About the service: The Chestnuts is a care home for seven people with a learning disability. The home is divided into three separate units called Lower Woodlands, Upper Woodlands and Meadow View, which are managed as one service.

People’s experience of using this service:

¿ Staff had real care and empathy and knew people well. Staff were extremely caring, kind and compassionate. They also conveyed they really valued working with people at the home.

¿ The team worked hard to focus on providing an atmosphere like a family home. Staff were calm and unobtrusive, allowing the person to be the focus of attention and promoting equality for all.

¿Staff were knowledgeable and confident in ensuring better outcomes for people. The staff had a clear understanding of their role and how to best support people.

¿People really benefited because the registered manager led with a clear vision to enable people to live fulfilled lives as independently as possible.

¿There was a transparent culture where staff felt able to discuss issues or incidents in an open way. This in turn promoted improvement. Positive teamwork and communication was embedded in the team.

¿People were at the heart of the service and there were many celebrated positive outcomes for people.

¿Care records reflected people's needs thoroughly and in a person-centred way. For example, each person had their own unique pictures used alongside their care plan. This was to help them understand what was written.

¿ People were supported to take positive risks and be as independent as possible. People were enabled through encouragement to be independent and undertake as much as possible for themselves.

¿ Risk assessments were detailed and ensured people experienced minimal restriction. There were many ways people were supported out of their usual routines and encouraged to try new experiences.

¿People benefited because a range of initiatives were used to assist people to communicate their preferences, choices and make decisions.

¿Staff went to great lengths to support people who lacked capacity to express their wishes, and staff were unhurried and patient. The communication plan stated reasons why a person might want to communicate and how certain behaviours may indicate a specific way of expressing a need.

Rating at last inspection: The service was rated Good

Why we inspected: This was a scheduled inspection based on previous rating

for more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This was an unannounced inspection, which meant the staff and the provider did not know we would be visiting. The inspection was carried out by one inspector on the 27 and 29 September 2016.

The Chestnuts provides accommodation and personal care for up to seven people who have a learning disability. The home was divided into three separate units, Lower Woodlands, Upper Woodlands and Meadow View, which were managed as one service called The Chestnuts. There were six people living in The Chestnuts with two people living in their own self-contained flats.

There was a registered manager in post; they were also responsible for another service operated by Milestones Trust. This was a temporary arrangement and was planning to stop by the end of October 2016. 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.

Sufficient staff supported people. However, there was a reliance on bank and agency staff. This was because a small team of staff were supporting a person living at another property owned by Milestones Trust. This was being overseen by the registered manager. This person previously resided at The Chestnuts. This was a temporary arrangement until alternative accommodation could be sought. Assurances were given this had been found and the staff would be returning to The Chestnuts by the end of October 2016. Staff told us this would help with moral and reduce the pressures on the registered manager.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Learning had taken place in respect of any allegations of abuse to improve the service for people living at The Chestnuts ensuring their safety. Systems were in place to ensure people were safe including risk management and safe recruitment processes.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager. Staff were committed to providing a service that was tailored to each person they supported. Staff had received training to enable them to meet people’s needs.

People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided. Staff were evidently using the home’s complaint process to raise concerns on behalf of people in respect of the environment, health care and improvements to the delivery of care.

People were provided with a safe, effective, caring and responsive service. The registered manager was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the service.

Some of the people living at The Chestnuts had complex needs and were unable to tell us about their care. We observed people being supported in Meadow View with their midday meal, and relaxing in communal areas. We visited Lower Woodlands and spoke with one person. People who lived in Upper Woodlands were out on activities.

At the last inspection we found people living in Meadow View had not always been respected in how they were supported with their daily life. At this inspection we found significant improvements had taken place such as environmental changes that benefited people’s dignity. Transport was now available for people to access the community.

We observed the interactions between members of staff and people in different areas of the home. We found staff to be respectful and caring in their approach. Staff knew how to raise concerns about people’s care and safety. A more consistent staffing structure was now in place with sufficient staffing that supported people with their needs. Staff had received training and support to deliver care and treatment safely and to an appropriate standard.

We saw that the improvements, as set out in the action plan we had received following the last inspection, had been met.

Effective systems were in place to regularly assess and monitor the quality of service that people had received.

Record keeping had improved with accurate and appropriate records maintained.

Some people living at The Chestnuts have complex needs and these people were unable to tell us about their care. We carried out observations of the interaction between members of staff and the people they supported in different areas of the home.

People were spending time in their communal areas; whilst others were in their own rooms.

We talked with some people and saw they were relaxed in the company of staff and that staff were respectful in their approach.

We observed in other areas of the home that staff did not look comfortable when supporting other people with their needs; there was a low morale and staff had limited interaction and communication with people.

We looked at peoples' care files and saw that although peoples’ care and support was planned, there were some areas of peoples’ care that had not been delivered in a way that was intended to ensure their safety and welfare.

We saw through staff rosters and from talking with staff that there had not been sufficient staff to support some people with their care needs and activities and that this had impacted on peoples’ wellbeing.

We looked at various records kept at the home including how people were being kept safe, how staff were being trained to meet peoples' needs and how the quality of the service had been monitored.

We found that accurate records to provide staff with appropriate information to support people with their needs had not always been kept up to date.