HF Trust Chestnuts

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.

Chestnuts provides care and accommodation for up to six people who have learning disabilities. The service is part of the HF Trust Limited a charity that operates 70 registered services throughout England to support people with learning disabilities.

At the time of the inspection five people were living at the service. The service was based in a large detached building set within its own gardens in a rural location. One person had en-suite toilet and shower facilities. The other people shared a communal bathroom, along with a communal lounge and kitchen. The manager told us there were plans in place to make significant structural changes. The office was to be relocated and a self-contained flat developed.

The service is required to have a registered manager but there was no registered manager in post at the time of the inspection. The previous registered manager had left the service in September 2017 and a new manager had been appointed. The new manager was being well supported by the registered providers local leadership team and was due to complete a five day residential training course on their roles and responsibilities. Once this training was completed it was the intention of the manager to commence the registration process with the commission.

People told us, “[The manager] is lovely” and staff commented, “[The manager] is very conscientious, very approachable. I do not hesitate to contact her if I have a query” and “Morale is very good. It is a real team home here. Very supportive”. We saw that staff were well motivated and records showed staff had received regular supervision to support them in their roles. The new manager told us she was also well supported and able to access guidance from the provider’s local senior managers whenever necessary.

People told us they felt safe and staff understood their role in protecting people from abuse and avoidable harm. Care plans included detailed risks assessments designed to ensure people’s safety, while encouraging them to be as independent as possible. Where incidents and accidents occurred these were documented and investigated to identify any changes that could be made to improve people’s safety.

There were sufficient staff available to meet people’s needs. Two staff were on duty on the day of our inspection and staff told us, “For me yes I think there are enough staff.” People who used the service were actively involved in staff recruitment processes and records showed that all necessary pre-employment checks had been completed.

People were supported to engage with a variety of activities they enjoyed. During our inspection we saw people baking cakes, making blankets and planning model making tasks with staff and volunteers. People told us, “We played bingo last night” and “I have done a lot this week while staff commented, “People do a lot of activities, There is enough for people to do” and “We support people to do the things they enjoy”. The service had a minibus which all staff could drive and was used to enable people to attend various events in the local community.

Staff knew people well and had a good understanding of each person's individual care and support needs. New staff completed the provider’s formal induction training. Staff new to working in the care sector followed the induction standards for the care certificate. New staff were supported by more senior support staff by carrying out shadow shifts before they were permitted to provide care independently. One recently appointed staff member told us, “The training was good actually. I did a lot of shadowing. It was for something like six weeks.” There were systems in place to ensure training was regularly updated and staff told us, “I think the training is very good” and “It gets refreshed every year”.

Staff understood the requirements of the Mental Capacity Act 2005 and where people’s care plans were potentially restrictive, applications had been made to the local authority for their authorisation in the area of restrictive practice.

People’s care plans were informative and provided staff with sufficient information to enable them to meet the person's care and support needs. These documents included information about how people preferred to communicate and how best to present information to enable people to make decisions and choices. Care plans were designed to encourage people’s independence. Where personal care was required, staff were provided with details of the level of support the person normally required. It included information about the specific task and details of how the person preferred to be supported.

The service records were well organised and there were appropriate quality assurance systems in place. These systems were used to drive continuous improvements in performance. Where any issues were identified action plans were developed and prompt action taken to address the concern. People were actively encouraged to provide feedback on the service’s performance. A survey had recently been completed. Responses received had been consistently positive with comments including, “I like living with my friends at Chestnuts”.