Welcome House - The Chestnuts

Welcome house – The Chestnuts is a care home which provides accommodation and personal care for up to 15 people with mental health needs. At the time of our inspection, eight people lived in the home. They were fairly independent therefore required minimal support with their personal care needs.

People’s experience of using this service:

The provider failed to always assess and mitigate risks to the health and safety of people. The provider had not always completed incidents and accidents records. The systems and processes to assess, monitor and improve the quality and safety of the service were not wholly effective.

We have made two recommendations about accessible communication and relevant activities for people.

People gave us positive feedback about their safety and told us that staff treated them well. Staff administered prescribed medicines to people safely and protected people from the risk of infection. The provider carried out comprehensive background checks of staff before they started work. The provider had a system to manage accidents and incidents.

Staff received support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach the registered manager at any time for support. The registered manager worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care. People were supported to have maximum 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.

The assessment of people’s needs had been completed to ensure these could be met by staff. The registered manager worked with other external professionals to ensure people were supported to maintain good health. People were involved in making decisions about their care and support. People were treated with dignity, their privacy was respected, and supported to be as independent in their care as possible.

Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People knew how to make a complaint. The registered manager knew if someone required end of life care.

There was a management structure at the service. Staff were aware of the roles of the management team. They told us the registered manager was approachable. People and their relatives commented positively about staff and the registered manager. The registered manager had worked in partnership with a range of professionals.

Rating at last inspection and update

The last rating for this service was good (published 23 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessment and their management and effective quality assurance systems at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Welcome House - The Chestnuts is registered to provide accommodation and personal care for up to 15 people with mental health needs who do not require nursing care. The people who used the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, nine people lived in the home. They were fairly independent therefore required minimal support with their personal care needs.

At the last Care Quality Commission (CQC) inspection in 14 July 2015, the service was rated Good in all domains.

At this inspection, we found the service remained Good.

People continued to be safe at Welcome House - The Chestnuts. People were protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff had extremely good relationships with the people who lived at the home. People understood that staff would support them during difficult times and could rely on staff to always be there for them, providing guidance when needed. People were empowered to make their own decisions and to take responsibility for them. Staff maintained people’s privacy and dignity ensuring that any care or discussions about their care were carried out in private. Interactions between staff and people were caring and respectful, with staff being consistently patient, kind and compassionate.

The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

During this visit we found that improvements had been made and the home was clean throughout. Damaged flooring, fixtures and fittings had been repaired or renewed and there were procedures in place to make sure that the home was cleaned effectively. This meant that people were being cared for in a clean and hygienic environment.

There were 12 people living in the home at the time of our visit. People told us they were happy living in the home. They said, 'The staff are very good, I like living here.' 'There is always someone to talk to.' 'I can go out whenever I want to. There is always something to do, I don't get bored.' 'I would say if I wasn't happy about I anything, they would sort it out.' "There is nothing to complain about."

We found that the care and support that people received was well planned and delivered in a way that protected people from risk of harm. Medication was stored securely and administered safely. There were robust recruitment procedures in place to make sure that staff were suitable. People knew who to talk to if they were unhappy about anything.

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. Staff were given appropriate professional development to enable them to understand people's needs and provide appropriate care and support. Hygiene standards in the home were not adequate to make sure people were protected against risk of infection.