This was an unannounced inspection carried out on 2 February 2017.

Chestnuts Retirement Home can provide accommodation and personal care for 14 older people. There were 14 people living in the service at the time of our inspection.

The service was operated by a company that was the registered provider. The company had four directors. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At our inspection on 8 December 2015 there were two breaches of legal requirements. We found that medicines had not always been safely managed. We also found that quality checks had not been consistently effective in quickly resolving problems. These problems included shortfalls in completing repairs to the accommodation and ensuring that care was provided in a way that respected people’s legal rights. Other shortfalls included the arrangements that had been made to promote positive outcomes for people who lived with dementia and to ensure that people were supported to maintain a healthy body weight.

After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 28 February 2016. At the present inspection we found that the necessary improvements had been made and that the two legal requirements had been met. However, we also found that quality checks of the accommodation needed to be developed still further. This was so that they could quickly resolve the small number of problems that remained to be addressed.

At this inspection we also found that staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. There were enough staff on duty to provide people with the support they needed and background checks had been completed before new staff were appointed.

Staff had been provided with support and guidance and they knew how to support people in the right way. People enjoyed their meals and staff had supported them to obtain all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people's right to privacy, promoted their dignity and there was provision for confidential information to be kept private.

People had been consulted about the care they wanted to receive and had been given all of the practical assistance they needed. When people became distressed they had received appropriate individual support and reassurance. People had been encouraged to pursue their hobbies and interests and there was a system for resolving complaints.

People had been invited to suggest improvements to their home. The service was run in an open and inclusive way, good team work was promoted and staff were supported to speak out if they had any concerns. People had benefited from staff acting upon good practice guidance.

This was an unannounced inspection carried out on 8 December 2015.

Chestnuts Retirement Home can provide accommodation for up to 14 older people who need personal care. There were 14 people living in the service at the time of our inspection.

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.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach referred to the way in which medicines were managed. The arrangements were not robust and did not ensure that people always used medicines in a safe way. The second breach referred to the way in which quality checks had been completed. They were not rigorous or effective and this had resulted in a number of shortfalls not being quickly identified and resolved. These breaches had increased the risk that people would not always safely and responsively receive all of the care they needed. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the end of the full version of this report.

Staff knew how to report any concerns so that people were kept safe from abuse. People had been helped to promote their wellbeing and to avoid having accidents. There were enough staff on duty and background checks on new staff had been completed before they started work.

Staff had received most of the training and support they needed. However, they did not have all of the knowledge and skills they needed to support people who lived with dementia. Although people had not been reliably helped to check their body weight, staff had supported people to have enough nutrition and hydration. In addition, staff recognised when people were unwell and had arranged for them to receive the necessary healthcare services.

The registered manager and staff had supported people to make decisions for themselves. When this had not been possible the registered manager had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had not taken all of the necessary steps to ensure that people’s rights were being protected.

People were treated with kindness and compassion. However, people’s right to privacy was not fully respected and some of the arrangements for maintaining confidentiality were not robust.

The registered persons had not ensured that there were robust arrangements to promote positive outcomes for people who lived with dementia and who could become distressed. We recommend that the registered persons explore the relevant guidance on how to enable staff to effectively support people who live with dementia and who can become distressed. However, most people had been consulted about the care they wanted to receive and had been supported to pursue their hobbies and interests. Staff had supported people to express their individuality, people had been helped to meet their spiritual needs and there was a system for resolving complaints.

People had not been fully involved in the development of the service and they had not benefited from staff acting upon good practice guidance. However, steps had been taken to promote good team work and staff had been encouraged to speak out if they had any concerns.

The summary is based on our observations during the inspection, speaking with seven people who used the service, three relatives, the manager and three staff. In addition, we looked at care records, the arrangements to keep people safe from abuse, the management of medication, staff training and quality assurance.

We considered our inspection's findings 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? This is a summary of what we found:

Is the service caring?

People said that staff were respectful, kind and attentive. They considered staff to be kind and to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We saw that most of people's individual needs for care had been assessed and met. Staff knew about each person’s care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person’s changing needs and wishes. However, we recommended that an improvement be made to the way in which staff ensured that people maintained a healthy body weight.

Is the service safe?

There were reliable systems for managing people’s medication. This helped to ensure that medicines were used safely and consistently. Staff understood most of their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse. The provider had made some arrangements to protect people against the use of unlawful or excessive control or restraint. This provision included having policies and procedures to guide staff in the correct application of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The safeguards are designed to protect people when they need to have their liberty restricted. However, we found that some staff did not have a thorough knowledge of how the safeguards should be correctly used. We recommended that the provider ensured that all staff had the knowledge and skills they needed to reliably implement the safeguards.

Is the service effective?

People were helped to stay safe by avoiding most risks to their health and safety. There were safe working practices to help people with reduced mobility. This reduced the likelihood of people experiencing falls and accidents. However, we recommended that other risks were managed in a more robust way. These included the risk of people being burnt because one of the radiators was not guarded. In addition, repairs were needed in the kitchen so that all surfaces were easily cleanable and so could be kept in a hygienic condition.

Is the service well led?

People had been consulted about their experience of using the service. There was a clear line of management. This meant that important decisions about organising someone’s care were made by senior staff while carers could use their own judgement to provide a flexible service. However, we recommended that improvements be made to the quality assurance system so there was a clear record of how standards were being maintained.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of the inspection.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with three people who used the service and one relative. We spoke with the manager, the deputy manager and two members of staff. We also observed people being supported by staff during mealtime and care delivery.

We saw that people who required special diets for medical reasons received the appropriate nutrition which met their needs. One person who lived at the home told us, "The food is good, it was roast pork today."

One person who was visiting a relative told us, "It's brilliant. To be honest I was very anxious about (my relative) coming here but it has been marvellous. It's run like a family home."

People who lived at the home told us that it was a good, safe place to live and that the care they recieved was very good.We used a number of different methods to help us understand the experiences of people using the service, because some of the the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of people living at the home and others who told us that the care given to people living at The Chestnuts Retirement Home was very good.