HF Trust Chestnuts

Updated 13 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

Chestnuts-Bognor Regis is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Chestnuts-Bognor Regis is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who live at Chestnuts–Bognor Regis. We spoke with 4 relatives and 5 members of staff. We also spoke with the area manager, the registered manager, deputy manager and 2 support workers. We reviewed a number of records including, support plans and medicine records, staff recruitment and training records and a range of other records relating to the management and safety of the service.

Updated 13 June 2023

About the service

Chestnuts-Bognor Regis provides care and accommodation for up to 6 people who have learning disabilities and/or autistic people. At the time of the inspection 5 people were living at the service. The service was based in a large, detached building set within its own gardens in a village location.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support: The service had failed to provide a calm home which supported people to enjoy their life without anxiety or emotional upset. People told us they did not feel safe and some people had experienced verbal and physical harm from other people they lived with. The provider had failed to ensure managers and staff had all the training and guidance they needed to support people appropriately when they were upset or anxious.

The provider has taken action to mitigate the risks following the inspection. Staff have interim guidance to support people who may behave in ways which harm others. The providers positive behaviour support (PBS) team are now fully involved in supporting the registered manager and staff. Positive behaviour support enables staff to understand how best to intervene to reduce the likelihood of behaviours of concern and to reduce the need for restrictive practices.

The home used an active support approach aimed at increasing people’s participation in daily life, increasing people’s skills and being a valued member of their household. People were generally supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care: We observed kind and compassionate care being delivered by both permanent staff and agency staff. People told us they liked the staff. One person said, “Staff are alright, I am just getting to know the new ones, we have had a lot of agency in the past.” Care was mostly person-centred and staff spoke of people with friendliness and respect.

Right Culture: There were inadequate processes in place for assessing and monitoring the quality of the service. Systems had failed to identify shortfalls in staff training, meaning staff were not suitably skilled in positive behaviour support. The leadership team had not effectively analysed incidents in order to learn lessons that could have reduced harm to people.

Where issues had been identified by the providers audit system, actions were not always followed up in a timely way.

People and relatives told us they could talk to managers and staff freely. One person said, “I like all the staff.”

Staff told us they felt supported by managers and the provider. New staff were inducted into the values of right support, right care, right culture. One staff told us “I feel very supported to ask questions of the registered manager.”

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

Rating at last inspection

The last rating for this service was good (published 10 January 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chestnuts-Bognor Regis on our website at www.cqc.org.uk.

Enforcement

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, safeguarding and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.