Chepstow House

Chepstow House is a residential care home, providing personal care and accommodation. People living at Chepstow House live with dementia, learning disabilities or autistic spectrum disorders, mental health conditions, sensory impairments or physical disabilities. Care and accommodation is offered to older and younger people. There were 10 people living at the home at the time of our inspection.

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

People were supported by a well-established staff team that knew them well and how to keep them safe. Staff were trained in safeguarding and demonstrated a good understanding of recognising signs of abuse. Staff knew how to report any concerns and told us they would be acted on appropriately by the management team.

Risks to people had been identified. Staff had a good understanding of individual people's risks and how best to support people to reduce these.

People were supported to take their medicines as prescribed by trained staff. Staff understood how people preferred to take their medicines and action to take should an error occur with medicines.

Areas of the home environment were undergoing a refurbishment and required completion of the refurbishment, to ensure the likelihood of the spread of infection was reduced.

Staff were able to debrief following any incidents and any lessons learnt were shared with the staff team to drive through further improvements in people’s care.

People’s care and support was personalised and tailored to meet their needs. Staff showed a good understanding of people; their likes/dislikes, routines, and how they communicate.

Staff were provided with training and regular refresher training to enable them to carry out their roles effectively. Staff told us they felt they were supported.

Where possible people were encouraged to be involved in menu planning. Staff supported people to eat and drink enough to remain healthy. Staff were ensuring people’s eating and drinking intake was recorded.

The staff team ensured people’s health needs were met and sought appropriate healthcare when required.

People had been included and involved in the refurbishment works and chosen their own colours for their bedrooms.

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.

A variety of audits and monitoring systems were in place to maintain oversight of the service and to further drive through improvements.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions Safe, Effective and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence. People were supported to live their lives how they wanted to and were supported to continue doing things that interested them.

Right care: People were supported by staff that were kind and caring. Staff were passionate about their roles and the people they were supporting. They knew people well and knew their likes, dislikes, needs and preferences. This allowed staff to provide personalised care that met people’s needs.

Right culture: There was a positive culture in the service that promoted independence. The staff team spoke positively about each other and the support they received from the management team.

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 29 January 2019).

Why we inspected

We received concerns in relation to the management of people’s care needs, meeting people’s needs effectively and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions 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 based on the findings of this inspection.

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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chepstow House 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.

• People enjoyed living at Chepstow House and were cared for by staff who were kind and recognised people’s areas of independence.

• Staff were respectful to the people they cared for and promoted people’s right to dignity and privacy.

• People's, their relatives' and other health and social care professional’s views were listened to when people’s needs were assessed and plans for their care were developed.

• People were supported to enjoy the best health outcomes possible, and staff were proactive in addressing people’s health and well-being needs. Staff advocated for people so they had access to the healthcare they wanted. There were effective ways of working with other health and social care professionals.

• Staff recognised when people’s needs changed and made adjustments, so people continued live at the place they wanted to and to maintain relationships with other people at Chepstow House and staff who were important to them.

• People were confident to make their own day to day decisions and choices; staff supported people to do this when they wanted assistance, by using people’s preferred ways of communicating.

•Staff understood people’s safety needs well and supported them so their individual risks were reduced.

• People were supported to have their medicines safely, by staff who were competent to do this. People’s medicines were regularly checked and reviewed.

•There were sufficient staff to care for people at the times people wanted assistance, and people were supported by staff who knew their preferences well.

•The environment at the home was regularly checked. The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• Staff had received specialist training and developed the skills they needed to care for people. This helped staff to provide good care to people.

•Staff supported people to have the nutrition they needed, based on their preferences, so people remained well. Where people required specialist diets, or assistance or equipment when eating and drinking this was provided.

•People were supported to enjoy a range of activities which reflected their interests. This included support to enjoy spending time in the community, doing things they liked and to keep in touch with people who were important to them.

•Systems were in place to take any learning from complaints and to reflect on people’s needs and to further inmove people’s care.

•The registered manager sought suggestions for improving people’s care further. We found suggestions were listened to.

•The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through. The registered manger planned to continue to develop the facilities at the home and to further develop people’s access to information to enable people to continue to make informed choices about their care.

•We found the service met the characteristics of a “Good” rating in all areas; More information is available in the full report

Rating at last inspection: Good. The last report for Chepstow House was published on 4 August 2016.

About the service: Chepstow House is a is a residential care home, providing personal care and accommodation. There were 14 people living at the home at the time of our inspection. People living at Chepstow House live with dementia, learning disabilities or autistic spectrum disorders, mental health conditions, sensory impairments or physical disabilities. Care and accommodation is offered to older and younger people.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Chepstow House is registered to provide accommodation for personal care for a maximum of 14 people with learning disabilities or autistic spectrum disorder. There were 14 people living at the home on the day of our visit. At the time of our inspection 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 were supported by care staff that reduced their risk of harm and from the risk of abuse. All care staff knew each person well which helped them to understand and reduce their risk of harm or abuse. Care staff were consistent in helping people with any anxiety or distress by providing reassurance and guidance. Care staff told us that helping people to live in a calm and relaxed environment reduced the risk of abuse to people living at the home. All care staff felt confident in recognising any potential signs of abuse and would report these through to senior staff or management at the home.

People said care staff were available and there were sufficient numbers of staff to provide care to all people living at the home. Where people had risks identified as part of their daily living, care staff provided support to reduce those risks. People had their medicines given to them when required and at the correct time.

People were cared for by care staff who told us their training reflected the needs of people who lived at the home. Where people had not been able to consent to certain aspects or decisions about their care, records of decisions had been completed.

People had access to snacks and meals throughout the day and night. Where people required support to prepare their meals care staff helped them. People had accessed other healthcare professionals to support them.

People told us they liked the care staff and had developed positive and respectful relationships and care staff were very kind and caring in their approach. People’s privacy and dignity were respected and they were supported and empowered to be independent in all aspects of their lives.

People were involved in the planning of their care and were regularly involved in updating their care plans. People’s care plans recorded their care needs in an individual way that reflected their preferences and life histories. People got to choose their hobbies, interests and the things they did whilst in their home or out and about.

People were happy to raise any concerns or worries directly with the care staff who were able to provide solutions or answers at that time. The registered manger was keen to answer people’s concerns.

People were involved in their home and knew the registered manager. People were seen to approach and make request through the day with all care staff, including the registered manager. The registered manager told us it was important that they were approachable and visible within the home which helped them monitor and maintain a home which people liked. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

People told us they liked the food and that they were given plenty of drinks. We found people's dietary preferences and special requirements were being met. Staff knew people and their preferences well and had time to support them during mealtimes.

People's medicines were being safely managed.

We found that there were enough staff to support people. The staff were suitably trained and felt supported. Additional staffing had been funded as two people's needs had increased during 2013. The staff team was quiet stable and there were staff who had worked in the home for over ten years. This meant that they knew people very well which particularly helped those who had communication difficulties.

People told us they liked the staff and they felt they treated them with respect and listened to their views. They felt safe in their home. One person's relative told us they would be able to raise any concerns but had not needed to. They said, 'there is a good variety of activities' and 'the care is absolutely fabulous'. Staff told us they had time to spend with people and they were well supported and trained.