We carried out an inspection of Chestnut Grove Rest Home on 17 and 23 February 2016. The first day was unannounced. We last inspected the home on 3 June 2014 and found the service was meeting the regulations that were applicable at that time.Chestnut Grove is a large detached property, situated in a quiet residential area of Lostock Hall. The home provides care and support for up to 11 older people in single occupancy rooms. All areas are tastefully decorated and furnished to a high standard. There are landscaped gardens to the side and rear of the home which are accessible via ramps.
The service was managed by 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
During this inspection we found the service was meeting the current regulations.
The service provided an outstanding level of care and support that placed people at the heart of their care and promoted their right to be self-determining in how they lived their lives. All the people, their relatives, visiting professionals and staff we spoke with had nothing but praise for the service and the excellent quality of life people experienced. The ethos of the service described by staff was to ensure people’s rights to privacy, dignity, and freedom of choice was embedded into the culture of the home and people’s diversity was embraced.
People living in the home told us they felt safe and very well cared for. They considered staff were always available to support them when they needed any help. Recruitment processes and procedures followed, ensured new staff were suitable to work with vulnerable people.
Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. Staff were clear about their responsibilities for reporting incidents in line with local guidance.
Risks to people’s health, welfare and safety were managed very well. Risk assessments were in place in relation to pressure ulcers, behaviours, nutrition, falls and moving and handling. Staff understood the concept of what was acceptable risk taking in order to promote positive experiences for people.
There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines. Staff responsible for administering medicines had been trained.
Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.
Staff had exceptional insight and understanding of people’s personal values and needs. Staff demonstrated through their actions, people were very important and people experienced a sense of belonging and worth in their lives. Staff had been very well trained to ensure people’s right to privacy, dignity, independence, choice and rights was central to their care. Equality and diversity issues were given a high profile within the service with supporting guidance from Age Concern ‘The Whole of Me’ used for reflective practice.
All people we spoke with were very positive about staff knowledge and skills and felt their needs were being met appropriately. Staff felt confident in their roles because they were well trained and very well supported by the registered manager to gain further skills and qualifications relevant to their work. They were highly motivated and committed to provide a high quality of care.
People were provided with a nutritionally balanced diet. All of the people we spoke with said that the food served in the home was very good. Staff worked closely with healthcare professionals to ensure people’s dietary needs were met.
The home provided a well maintained very pleasant and homely environment for people who described their accommodation as “home from home”. People told us they liked living in a small home because they got to know everyone very well.
People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.
We found staff were very respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. People using the service, relatives, visitors and health professionals all spoke very highly of the high standards afforded to people living in the home. The care was described as ‘going above and beyond’ ‘exceptional’ and ‘remarkable’. Relatives also considered their welfare was always considered and they too felt part of the home life.
Staff had been trained in End of Life care. This meant staff could approach people’s end of life care with confidence and ensure their dignity, comfort and respect was considered. Health professionals, relatives and a visitor described the service's approach to end of life care as outstanding. “The staff here have exceptional qualities. I think the manager leads by example. They are all compassionate and work well in ensuring people experience a dignified pain free death.” People using the service and staff were offered emotional support during and after bereavement by the registered manager.
People told us staff provided consistent personalised care and support. They were consulted and involved in identifying their needs and how they liked to be supported. All people had a comprehensive person centred plan which was reviewed at regular intervals. This provided staff with very good insight into people's personal routines and preferences.
An outstanding feature of life at the home was family involvement. People we spoke with and their relatives told us they ‘felt’ like family and that staff treated them as such. We were given many examples of how this was achieved including the use of iPad, iPod and telephone made available for people’s use.
People were supported to live full and active lives and use local services and facilities. Activities were meaningful and varied. Faith needs were managed very well. The service supported charities such as the hospice, Salvation Army and The British Legion and the service sponsored a rescue dog. Initiatives like this helped people feel valued for their contribution to society.
People, their relatives, staff and visitors to the home described the management and leadership of the service as exceptional. The registered manager was passionate in her commitment to providing high quality care to people using the service, their relatives and friends and staff.
Staff told us the registered manager made them feel special and valued and they were very well rewarded and had a good work-life balance.
We found there were effective systems to assess and monitor the quality of the service. People using the service, their relatives and staff contributed to the evaluation of the service and made recommendations for improvement. Results of surveys showed a very high satisfaction with the facilities, the staff and registered manager.
There was an effective and thorough quality assurance system in place to ensure any improvements needed within the service were recognised and the necessary action was taken to implement any changes.
The registered provider had achieved the Investors In People Silver Standard Accreditation.