Chestnut Grove Rest Home is a residential care home which is registered to provide care and support to 12 older people. The detached home is situated in Lostock Hall.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection visit we found the service remained Outstanding.

People continued to receive personalised care which was responsive to individual need. Staff had an excellent understanding of people’s individual needs and life history so care could be provided with support which was individual to them. Services were flexible and people could decide how and when their care was provided.

People, relatives and professionals all agreed the service continued to be exceptionally well managed. Everyone praised the skills of the management team and their ability to provide an exceptional service. Governance was embedded within the service and was based upon good practice guidance.

People, relatives and health professionals told us the care provided was effective and people experienced positive outcomes whilst living at Chestnut Grove Rest Home. Professionals told us they considered the home one of the best in the area.

People continued to receive a highly effective service which was person-centred and put them at the heart of their care. People and relatives told us staff were empathetic and motivated to provide compassionate care. There was a continued emphasis on privacy , dignity and human rights. Relatives praised end of life care provision at the home.

The registered provider was extremely responsive in seeking feedback from people and relatives to ensure people were happy with the service provided.

Links within the local community continued to be a priority. Excellent links had been forged with the local hospice which provided training and support to both staff and people who lived at the home. The home had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged.

People who lived at the home and relatives repeatedly praised the quality and choices of food provided. Healthy eating was promoted.

The registered provider understood the importance of providing holistic health care. People had been supported to effectively manage negative life experiences which had impacted upon their well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Consent to care and treatment was actively sought.

Staff turnover was low. Staff at the home said they experienced high levels of job satisfaction and good team morale. They said that as a result staff often went the extra mile.

People and relatives praised the way in which safety and risk was managed within the home. We were repeatedly told by relatives and professionals that people remained safe whilst living at the home.

Systems, processes and practices were embedded to safeguard people from abuse and risk of harm. Good practice guidance had been followed to keep people safe. Staffing levels were continuously reviewed to ensure there were enough staff on duty to provide flexible care.

Further information is in the detailed findings below.

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.

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During our visit, we spoke with three of the eleven people using the service. They shared some of their experiences at the home. We spoke with two care workers, the manager and the deputy manager.

This is a summary of what we found.

Is the service safe?

We saw that people were being cared for in an environment that was safe and clean.

Three people who used the service told us they felt safe living at the home. One person said, “I am looked after very well.”

We looked at the care plans of three people who used the service. These plans identified the individual care needs of people who used the service. In the main the care plans provided clear directions for staff to follow in order to ensure people’s needs were met although one that we looked at required more detail about the assistance needed, for example, to use the hoist.

Staff had received training to enable them to meet the needs of the people who used the service. This meant the provider could demonstrate that the staff employed to work at the home had the skills and experience needed to support the people living there.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure that people in care homes and hospitals are looked after in a way that does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so that they understood when an application should be made and how to submit one.

Although members of staff had received training in the management of medication we saw that one medication administration record was not accurate. There was no evidence of any medication errors but a lack of clear records increases the risk of mistakes being made.

The home had received a food hygiene rating of 4 on 6th May 2014. This reflects the standard of food hygiene found on the date of inspection by the local authority.

Is the service effective?

People’s health, social and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly.

We saw from the training records we viewed that staff had received training to enable them to meet the needs of the people living at the home. Discussion with staff and examination of records confirmed that a programme of training was in place so that all members of staff were kept up to date with current practice.

The people we spoke with told us that they were happy with the care they received and that their needs were met. They spoke positively about the care they received and the staff who supported them. It was clear from what we saw and from speaking with staff that they had a good understanding of the care and support needs of the people using the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “I think it’s marvellous.” A thank you card from a family member said “In his final years he was admirably looked after.”

One care plan that we saw stated that the person could become agitated and needed “love and reassurance” to help them settle.

We saw that the staff showed patience and gave encouragement when they were supporting people and that people were able to do things at their own pace and were not rushed.

The activities co-ordinator explained how she began each session with a short hand massage for the people using the service, which enabled her to spend some time with each person individually.

Is the service responsive?

People’s needs had been assessed before they moved into the home. The records we saw confirmed that people’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Throughout our visit we found the atmosphere was calm and relaxed.

We saw that people’s rooms were spacious, light and clean, people had personalised their rooms with their belongings and furniture. The gardens were large with seating areas. There were ramped entrances for easy access.

Is the service well-led?

We saw evidence that the service worked well with other agencies and services to make sure people received their care in a joined up way.

We found from speaking with staff that they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw that quality assurance processes were in place to make sure that the provider monitored the care provided and made improvements where necessary. For example, satisfaction surveys had been completed by people using the service and their families and the results had been analysed. However, the quality assurance system required some further development in order to ensure that all aspects of the care provided at the home were properly monitored.

People told us:

"The carers are really nice...They always knock...They're good at explaining what they want to do for me...My privacy and dignity is respected...I choose what I want to do and when."

"I came here out of choice, I was really impressed by the place...I'm well looked after...I really like the garden."

"It's always clean and tidy...They do everything each day."

"I'd see one of the staff if I had an issue...I'm sure they'd take it seriously and sort it out."

A relative said:

"It's fantastic! I'm really very happy with how [relative] is looked after here...They don't just meet her needs, she gets plenty of stimulation from the staff...I'm always kept up to date by the home and they get the GP out if I can't get here...There's lots going on...It's a real home from home."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People experienced care, treatment and support that met their needs and protected their rights.

People were protected from the risk of infection because appropriate guidance had been followed and were cared for in a clean, hygienic environment.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

There was an effective complaints system available.

We spoke with six people living at the home, two relatives and three staff members during the course of our visit to Chestnut Grove. We received positive comments from everyone. The residents and relatives were very complimentary about the staff team and spoke very highly of the manager, who is also the provider of the service.

Comments from residents included:

"I wouldn't want to be anywhere else but here. It is so comfortable and friendly."

"They (the staff) are excellent. Very caring and they aren't overpowering or domineering."

"It is deffinitely home from home. The atmosphere is so friendly and they (the staff) can't do enough for me."

One person who was a regular visitor to the home commented, "I really wouldn't mind living here myself. It really is a lovely place."

All members of staff spoken with were very complimentary about the management of the home. One stated, "Mary is a fabulous manager. She is very helpful and supportive."