Archived: Chestnuts Residential Home

Updated 31 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

An unannounced inspection took place on 25 July 2018 and was completed by two adult social care inspectors. Prior to the inspection we contacted the local authority safeguarding and commissioning teams and Healthwatch. Healthwatch is an independent champion whose purpose is to understand the needs and experiences of people who use health and social care services. We used information they provided to aid our planning of this inspection.

We looked at information held about the provider and the service including statutory notifications relating to the service. Statutory notifications include information about important events, which the provider is required to send us. On this occasion, we had not asked the provider to send us a provider Information return (PIR). A PIR is a form that asks the provider to give some key information about the service. This includes what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt was relevant. We used this information to help us plan this inspection.

During the inspection, we spoke with two people who used the service, two relatives, two members of staff, the deputy manager and the registered manager. After the site visit we spoke with one staff member and received feedback from four staff members.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care, to help us understand the experience of people who could not talk with us.

During the inspection we completed a tour of the environment. We looked at three care plans, the medicine administration records of three people and accidents and incidents. We looked at the recruitment records of four staff, staff training records and staff meeting minutes. We looked at a selection of documentation that related to the running of the service; these included quality monitoring audits, policies and procedures and environment safety certificates.

After the site visit the registered manager sent us information about settings for pressure relieving mattresses, details of complaints and further quality monitoring documents.

Updated 31 October 2018

Chestnuts Residential Home was inspected on 25 June 2018 and was unannounced. This was the first time the service had been inspected.

Chestnuts Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is owned and operated by Chestnuts Bargate Ltd.

Chestnuts Residential Home is in Grimsby and located close to the town centre. It accommodates a maximum of 26 people in one building, with rooms spread over three floors. At the time of the inspection 25 people were using the service. Some of the people who lived at the home were living with a dementia. Communal areas include a dining area, conservatory and a lounge with access to a secure garden. Toilet and bathroom facilities are located on all three floors. There are two shared bedrooms and the other bedrooms are single rooms, with some having access to an ensuite.

At the time of the inspection there was a registered manager in place. 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 three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These breaches related to Regulation 12 (Safe care and treatment); Regulation 15 (Premises); Regulation 17 (Good Governance). We also found one breach of the Health and Social Care Act (Registration) Regulations 2014; Regulation 18 (Notifications). This was because registered persons had failed to notify us of events which they are legally required to do. You can see what action we have told the provider to take at the back of the full version of this report.

Areas of the service had strong odours and were not clean and hygienic, which placed people at risk of developing infections. Some items of furniture, linen and carpets were not fit for purpose and needed replacing. Not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. You can see what action we have told the provider to take at the back of this report.

There was a quality monitoring system in place, however it did not identify the problems we found with the environment. Where quality shortfalls were identified, action plans were not implemented to resolve the problems.

People and their relatives felt the service was safe. Staff could recognise signs of abuse and followed procedures to report concerns. Accidents and incidents were monitored and analysed to reduce the risk of them reoccurring. Staff told us, they felt more staff were needed to meet people’s needs. The registered manager often provided care to people to support the staff. We made a recommendation in relation to staffing levels.

People’s needs were assessed before they moved into the service and reviewed regularly to capture any changes to their health and wellbeing. People were supported to have healthier lives through timely access to healthcare services. Staff worked closely with various agencies and followed professional advice. Staff had the skills and knowledge to support people. People were supported to eat and drink enough and had a balanced diet, including those people who required specialised diets.

Medicines were stored securely and people received their medication as prescribed. Protocols were not in place to support staff when administering ‘when required’ medicines. We have made a recommendation about this.

People were supported to have maximum choice and control of their lives. Staff had good knowledge of the Mental Capacity Act 2005 and supported people the least restrictive way. The policies and procedures supported this practice. Some people were deprived of their liberty and authorisations had been sought in line with Deprivation of Liberty Safeguards (DoLS).

Staff were kind and caring towards people. We observed positive interactions between staff and people. People were supported in a respectful and dignified manner until the end of their lives. Staff had explored people’s end of life wishes and plans were in place to ensure people had a pain free death.

Relatives and staff told us there was lots of activities going on within the service. Staff communicated with people in the way they understood. A complaints procedure was in place, though no complaints had been received.

This is the first time the service has been rated Requires Improvement.