Chestnut House

About the service

Chestnut House is a supported living service for people living with a range of care needs, including mental health and learning disability needs. It operates two shared houses where people have access to their own flat and share communal areas. Other people were supported in individual homes. The service was supporting 27 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People were supported by staff who understood their role in protecting them from the risk of harm. People were supported to take reasonable risks, so that they could do things they enjoyed and be part of the local community. Environmental risks were assessed and managed to enable people to keep safe. Accidents and incidents were reviewed to help identify lessons learnt and these were shared with staff. Enough trained staff were available to support people.

Where needed people were supported in a safe way to take their prescribed medicine. The staff's suitability to work with people was checked before they commenced employment. People were protected from the risk of infection as staff followed government guidelines regarding Covid 19.

Checks were undertaken to monitor the quality and safety of the service. The views of people using the service and their relatives, staff, and professionals were gathered to help improve the service. The registered manager and staff team worked well with health, social care and criminal justice professionals.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Safe and Well Led key questions, the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The leadership of the service was provided in an open and inclusive way. This supported a culture that enabled people to live inclusive and empowered lives. People confirmed they were supported to be as independent as they wanted to be and were empowered to make decisions to achieve positive outcomes.

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 22 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about risk management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains good. 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 on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Chestnut House is a supported living service for people living with a range of care needs, including mental health and learning disability needs. It operates two shared houses where people have access to their own flat and share communal areas. Other people were supported in individual homes. The service was supporting 22 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People had not always been protected from the risks of infection as staff had not always worn facemasks in line with government guidelines. On occasion, people were not always compatible when sharing accommodation together. Where people’s behaviours had a negative impact on others, the provider took-action to resolve any issues. The provider took steps to promote people’s safety and reduce known risks.

Steps were taken to promote staff safety. Staff were suitable for the role they were employed in and there were sufficient staff to care for people safely. Staff felt well-supported by the management team. Staff were trained to administer medicines safely where people required this.

Safeguarding processes were followed when needed to promote people’s safety, and staff were knowledgeable on these. Any accidents and incidents were reviewed to help identify lessons learnt and these were shared with staff.

The registered manager led with an open and inclusive management style and this helped set a positive and person-centred culture where people were supported to achieve positive outcomes. Arrangements were in place to check and monitor the quality and safety of services. Views of people, staff, relatives and other professionals were gathered to help improve the service. The service worked well with a range of other health, social care and criminal justice professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 March 2020).

Why we inspected

This was a focussed inspection. The inspection was prompted in part due to concerns received about risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Chestnut House provides personal care in people’s own homes and to people living in supported living settings. At the time of the inspection there were six people supported in one supported living setting, and 13 people supported in their own homes. Where people receive care at home, not everyone received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People using the service received care with their mental health care and learning disability needs. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and / or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that us appropriate and inclusive for them.

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

Reviews of incidents did not evidence all reasonable steps had been taken to reduce risk of recurrence. Care plans did not always evidence how incidents had been reviewed.

Not all statutory notification had been submitted in a timely manner as required. Not all checks and audits had identified shortfalls in the service.

Guidelines to help staff offer ‘as and when required’ medicines consistently were not in place. Records showed people were offered their medicines as prescribed and staff had been trained and had their competency checked to administer medicines safely.

Systems were in place to help ensure people were protected from the risks of abuse and avoidable harm. Staff had been trained in safeguarding and were knowledgeable about what steps to take to protect people.

People were cared for by sufficient numbers of staff. Recruitment processes checked to help ensure staff employed were suitable for their job role.

Staff were aware of what steps to take to help prevent and control infections. Staff had been trained in areas relevant to people’s needs and told us they felt supported by the management team. People’s needs were assessed with them and their choices and preferences promoted.

People received care to plan and prepare meals if required; this helped to ensure they received sufficient nutrition and fluids. People were supported to live healthier lives as they were supported to access appropriate healthcare services when required.

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’s views and preferences were reflected in their care plans. Staff had been trained to help them understand equality and diversity issues. People’s dignity and independence was promoted. People were cared for by friendly staff.

People received personalised and responsive care. People were supported to achieve their goals and pursue activities that supported their independence. Communication needs were assessed, and any needs supported. Processes were in place and followed to ensure any complaints received would be investigated and resolved.

Systems were in place to monitor people’s call times and the care provided to people. People and staff were involved in the development of the service. The provider was developing further systems to ensure people, relatives, staff and other stakeholders’ views could be gathered and used to develop the service.

The service had a clear aim to provide personalised care and positive outcomes for people; staff demonstrated they were committed to this aim. The service had policies and procedures in place to help ensure the provision of services to people followed recognised practice.

We have made a recommendation about the provider submitting CQC notifications when required to do so.

Please see the action we have told the provider to take at the end of this report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This is the first inspection of this provider since they registered on 19 February 2019.

Why we inspected

This was a scheduled inspection based on the providers registration date.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.