The inspection took place on 18 and 22 October 2018.

Chescombe 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.

Chescombe accommodates 19 people across three separate houses called Treetops, Lavender and Orchard. In addition there are three self-contained flats.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good 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.

There was 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 received a safe service. There were sufficient staff to meet the needs of people they supported and to enable them to carry out a variety of activities. People received safe support with their medicines. Staff understood the importance of safeguarding people from abuse and reporting any concerns they had.

Staff were knowledgeable about people’s health needs and worked with other health and social care professionals to ensure these needs were met. People were given choices and asked for their opinions on meal choices. Staff were knowledgeable about the Mental Capacity Act 2005 and incorporated the principles of this legislation in to their practice.

We saw that strong relationships had been formed between people using the service and staff. People shared good humour with staff and we saw that people were content and settled in their company. People were supported to maintain contact with their families.

People were given opportunity to take part in a range of activities. The service hired a local hall for activities such as cooking and fundraising events. During our visit, we saw Halloween crafts taking place. There were systems in place for managing and responding to people’s complaints.

The service was well led. There was a registered manager in place supported by individual house managers. There were systems in place to monitor the quality and safety of the service provided. People were given opportunity to provide their views and opinions on the service they received.

The inspection took place on 26 and 28 April 2016. This was an unannounced inspection. The service was last inspected in February 2015 and was in breach of the following:

Regulation 12 HSCA (RA) Regulations 2014 Safe care and Treatment: The registered person was not making appropriate arrangements for the recording of people’s medicines.

Regulation 15 CQC (Registration) Regulations 2009 Notifications – notice of changes: The registered person was not notifying the Commission of all relevant changes affecting the running of the service as required under this regulation.

Regulation 17 HSCA (RA) Regulations 2014 Good Governance: The registered person was not operating an effective system for assessing and monitoring the quality of the service provided.

At the time of this inspection, there was evidence the provider had taken action to ensure it was complying with these regulations.

The service is registered to provide accommodation for up to 19 people and cares for people who predominantly have learning disabilities needs. The home is divided into three individual houses.

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.’

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which promoted this.

The service was responsive. Care plans were person centred and provided sufficient detail to provide safe, high quality care to people. Care plans were reviewed and people were involved in the planning of their care. There was a robust complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions required to improve the service. Staff, people and their relatives spoke positively about the registered manager.

This inspection took place on 17 February 2015 and was unannounced. The previous inspection of Chescombe was on 11 December 2013. There were no breaches of the legal requirements at that time.

Chescombe is a care home without nursing for up to 19 people with learning disabilities. The accommodation consisted of three houses called Treetops, Lavender Lodge and Orchard House. There were also self-contained flats for three people.

Chescombe did not have a registered manager at the time of this 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.

The previous registered manager was in the role of ‘executive manager’ with the organisation and they left their position in November 2014. Their registration was cancelled, although the provider did not provide us with the reports about the management of the service that were required at the time. We received further information about the management arrangements following the inspection.

Senior staff had taken on some additional responsibilities in the absence of a registered manager. However not all aspects were being covered, including the arrangements being made for monitoring the service. Information relating to quality assurance was not all available to show that standards were being checked and improvements made where necessary.

People told us that they felt safe living at Chescombe. However, procedures were not always being followed in a consistent way to provide a good level of protection. These were shortcomings in how people’s medicines were being managed. 

People received support from staff which helped them in different areas of their lives. This included help to arrange check ups and appointments so that people maintained good health. People had individual plans which mostly provided good information about their needs and the support that had been agreed. Staff had received training so they were competent in the tasks they carried out.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and helped people with making decisions. Choice was being promoted and information had been produced in ways which made it easier for people to understand. Menus, for example, included photographs of the meals and people told us they could choose what meals they wanted.

People were treated with respect and in a caring way by staff. Staff helped people to maintain good relationships and to have a comfortable and well decorated home environment.

People took part in activities they enjoyed. They went out on a regular basis and could choose what they wanted to do, such as going shopping. People had meetings together when they could talk about the day to day arrangements and resolve any issues.

We found three breaches of regulations during our inspection. These concerned the recording of medicines, notifications by the provider and the arrangements being made for quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

We had been informed by the home that there had been five medicines errors during October 2013 and November 2013. Some people had not been given their medicines at the right time which could put people at risk of harm.

We visited Chescombe to follow up these concerns. We visited all three of the houses where people lived called Treetops, Lavender Lodge and Orchard Lodge. We also visited two of the three flats and spoke with two of the people living there about how they were supported to take their medicines.

We found more robust arrangements had been put in place in Treetops where the medicine errors had taken place and action taken included retraining the members of staff and re assessing their competency to administer medicines to people.

When we visited the home in July 2012 we found people had not always experienced care, treatment and support that met their needs and protected their rights. At this inspection we visited all three houses and found that improvements had been made with staff supporting people through a more consistent approach.

We spoke with one person who told us they liked living at Treetops, we saw people leaving the house to attend activities with their individual staff. We observed staff to be respectful in their manner and when we spoke with staff they demonstrated a good knowledge of people’s needs.

We found at the previous inspection that people had not always been protected from the risk of abuse. At this visit we found the levels of aggressive incidents between people had reduced significantly and that strategies had been used by staff to protect people from the risk of abuse.

Improvements had been made to support staff to deliver care and treatment to people safely and to an appropriate standard through a planned training and supervision programme.

We saw that people were now better protected through the management of risks with systems in place to assess the quality of the service.

People were protected from risks of unsafe or inappropriate care because their personal records were accurate and fit for purpose.

We carried out a routine and scheduled inspection of Chescombe on 20, 23 and 24 July 2012.

We spoke with the registered manager, three senior managers, and care staff.

We used a number of different methods to help us understand the experiences of people using the service. We spoke with three people; because other people using the service had complex needs, and were not able to tell us their experiences, we carried out observations of their care and interaction with staff in different areas of the home.

Chescombe is under safeguarding measures following a high level of aggressive incidents between some of the people living at the home. The home has voluntarily agreed not to admit any further people to one of the three houses called Orchard Lodge. People had moved to the new home in 2011. We were told that for some people, the new environment had contributed to the incidents that had occurred combined with peoples' differing personalities. Some of the peoples’ behaviours had been difficult to manage resulting in some people hurting others.

Since the move there had been staff vacancies but these were in the process of being filled.

Some people spoken with told us that they preferred the house they lived in now as it was nearer to some of the places they enjoyed visiting. We were told people made choices about what they wanted to do and where they wanted to go. We were given examples such as using public transport to get around Bristol and the surrounding areas, shopping and the food they wanted.