About the service:

• Chestnut View accommodates 18 people, who may be living with dementia in one adapted building.

•Chestnut View is situated in a residential area in the Chellaston area of Derby.

•At the time of our visit there were 17 people using the service.

People’s experience of using this service:

•People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm.

•People were supported to take their medicines in a safe way.

•Recruitment procedures needed to be more thorough ensuring the all required checked were in place prior to new staff commencing employment with the provider.

•Staff told us they had received training and an induction that had helped them to understand and support people. We have made a recommendation about the induction program ensuring it is in line with the Care Certificate.

•Risks were managed according to individual need ensuring people were supported safely.

•People were protected by the provider's infection control procedures, which helped to maintain a clean and hygienic environment.

•People were supported to have maximum choice and control of their lives. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005.

•People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

•People were cared for by staff who were kind and caring. Staff respected people's privacy, dignity and supported people with their independence. Visitors were welcomed at Chestnut View.

•People were supported to take part in activities of their choice and were supported to access local community facilities to enhance their well-being.

•The provider’s complaints policy and procedure were accessible to people. People knew how to make a complaint and felt the provider would take action to address any concerns.

•The provider monitored the quality of the service people received, to drive improvement. People were asked for their views about the service.

Rating at last inspection:

•At our last inspection, the service was rated "requires improvement". Our last report was published on 29 January 2018.

Why we inspected:

•This was a planned inspection based on the rating of the last inspection. At this inspection visit we saw improvements had been made.

Follow up:

•We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The inspection took place on 21 November 2017 and was unannounced. At our previous inspection during 25 and 26 October 2016 the provider was meeting the regulations we checked. However the provider was required to make improvements in some areas and received an overall rating of requires improvement. This was because we identified areas of unsafe, ineffective and unresponsive care. This was because the service was not consistently well led. At this inspection improvements had not been made and two breaches in regulations were made. This is the second consecutive time the service has been rated Requires Improvement.

Chestnut View 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.

Chestnut View accommodates 18 people, who may be living with dementia in one adapted building. The home is over two floors, there is an extension which also includes bedrooms and a communal and dining area. The main part of the home has a dining area and two communal lounges. There is a stair lift. There were 10 people living at the service at the time of our inspection. Chestnut View is situated in a residential area in the Chellaston area of Derby.

There was no registered manager in post. 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 were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

People who were supported with their medicines were not always protected against the risks associated with poor medicines management as their medicines were not always stored safely.

The provider's arrangements for staff recruitment were not thorough and did not ensure suitable people were employed.

People's care records showed risk assessments were completed. However these were not always kept under review. Risk assessments were not always completed for all areas of identified risks and were not always updated following a significant incident regarding one person at the service.

People and relatives we spoke with felt people were safe at Chestnut View. Staff had an understanding of potential abuse and their responsibility in keeping people safe.

People were not always supported to maintain their interests. People were also not supported by the provider in accessing the local community, which did not promote integration with the community.

Staff did not have adequate training to support people's individual needs. Staff told us they enjoyed working at the service. However they raised concerns about the changes in management.

The management and the leadership of the service was not as effective as it needed to be. There have been a number of changes in management since the service registered, which had resulted in a lack of consistency and vision to drive improvement.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required.

People we spoke with all told us that staff were friendly and caring. Our observation showed staff treated people kindly and in a way which respected people's privacy and dignity.

People were not always supported to maintain their interests. People were also not supported by the provider in accessing the local community, which did not promote integration with the community.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint.

We found that the provider’s quality assurance syst

The inspection took place on 25 and 26 October 2016 and was unannounced. At our previous inspection during June 2014 the provider was not meeting the regulations we checked. This was because we identified areas of unsafe, ineffective and unresponsive care. This was because the service was not well led and we carried out enforcement action. The provider sent us a report in September 2014 explaining the actions they would take to improve. At this inspection improvements had been made and all of the breaches in regulations had been met. However some further improvements were needed.

Chestnut view provides residential care for up to 18 older people, who may be living with dementia. The home is over two floors, there is an extension which also includes bedrooms and a communal and dining area. The main part of the home has a dining area and two communal lounges. There is a stair lift. There were 18 people living at the service at the time of our inspection. Chestnut View is situated in a residential area in the Chellaston area of Derby.

There was a registered manager in post. 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 relatives we spoke with felt people were safe at Chestnut View. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe. The provider had procedures in place for the management of medicine, which were not always adhered to by staff. This showed the provider could not be confident that people were always receiving the correct medicine and dose.

Recruitment procedures ensured suitable staff were employed to work with people who used the service. Sufficient numbers of staff were deployed to support people. Risks to people were identified and assessed.

People were supported by staff that were generally kind and caring. People’s choices and decisions were respected. Staff respected people’s privacy and dignity. People’s independence was promoted.

People were not always supported to engage in interests and activities, to suit their choices. People and relatives knew how to raise concerns.

We observed staff sought people’s consent before they provided care and support. Some people were subject to restrictions and the provider had identified where their support needed to be reviewed. However capacity assessments were not always completed in line with the mental capacity act principles.

People were supported at mealtimes and received sufficient food and drink that met their nutritional needs. Staff were supported through supervision and training and demonstrated knowledge of people’s needs. Staff received training in areas that were relevant to the needs of people who used the service. People were supported to access other health care services as required.

The registered manager was viewed as being open and approachable and involved in the day to day management of the service. Staff felt supported by the registered manager.

The provider had systems in place to monitor the quality of the service, however further improvements were needed to drive improvement. Records were not kept to ensure a person received adequate fluid and the internal medicines audit did not identify medicines were not always handled safely.

We visited Chestnut View on a planned unannounced inspection, and to follow up on areas of concern identified by the local authority and the Care Quality Commission. This meant that the service did not know we were coming.

We looked at two people's care records and spoke with three staff. This is known as pathway tracking and helps us to understand the outcomes and experiences of a selected sample of people. There were 15 people using the service at the time of our inspection visit

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe and had no concerns regarding the staff that supported them.

The service was not clear about their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (Dols). Where people lacked capacity and decisions needed to be made in their best interests, the provider had not acted in accordance with legal requirements.

Our observation showed that staff did not always use safe moving and handling techniques when supporting people.

A system was in place to manage people’s medication. However we identified that the stock balance of some medications did not correspond with medications administered. The provider did not have appropriate arrangements in place for the handling of controlled drugs.

At the inspection visit the provider was not clear as to whether or not the nurse call system was working throughout the home. We were extremely concerned about the safety of the people using the service, due to the lack of clarity as to whether or not the nurse call system was working. Following the inspection visit we received confirmation from the providers that the system had been upgraded on 26 June 2014.

The provider did not have robust recruitment procedures to protect people from abuse.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to capacity and best interest decision making, care and welfare of people who use the service, medication management, safety and suitability of premises and recruitment of staff.

Is the service effective?

We saw no evidence to confirm whether people's health and care needs were assessed with them or their relatives. Support plans were not detailed regarding people's needs and information about how people were supported with those needs. One person did not have a support plan in place, even though they had been at the service since March 2014.

We have issued a compliance action regarding the care, treatment and support people required to meet their needs and protect their rights.

Is the service caring?

People told us they were supported by kind and caring staff.

Staff interactions with people living at the service were limited and the interactions we did see appeared to be mostly task orientated.

We observed a positive working relationship between the care staff and the people they supported.

Is the service responsive?

One visitor told us that the staff had been encouraging their relative with their dietary intake.

The induction program was not thorough, which did not ensure staff were properly trained and was not in line with recognised standards within the care sector.

Staff had not received training in all essential areas.

Not all staff had received training on the MCA and the Dols. Some staff had a limited understanding on how to support people who could not make decisions for themselves when required.

Is the service well-led?

At this inspection visit we found that the registered provider did not have effective systems in place to monitor the quality of the service, and to identify and manage risks to people using the service. For example there was no evidence to show that learning from incidents took place and that appropriate changes were put in place to minimise risks to people using the service and others. No systems were in place to complete a review of any accidents and incidents in the service, which looked at any patterns or issues.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to monitoring the quality of the service provided.