About the service: Chestnut Lodge is a residential care home that was providing personal care to eight people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People felt safe living at Chestnut Lodge and had their risks assessed and reviewed regularly. Staff understood the actions needed to prevent avoidable harm including the prevention of avoidable infection. Medicines were ordered, stored, administered and disposed of safely by trained staff.

Staff had been recruited safely ensuring they were suitable to work with vulnerable adults and staffing levels responded to the needs of people. People were cared for by staff who had received an induction and had on-going training and support that enabled them to carry out their roles effectively.

Pre-admission assessments had been completed with people and their families and gathered details of people’s needs and choices. This information had been used to create care plans that reflected peoples care needs and lifestyle choices, spiritual and cultural needs and were reviewed regularly and understood and followed by the care team. People received responsive and compassionate end of life care.

Relationships between people and the staff team were positive, kind and caring and people felt involved in decisions about their care. People had their privacy, dignity and independence respected. People had opportunities to be involved in activities both within the home and the local community.

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.

Leadership was visible and the registered manager and deputy worked alongside the care team enabling practice observations, learning and development and teamwork.

Quality assurance systems included an annual survey, monthly audits, a complaints process and regular meetings with people, their families and staff. When improvements were identified actions had been taken appropriately and outcomes shared to aid learning and improve service delivery.

A full description of our findings can be found in the sections below.

Rating at last inspection:

The service was rated ‘Good’ at our last inspection carried out on the 28 September 2016.

Why we inspected:

This was a planned inspection based on previous rating.

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.

The inspection took place on 30 August 2016 and was unannounced. The inspection continued on 31 August 2016 and was announced. It was carried out by a single inspector.

Chestnut Lodge provides accommodation and personal care to up to 11 elderly people. The accommodation was split over two floors. There were five bedrooms on the ground floor and six on the first floor. A stair lift supported people up and down the stairs. Eight bedrooms were ensuite and three were not. There were two bathrooms which both had assisted baths. The home had a kitchen and staff office. There was a communal living area and a separate dining room for people to come together.

The service had 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.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, end of life, nutrition and dementia.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest.

People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements.

People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available to people. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected needs identified. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and family. We noted that it contained mainly positive feedback. The results had been analysed and actions were set for the management team to follow up. We saw

People told us their needs were met. We spoke with seven people and the friend of a person. Everyone told us that their care needs were met. One person told us that “it is home from home. Staff are very kind” and another person told us “They (staff) are good to me. I am well looked after.” The friend told us the home was “very good, they (staff) are very helpful.”

People spoke highly about the food they were offered and were given a choice of suitable food and drink to meet their nutritional needs.

The home had systems in place to regularly assess and monitor the quality of the service and people's views were sought.

There were effective systems in place to handle complaints.

People told us that staff were respectful and we observed staff respecting people, knocking on doors and interacting with people in a respectful way.

People were involved in activities. Throughout the day we observed people knitting, listening to music, reading the paper and joining in with a quiz. People told us they were happy and that the home was “friendly and homely”.

People were able to make choices and were supported to maintain their independence.

Risk assessment were up to date and reflected the needs of people.

We found the home to be clean and in a good state of repair. The home had employed a cleaner and there was a cleaning plan which identified how each area needed to be cleaned and the frequency.

Medication was stored correctly and medication charts were completed.

Staff had appropriate employment checks prior to commencing employment. We observed people’s care needs being met in a timely manner and staff reported there to be adequate staffing levels. Staff received training and there was evidence of supervision, observation and appraisal.

The home had a medication audit and care plan audit. Incidents were recorded and appropriate action taken. The home conducted surveys for people and their relatives and a high number of these had been completed and returned. Staff recorded verbal or informal complaints in peoples own records. There was no collation of this information so themes could not be identified.

We visited Chestnut Lodge unannounced on Monday 28 November 2011. We spoke to seven people who live in the home and with two relatives who were visiting. We spoke to both staff that were on duty and observed how care was given throughout the day.

One person told us that she sees her room as very much her own private space. This is respected by staff who support her in maintaining her independence. People told us that their rooms are cleaned properly once a month and the bed linen is changed weekly.

A person told us that her primary need was for quick attention and when she uses her call bell it is answered quickly. A visitor told us that their relative had been very happy living at Chestnut Lodge and was ‘very well looked after’.