We undertook a comprehensive inspection on 18 and 21 May 2018. The inspection was unannounced.

Chestnut House 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 House is registered to provide accommodation for up to 33 people living with a mental health problem or younger adults. The service can accommodate 19 people in the main house and a further 14 people in seven self-contained flats. During our inspection there were 32 people living in the service. Seven people were living in the service under a tenancy agreement and did not receive personal care from the provider. We have not referred to these people in our inspection report.

There was a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the service in November 2016. The service was rated requires improvement.

Staff were aware of how to keep people safe from the risk of harm and abuse. People had their medicines administered safely by trained and competent staff.

Quality monitoring systems were in place. However, these did not identify weaknesses in the standards of cleanliness in some areas of the service. People were not always provided with a balanced and nutritious diet or involved in planning their menus.

People had their care needs assessed and their care was planned in line with up to date guidance and legislation. There were sufficient staff to care for a person's individual needs and staff were trained appropriately.

People were cared for by kind, caring and compassionate staff. People and staff had a good relationship and the service had a family atmosphere. People were cared for as unique individuals and their privacy and dignity were respected.

Staff supported people to spend their time as they wished and people frequently went on shopping trips to a nearby town.

People spoke highly of the care they received and the attitude of staff. Staff enjoyed working at the service and were proud of their achievements. The registered manager was proactive and had introduced improvements to the service.

People who live in the service and staff have a voice and are supported to give their feedback on the service.

This is the second consecutive time the service has been rated Requires Improvement.

We inspected Chestnut House on 23 November 2016. Our inspection was unannounced.

Chestnut House is located in the village of Marton, which is near to the town of Gainsborough in Lincolnshire. The home provides care for up to 33 people living with mental health difficulties or mild learning disabilities. There are 19 single rooms in the main part of the home and seven two bedroomed self-contained flats in a separate part of the home. There were 33 people living at the home at the time of our inspection.

There was a registered manager in place who had recently stopped working at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. An application for the registered manager to be cancelled was being submitted and a new manager had been appointed by the provider. At the time of this inspection they were in the process of applying to register with us. We refer to this person as the manager throughout this report.

During our inspection visit we found some areas in which improvement was needed to ensure people were provided with safe, effective care and that the provider’s regulatory responsibilities were met in full.

The management of people’s medicines had not always been conducted safely in line with good practice and national guidance.

People and their relatives were involved in planning how they wished their care to be provided. However, care plan reviews did not give clear enough information about the effectiveness of the care plan or any actions planned or taken after reviews had been completed.

Activities were available for people to take part in. However, the range of available activities in the home did not always support people to be consistently stimulated or maintain and further develop their interests and hobbies.

Although people were invited to comment on the quality of the services provided the arrangements in place for people to give regular feedback about the home were not always effective. We also found that audit and quality monitoring systems were not consistently effective.

In other areas, the provider was meeting people’s needs effectively.

Staff knew how to recognise signs of potential abuse and how to report any concerns. People’s rights were respected and staff understood how to support people to make decisions and choices in line with legal guidance.

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. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection none of the people who lived at the home were subject to DoLS authorisations.

People had access to a range of healthcare services and were supported to enjoy a varied diet in order to help them stay healthy.

Staff were recruited appropriately in order to ensure they were suitable to work within the home. Staff were also supported and provided with training to develop their knowledge and skills.

There were systems in place for handling and resolving formal complaints and the provider and registered manager took action to address concerns when they were raised with them.

There were 28 people living at Chestnut House on the day of our visit. Seventeen people lived in single room accommodation in the main building. A further 11 people were accommodated in a part of the service called Chestnut View in two bedroomed self-contained flats which had their own kitchen, lounge and bathroom. The service provided care for people living with mental health problems or a mild learning disability.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with people using the service and the staff supporting them. We spoke by phone with a health professional who was familiar with the service. We spoke with five people. We also looked at six care records. We were unable to speak with family and friends as there were no visitors to the home on the day of our inspection.

Is the service caring?

We saw recorded in the care files that when a person’s condition changed or deteriorated care staff called in the appropriate health professionals such as the person’s GP or mental health team.

People were supported to be involved in their local community. We spoke with one person who told us they often went to the village shop. Other people told us they took the free shoppers' bus to a nearby town to do a weekly shop for personal items.

Is the service responsive?

There were processes in place to support staff to manage an emergency. For example, the contact details for the local mental health crisis team and the acute mental health admissions unit were posted beside the telephone in the office.

We saw that the provider had contingency plans in place in event of an emergency situation.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

Regular safety checks were carried out on equipment used to make sure people were protected if there was a fire, emergency lighting and night time security. We found where risks were identified appropriate action had been taken to address these.

The service was safe, visibly clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly and therefore did not put people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment to ensure its safety.

People told us they felt safe and secure.

Is the service effective?

We looked at care files for six people. People had signed consent forms for having their photograph taken for identification purposes and at social events and for sharing their care files with other health and social care professionals.

We found pre-admission assessments of people's needs had been undertaken. People’s risk assessments and care plans had been completed on admission and were reviewed regularly to ensure they were accurate. Any changes to people's plans of care were recorded and signed by the person and their key worker.

We saw the supervision and appraisal programme for 2014. All staff had received or had been booked to receive an annual appraisal and supervision every three months.

Is the service well led?

We read the minutes of the last quarterly residents' meeting held on 03 April 2014. Eleven people had attended and had discussed access to training to boost their self-esteem, the menus and the changes to the care file format. This meant people had a say in the running of their home.

All the people we spoke with told us they were happy with their care and treatment and felt safe and secure living in the home.

Prior to our inspection we reviewed all the information we had received from the provider. As part of our inspection we spoke with four people who used the service. We also spoke with the cook, two support workers and the registered manager.

We spoke with two relatives about their views. We observed the support staff gave to people who used the service. We also looked at records, including care files of four people and carried out a tour of both buildings.

We found people gave consent to their care and the provider was aware of the legal requirements if people lacked capacity to do so.

We asked people who used the service what they thought of the food that was provided for them. One person told us, “There’s a good menu with plenty of variety and choice." We found that cultural nutritional requirements were respected which showed the provider was responsive to people’s needs.

We found that people were safe. One person said, “I feel very safe here. The staff are very good, you can have a laugh with them.” We saw the building was clean, safe and effectively maintained.

We found the service to be well led.

We spoke with five people who lived at the service, the relative of one person by telephone, two staff members, a visiting community nurse, and the registered manager.

We looked at records. These included care records and information about how the service operated. We also spent some time in communal areas of the home. We spoke with people and observed how staff supported people to do what they wanted. We found staff used the training they had received to provide safe care.

People told us they liked living at the home. One person said, “I feel proud of what I have achieved with their (staff) help. I am building myself up well and feel good today.”

People also told us that they enjoyed doing a range of activities which included; going to college and taking part in community activities and trips. People told us they did this with help from staff members, the manager, and their families. One person said, “I come and go as I want. I like the fact there are no restrictions on what I can do.”

One person talked about their interests and how they were supported to access opportunities for higher education. The person said, "I am doing a health and beauty course at college. I am working my way toward being independent one day and living on my own."

People told us they felt safe and spoke about the support they received. One person said, "I have never felt unsafe here. If we have any problems there is always someone we can talk to. They (staff) look out for you."

When we visited Chestnut House people told us they were happy with the care they received. They told us they attended residents' meetings and were able to give their views on the service. They said they were supported to be independent and one person said they “Do things for themselves.”

People told us they were part of the local community. One person said they had a mobility scooter, went to the pub and knew all the locals. Another person told us they went to the pub for meals. One person attended the local church and went to Aqua-aerobics weekly. When we spoke to people they said they had trips out and had been to Blackpool, Cleethorpes and had stayed in a caravan at Scarborough. They attended college courses.

We spoke to the chef who told us that people had a choice of two hot meals a day, one of which is suitable for vegetarians. The chef said that they had a list of people who need special diets such as diabetics and showed us how this was used.

We viewed one person’s room and saw that it had been personalised to reflect their needs. We saw that managers and staff respected and encouraged people’s lifestyle choices.