct medicine and dose.

Recruitment procedures ensured suitable staff were employed to work with people who used the service. Sufficient numbers of staff were deployed to support people. Risks to people were identified and assessed.

People were supported by staff that were generally kind and caring. People’s choices and decisions were respected. Staff respected people’s privacy and dignity. People’s independence was promoted.

People were not always supported to engage in interests and activities, to suit their choices. People and relatives knew how to raise concerns.

We observed staff sought people’s consent before they provided care and support. Some people were subject to restrictions and the provider had identified where their support needed to be reviewed. However capacity assessments were not always completed in line with the mental capacity act principles.

People were supported at mealtimes and received sufficient food and drink that met their nutritional needs. Staff were supported through supervision and training and demonstrated knowledge of people’s needs. Staff received training in areas that were relevant to the needs of people who used the service. People were supported to access other health care services as required.

The registered manager was viewed as being open and approachable and involved in the day to day management of the service. Staff felt supported by the registered manager.

The provider had systems in place to monitor the quality of the service, however further improvements were needed to drive improvement. Records were not kept to ensure a person received adequate fluid and the internal medicines audit did not identify medicines were not always handled safely.

We looked at two people's care records and spoke with three staff. This is known as pathway tracking and helps us to understand the outcomes and experiences of a selected sample of people. There were 15 people using the service at the time of our inspection visit

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

Is the service safe?

People told us they felt safe and had no concerns regarding the staff that supported them.

The service was not clear about their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (Dols). Where people lacked capacity and decisions needed to be made in their best interests, the provider had not acted in accordance with legal requirements.

Our observation showed that staff did not always use safe moving and handling techniques when supporting people.

A system was in place to manage people's medication. However we identified that the stock balance of some medications did not correspond with medications administered. The provider did not have appropriate arrangements in place for the handling of controlled drugs.

At the inspection visit the provider was not clear as to whether or not the nurse call system was working throughout the home. We were extremely concerned about the safety of the people using the service, due to the lack of clarity as to whether or not the nurse call system was working. Following the inspection visit we received confirmation from the providers that the system had been upgraded on 26 June 2014.

The provider did not have robust recruitment procedures to protect people from abuse.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to capacity and best interest decision making, care and welfare of people who use the service, medication management, safety and suitability of premises and recruitment of staff.

Is the service effective?

We saw no evidence to confirm whether people's health and care needs were assessed with them or their relatives. Support plans were not detailed regarding people's needs and information about how people were supported with those needs. One person did not have a support plan in place, even though they had been at the service since March 2014.

We have issued a compliance action regarding the care, treatment and support people required to meet their needs and protect their rights.

Is the service caring?

People told us they were supported by kind and caring staff.

Staff interactions with people living at the service were limited and the interactions we did see appeared to be mostly task orientated.

We observed a positive working relationship between the care staff and the people they supported.

Is the service responsive?

One visitor told us that the staff had been encouraging their relative with their dietary intake.

The induction program was not thorough, which did not ensure staff were properly trained and was not in line with recognised standards within the care sector.

Staff had not received training in all essential areas.

Not all staff had received training on the MCA and the Dols. Some staff had a limited understanding on how to support people who could not make decisions for themselves when required.

Is the service well-led?

At this inspection visit we found that the registered provider did not have effective systems in place to monitor the quality of the service, and to identify and manage risks to people using the service. For example there was no evidence to show that learning from incidents took place and that appropriate changes were put in place to minimise risks to people using the service and others. No systems were in place to complete a review of any accidents and incidents in the service, which looked at any patterns or issues.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to monitoring the quality of the service provided.