25 April 2022
During an inspection looking at part of the service
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.