Chestnut House is a care home providing personal care and accommodation for up to 19 older people and is owned by Beech House Care Homes Limited. No nursing care is provided. The home is situated in the Crumpsall area of Manchester.

At the last inspection of October 2015 the service did not meet all the regulations we inspected and were given two requirement actions for governance and keeping care plans and risk assessments up to date. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 09 and 10 May 2017.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were suitable activities to provide people with stimulation if they wished to join

We inspected this service on 13th October 2015. The inspection was unannounced which means they did not know we were coming to the service to undertake an inspection. The service was last inspected in July 2014 and was compliant in all five outcome areas inspected.

Chestnut House is a care home providing personal care and accommodation for up to 19 older people. No nursing care is provided. On the day of inspection there were 17 residents using the service.

A registered manager was in post and present on the day of inspection. 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.

Staff ratios were adequate to meet the needs of people accessing the service. The service benefitted from a stable staff team and robust recruitment processes were in place to ensure that the right people were appointed when this was required. Proper recruitment checks were carried out, including checks with the Disclosure and Barring Service (DBS). Both staff and management had an understanding of safeguarding and knew how to report an issue if they had concerns. This meant people were protected from the risk of unsafe care or treatment.

Risks had been identified with particular individuals and staff were aware of how to manage those risks.

Measures were in place to prevent the spread of infection with adequate hand washing facilities and appropriate signage. Medicines were obtained, stored and administered safely.

Staff were positive about the service as it ensured that all staff were trained and they invested in the personal development of the staff. Staff spoke highly about the training and the supervision process which was undertaken with them on a regular basis. We saw that appraisals had been held with staff but these weren’t always in line with company policy.

The registered manager and other staff had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS legislation and were able to describe when this would apply. We were shown evidence of DoLS applications submitted by the provider and authorised by the supervising authority. This demonstrated that the provider was working within the correct framework to ensure peoples’ rights were protected.

People were complimentary about the food on offer at mealtimes. Catering staff displayed knowledge about the various diets catered for and the home had been awarded a score of 4 out of 5 in the Food Hygiene Ratings, run in conjunction with the Food Standards Agency and the local authority.

We found that care plans contained information about individuals which would assist staff to deliver person-centred care. There were some good examples of staff involving residents in their care and of residents having choices with their daily routines.

There was an activities co-ordinator employed at the home who arranged entertainment, outings and activities for those wanting to take part.

Resident meetings were held on a regular basis. The provider sought the views and opinions of people using the service with regards to relevant topics concerning the home and care provided. There was a system in place for the manager to address complaints made to the home.

People spoke highly of the registered manager and staff felt supported in their roles. A quality survey had been initiated by the manager and responses provided by residents and relatives. People were positive about the service although some of the suggestions made by residents had not been actioned at the time of the inspection.

There was a system of audits in place but these did not always identify areas for improvement. We identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activites) Regulations 2014.

There was a Business Continuity Plan in place which outlined contingency arrangements following a possible disruption to the service.

In relation to the breach mentioned above you can see what action we told the provider to take at the back of the full version of the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is the summary of what we found

Is the service safe?

People had been cared for in an environment that was clean and hygienic. Policies and procedures were in place and adhered to in relation to the management of medicines. There was evidence of a plan of action following a recent fire safety inspection.

Is the service effective?

People told us they were happy with the care that they received and it was clear from talking to the staff and visiting professionals that they understood peoples care and support needs. One person told us "I think its brilliant here, they've got the right balance of humour and care". Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported in a kind caring environment. We saw care was carried out in a personalised unrushed manner. We were told that the staff were "all very nice to you".

Is the service responsive?

Peoples needs had been assessed before they moved into the home. Peoples records confirmed people's preferences and interests, and people had access to activities that were important to them.

Is the service well-led?

The manager was seen as very skilled by everyone concerned. People told us they were able to influence how the home was run.

On the day of our inspection we were not able to speak to all of the people who used the service as some were unwell and some did not wish to speak with us. We did have the opportunity to speak with two people who used the service and one visiting relatives.

People told us that they were happy living in Chestnut House and were well cared for comments included, " I like it here and am very happy", I like to have a lie in sometimes and that's ok". "The staff are very good, they listen to me and give me all the help I need. I have no concerns at all."

We looked at the care records for people who used the service and found that they were personalised and contained relevant information about people's choices and preferences.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs.staff had received training on safeguarding vulnerable adults.

Staff were provided with appropriate training opportunities and received regular supervision.

Efficient systems were in place to monitor the service.

People living in the home, or their representative, had been asked to give signed consent for the care and support they received. We saw evidence that care staff had respected people's rights to refuse or withdraw their consent within a framework of risk management.

People living in the home received safe personal care and support to meet their identified needs. A relative told us that care staff gave their full support to enable them to be involved in their X's care. One of the people accommodated in the home said, "The staff are very good. They listen to me, show me respect and give me all the help I need."

Two people told us that they enjoyed the food provided in the home. One person said, "The food is always good. We get enough to eat and drink, but you can ask for more if you fancy it."

We found that systems were in place to ensure that people received their medicines exactly as prescribed by their doctors.

We were concerned to find that the scales used in the home to weigh people were inaccurate, because they had not been calibrated. This prevented staff from accurately monitoring the health, welfare and safety of people who were assessed as at risk of poor nutrition.

On the day of our visit we saw that sufficient staff had been deployed to meet the assessed needs of people living in the home.

The service had an appropriate system in place for investigating and responding to complaints made by people using the service and their representatives.

We found the atmosphere of the home was very relaxed and homely and all the residents we met appeared to be content and comfortable.

We spoke to several residents during our visit and received some very positive feedback about the service provided at Chestnut House.

People expressed satisfaction with all aspects of life at the home and were happy with the standard of care they received. Comments included;

''They (the staff) are very good. Nothing is too much trouble.''

‘’I think we are very lucky here. We are well looked after.’’

We were also fortunate enough to speak to some visiting relatives during our inspection. Again, we received some very positive feedback and relatives expressed satisfaction with all aspects of their loved ones' care. One relative commented ''I’m always made to feel welcome. They always give me a drink which I think is very nice. I’m happy that my Mum is in such a good place where she is so well looked after.’’