The Chestnuts Residential Care Home is registered to provide accommodation up to 23 people who require nursing or personal care. At the time of our inspection there were 23 people living at the service. The service is a two storey premises located on the outskirts of Wisbech with accessible garden areas. The service has communal lounges and dining areas. The service has the home has 21 single rooms and one twin room with en-suite toilet and washbasin.

This unannounced comprehensive inspection was undertaken by one inspector and an expert by experience and took place on 18 July 2017. At the previous inspection on 12 March 2015 the service was rated as ‘Good’. At this inspection we found the service remained 'Good'.

A registered manager was in post at the time of the inspection but they were on leave. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 knew what procedures to follow to keep people safe from harm.

Accidents and incidents such as medicines recording, were identified and acted upon when required.

People were supported with the safe management and administered of their prescribed medicines.

Where people had been identified as being at risk, risk assessments such as those for malnutrition and skin integrity were being used to help manage risks effectively.

There were enough competent staff with the right skills to provide people with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People were effectively supported with their health care and nutritional needs. Staff supported people to access external health care professionals promptly.

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.

People were treated with compassion by staff who respected people's dignity and privacy.

People were given the opportunity to feed back on the service and their views were acted on.

People were offered and took an active part in a wide variety of interests and pastimes that were provided. People's needs were responded to in a person centred way.

The registered manager had had created an inclusive atmosphere within the service and this had fostered an open and honest team culture.

A quality assurance system was in place and this helped identify any shortfalls which were used to help drive improvement in the service.

Further information is in the detailed findings below.

The Chestnuts Residential Care Home is located in Wisbech close to the town centre. The home is registered to provide accommodation, support and non-nursing care for up to 23 people. At the time of our inspection there were 23 people living at the home accommodated in single occupancy rooms and one double room and is on two floors. People are free to access all areas of the home and gardens.

This unannounced inspection took place on 12 March 2015.

At our previous inspection on 29 April 2013 the provider was meeting all of the regulations that we assessed.

The home had a registered manager in post. They had been registered with the Care Quality Commission (CQC) since 2010. A registered manager is a person who has registered with the CQC to manage the service. Like registered managers, 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.

The registered manager had a robust recruitment process in place. This helped ensure that only staff of the right calibre and with suitable qualifications were offered employment. There was a sufficient number of suitable qualified and experienced staff working at the home.

Staff had been trained in medicines administration and safeguarding people from harm and were knowledgeable about how to ensure people’s safety. People were supported with their prescribed medicines by staff whose competency to safely administer these has been assessed regularly.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and staff were knowledgeable about when a request for a DoLS would be required. We found that no applications to lawfully deprive people of their liberty were required but the registered manager was aware of the action to take if this was needed. People’s ability to make decisions based on their best interests had been clearly documented to demonstrate which decisions they could make.

Staff always respected people’s dignity and privacy at all times. People’s care was provided with compassion and in a way which people really appreciated. People’s requests for assistance were responded to promptly.

People’s care records were up-to-date, held securely and were in a format which involved people as much as possible. People were supported with their hobbies and interests on a wide range of subjects.

People were supported to access a range of health care professionals. This included their allocated GP, optician, chiropodist and community nursing services. Risks to people’s health were assessed and promptly acted upon according to each person’s needs.

People were able to choose the meals they preferred. Diets appropriate to each person’s needs were provided and included soft food options, low sugar content and vegetarian meals for people who required specialist diets. There was a sufficient quantity of food and drinks available for people.

People, relatives and staff were provided with information on how to make a complaint and staff knew how to respond to any reported concerns or suggestions. Action was taken to address people’s concerns and to prevent any potential for recurrence. People were supported to access Independent Mental Capacity Advocacy (IMCA) services if they requested these services.

The registered manager had quality assurance processes and procedures, such as audits and meetings, in place to improve, if needed, the quality and safety of people’s support and care. People were supported to raise concerns or comment on the quality of their care.

Although there were some improvements that could be made, people’s rights to dignity and privacy were valued.

People’s right to give their consent was valued. However, the systems used to assess people’s mental capacity to make valid decisions about their care and support, could be improved.

All of the people who we spoke with were satisfied with the quality and standard of their support and care. Assessments of people’s risks and health and social care needs were carried out and planned. People received their support and care as planned.

Systems were in place to protect vulnerable people who used the service from the risk of abuse. This included the training of staff. People who we spoke with had positive comments about the staff.

Arrangements were in place to ensure that people who used the service had access to safe equipment.

Staff were supported to do their job, which they said was rewarding. There were arrangements in place for staff to attend training relevant to their role.

People had access to up-to-date information about the services provided at The Chestnuts Residential Care Home.

There was a system in place which allowed people to make their concerns and complaints known. People who we spoke with said that they knew who to speak with if they were unhappy about something but said that they had no cause to do so.

Arrangements and systems were in place to determine if people who used the service had the mental capacity to make valid decisions about their support and care.

People who we spoke with were satisfied with the standard and quality of their care. One person told us, “I don’t think there is any room for improvement.” People’s well being and health care needs were provided for. However, the quality of some people’s personal care could be improved, with their consent.

People were protected from the risk of harm from abuse. However, information about safeguarding people from abuse could be made more publicly available.

People lived in a comfortable place and they liked the facilities provided. However, fire safety improvements were needed to ensure that people's health and safety were not placed at risk.

The lack of lockable doors on communal bathing and toilet facilities failed to promote people’s privacy and dignity.

Staff were supported and trained to provide people with safe and appropriate support and care. One person who we spoke with said, “The staff are very good here.” We found improvements could be made to record when staff received one-to-one supervision.

People said that they were listened to. One person, for example, said, “Things get done as soon as we ask.”

People’s health and safety were placed at risk due to inadequate audits of fire safety and care records and inadequate safety checks carried out on used wheelchairs.

People we spoke with were satisfied with the care they are given and were positive about the respect they are shown from care staff and from the manager. Some of their comments included, "It's nice and homely here" and "This is the best home that I have lived in".

We spoke with six visitors who were very satisfied with the care and support that their relatives had received. Comments from relatives included, "The staff are friendly and make you feel welcome" and "We think the Chestnuts is the best home that we saw when we were looking".