Chestnut House

We found the following examples of good practice.

The home facilitated visits in accordance with local and national guidance. Staff contacted relatives regularly to update them on changes to their visiting policies and sent them monthly bulletins.

Managers and senior staff completed regular checks on staff compliance with personal protective equipment (PPE), and assessed their competency for donning and doffing PPE.

The home had a high standard of cleanliness due to robust cleaning regimes and dedicated domestic staff available every day of the week. In addition, night staff had cleaning regimes that further helped maintain high standards.

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

Improvements had been made since the last inspection for ‘as required’ medicine care plans to help ensure they were given to people safely, however the recording of some aspects of medication administration needed to be more consistent.

People were protected from the risk of infection. Staff wore personal protective equipment correctly and ensured people were socially distanced in communal areas of the home. Furniture had been rearranged to help with this. Risks to people were documented and risk assessments were personal to people. Monthly reviews of risk assessments did not always take into account incidents that had occurred that might elevate the risk.

People were protected from abuse. Relatives were complimentary about the home as management kept them updated and informed. Staff were happy working at the home and felt people living there were happy too. Staff were positive about the recent management changes and the improvements made to the service.

Audit processes were more effective in relation to 'as required' medicines, fire safety and care plan audits. These needed to be fully embedded and sustained. Medicine audits however had not identified the lack of consistency in the recording of some aspects of medicines administration, such as thickened fluids and the application of creams and pain patches. Some weekly safety checks had also slipped due to the absence of the maintenance person. Contingency measures were adopted by the service.

There was no registered manager at the time of this inspection. A registered manager from a sister home was providing oversight and management of the home, although was absent at the time of this inspection. They planned to submit an application to be the registered manager of Chestnut House. An area manager supported the interim manager and was at the home during this inspection.

Management had made changes to improve the quality and safety of the service. For example, improvements had been made to fire safety, the environment and standards of cleanliness.

Staff praised the support they received from the management team and said they were confident in their leadership. A relative told us, “This is a really nice place that is well run. I wouldn’t change anything. The atmosphere is alright.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 5 December 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Safe and Well-led key questions which contain those requirements. We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. You can see what action we have asked the provider to take at the end of this full report.

We also 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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed as this remains requires improvement. 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 House 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 have identified a breach in relation to management of the service. We will continue to monitor the service.

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 activities coordinator worked with people and their relatives to maximise contact while there were restrictions on visitors to the home. A tablet was sourced so people could have video calls with relatives, and cards with photographs were also sent to relatives.

• The area manager was instrumental in ensuring people were tested for Covid-19 before they were discharged from hospitals or other settings into the home.

Further information is in the detailed findings below.

Chestnut House is a residential care home providing personal care and accommodation for up to 19 people in Crumpsall, Greater Manchester. At the time of the inspection there were 19 people living in the home.

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

Quality assurance systems had not been effective at picking up issues identified during the inspection. This included fire safety, guidance to administer ‘when required’ medication, out of date staff training and the need to audit care plans to ensure accuracy. We identified one regulatory breach. We have made a recommendation about providing appropriate activities for people with dementia. We have made a recommendation about the Equality Act 2010.

Staff understood their safeguarding responsibilities. Recruitment practices were safe and the home was tidy and clean. Care plans were person centred and any risks to people were clearly recorded with clear guidelines for staff to follow.

Staff gave good feedback about the supervision and support they received. People were supported to eat and drink a balanced diet and were given choices. The home supported people to make their own decisions where possible and worked within the principles of the Mental Capacity Act.

People and relatives we spoke with told us that staff were kind and caring. We observed staff that were responsive to people’s needs and promoted their independence. Care files recorded what was important to people and what their choices and preferences were but did not record people’s involvement in formal reviews of their care.

There was good feedback from visiting professionals and people were supported to access health and social care professionals when they needed to. People’s communication needs were met and people were consulted about the running of the home in residents’ meetings.

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.

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 5 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one regulatory breach in relation to good governance. We also made two recommendations to support the home to improve. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection of October 2015 the service did not meet all the regulations we inspected and were given two requirement actions for governance and keeping care plans and risk assessments up to date. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 09 and 10 May 2017.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were suitable activities to provide people with stimulation if they wished to join in.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

Below is the summary of what we found

Is the service safe?

People had been cared for in an environment that was clean and hygienic. Policies and procedures were in place and adhered to in relation to the management of medicines. There was evidence of a plan of action following a recent fire safety inspection.

Is the service effective?

People told us they were happy with the care that they received and it was clear from talking to the staff and visiting professionals that they understood peoples care and support needs. One person told us "I think its brilliant here, they've got the right balance of humour and care". Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported in a kind caring environment. We saw care was carried out in a personalised unrushed manner. We were told that the staff were "all very nice to you".

Is the service responsive?

Peoples needs had been assessed before they moved into the home. Peoples records confirmed people's preferences and interests, and people had access to activities that were important to them.

Is the service well-led?

The manager was seen as very skilled by everyone concerned. People told us they were able to influence how the home was run.

People told us that they were happy living in Chestnut House and were well cared for comments included, " I like it here and am very happy", I like to have a lie in sometimes and that's ok". "The staff are very good, they listen to me and give me all the help I need. I have no concerns at all."

We looked at the care records for people who used the service and found that they were personalised and contained relevant information about people's choices and preferences.

We found that there were enough qualified, skilled and experienced staff to meet people's needs.staff had received training on safeguarding vulnerable adults.

Staff were provided with appropriate training opportunities and received regular supervision.

Efficient systems were in place to monitor the service.

People living in the home received safe personal care and support to meet their identified needs. A relative told us that care staff gave their full support to enable them to be involved in their X's care. One of the people accommodated in the home said, "The staff are very good. They listen to me, show me respect and give me all the help I need."

Two people told us that they enjoyed the food provided in the home. One person said, "The food is always good. We get enough to eat and drink, but you can ask for more if you fancy it."

We found that systems were in place to ensure that people received their medicines exactly as prescribed by their doctors.

We were concerned to find that the scales used in the home to weigh people were inaccurate, because they had not been calibrated. This prevented staff from accurately monitoring the health, welfare and safety of people who were assessed as at risk of poor nutrition.

On the day of our visit we saw that sufficient staff had been deployed to meet the assessed needs of people living in the home.

The service had an appropriate system in place for investigating and responding to complaints made by people using the service and their representatives.