13 January 2022
During an inspection looking at part of the service
Chestnut House Nursing Home is a care home providing personal and nursing care for up to 85 people. At the time of the inspection there were thirteen people living at the service, some of whom were older people living with dementia. People were all accommodated on the ground floor of the home.
People’s experience of using this service and what we found
The provider’s governance systems had not ensured that actions were taken in response to environmental shortfalls. We found no evidence people had been harmed but these shortfalls placed people at risk of harm or injury. They were identified in both the provider’s own audits and our last inspection report. We made a referral to the fire service who arranged a fire safety inspection visit. They identified there were actions that were needed to ensure the fire safety of the service and these works were required to be addressed within two months.
People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and very well cared for. Throughout the inspection we saw kind and caring interactions between people and staff.
There were enough staff to meet people’s needs and there was a stable staff team who knew people well.
Risks to people were identified and recorded, and staff knew how to respond to these risks in order to keep people safe. Medicines were managed safely and effectively by staff who were trained and competent to do so. A consistent system was not used to record people’s as needed medicines. The provider agreed to ensure this was implemented.
Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Overall, staff followed recommended IPC practices. Safe visiting was supported.
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.
People benefited from a manager, deputy manager and staff team who promoted a positive culture. They focused on people being treated as individuals and staff had continued to make improvements in the personalised care that people received. Relatives spoke highly of the manager and staff and the communication between them.
Rating at last inspection
The last rating for this service was requires improvement (published 5 August 2021) .The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the provider remained in breach of one regulation.
The service remains rated requires improvement. This service has been rated inadequate or requires improvement for the last seven consecutive inspections since 2017.
Why we inspected
We undertook this focused inspection as part of our public commitment to rerate services. This was to release capacity in the adult social care sector during the pandemic. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.
The provider has taken action to mitigate the risks identified and has worked with the fire service to ensure people’s safety.
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 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 Nursing Home 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 repeated breach of regulations in relation to the provider’s oversight and not acting in response to their own and CQC’s previous findings in relation to fire safety issues and hot water temperatures.
We have issued a warning notice that the provider must be compliant with the regulations by 1 April 2022.
Follow up
We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.