Alderwood L.L.A. Limited - The Chestnuts

Updated 28 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by four inspectors who visited the service on different days and supported remotely with making telephone calls to staff and relatives.

Service and service type

Alderwood – The Chestnuts is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alderwood – The Chestnuts is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day we inspected and then announced on three follow up visits. Inspection activity started on 25 April 2022 and finished on 8 June 2022. We visited the service on 25 April, 28 April, 5 May and 16 May 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method, and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff and the person themselves. In this report, we used this communication tool with three people to tell us their experience.

We also spoke with two relatives about their experience of the care provided. We spoke with 12 members of staff including team leaders and care workers. We spoke with the registered manager, regional manager, behaviour lead and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included the relevant parts of four people’s care records and medication records. We looked at three staff files in relation to the safety of recruitment. A variety of records relating to the management of the service, including policies, training records and procedures were reviewed.

After the inspection we continued to seek clarification from the provider to validate evidence found.

Updated 28 September 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Alderwood L.L.A. Limited - The Chestnuts is a residential care home providing personal care to up to six autistic people with mental ill health and learning disabilities, in one detached building. At the time of the inspection six people lived in the service.

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

The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture.

Right Support

People were not always being supported by staff who had received enough training to meet their needs. Care plans were not always personalised. We have made a recommendation about improving how people’s care plans are written.

Systems were in place to support those who lacked verbal communication to make choices.

Staff supported people to develop strategies to manage emotional distress and anxiety, when encountering a new situation or dealing with a change. Periods of anxiety or emotional distress were recorded, which included the action taken by staff to support people.

Staff supported people to access health and social care support. Staff supported people with their medicines safely. Positive relationships had developed with local health care providers, who provided support, taking into account people’s emotional needs for planned appointments.

Right Care

People were not always cared for by staff they knew. The provider relied on a high use of agency staff and was not always meeting people's assessed needs. This had the potential to put people at risk due to lack of knowledge of the service, people and systems.

People’s needs had not always been fully assessed, which meant people were at risk of experiencing sensory overload, which could then lead them to experiencing emotional and physical distress.

The service was impersonal. We have made a recommendation about improving the environment for the benefit of the people who use the service.

Many of the staff team provided kind and compassionate care and wanted to see improvements for the benefit of people receiving support.

People had detailed care records, which were regularly reviewed. Risks associated to people's care and choices were set out in their care records, however, due to the volume of documents, there was a risk that new staff may not quickly and easily identify the most up to date information in order to support people effectively.

Right Culture

We found negative language being used in some people’s care records which was not dignified.

Staff told us they were concerned about the high use of agency staff at the service as they did not always have the same drive for improvement or focus on quality within the service compared to permanent staff.

People were supported to have choice and control of their lives.

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 21 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about allegations that abusive practices were used at the care home. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alderwood – The Chestnuts on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

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.