This was an unannounced inspection carried out on 8 December 2015.
Chestnuts Retirement Home can provide accommodation for up to 14 older people who need personal care. There were 14 people living in the service 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.
At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach referred to the way in which medicines were managed. The arrangements were not robust and did not ensure that people always used medicines in a safe way. The second breach referred to the way in which quality checks had been completed. They were not rigorous or effective and this had resulted in a number of shortfalls not being quickly identified and resolved. These breaches had increased the risk that people would not always safely and responsively receive all of the care they needed. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the end of the full version of this report.
Staff knew how to report any concerns so that people were kept safe from abuse. People had been helped to promote their wellbeing and to avoid having accidents. There were enough staff on duty and background checks on new staff had been completed before they started work.
Staff had received most of the training and support they needed. However, they did not have all of the knowledge and skills they needed to support people who lived with dementia. Although people had not been reliably helped to check their body weight, staff had supported people to have enough nutrition and hydration. In addition, staff recognised when people were unwell and had arranged for them to receive the necessary healthcare services.
The registered manager and staff had supported people to make decisions for themselves. When this had not been possible the registered manager had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had not taken all of the necessary steps to ensure that people’s rights were being protected.
People were treated with kindness and compassion. However, people’s right to privacy was not fully respected and some of the arrangements for maintaining confidentiality were not robust.
The registered persons had not ensured that there were robust arrangements to promote positive outcomes for people who lived with dementia and who could become distressed. We recommend that the registered persons explore the relevant guidance on how to enable staff to effectively support people who live with dementia and who can become distressed. However, most people had been consulted about the care they wanted to receive and had been supported to pursue their hobbies and interests. Staff had supported people to express their individuality, people had been helped to meet their spiritual needs and there was a system for resolving complaints.
People had not been fully involved in the development of the service and they had not benefited from staff acting upon good practice guidance. However, steps had been taken to promote good team work and staff had been encouraged to speak out if they had any concerns.