Chester House Care Home

At this inspection we found breaches of 4 regulations. These related to concerns about the management of risk and the management of medicines, how people received care that was personalised and met their needs, safety and cleanliness of the premises, and how the provider ensured governance of the quality and safety of the service. We also identified a breach of the registration regulations in relation to the statement of purpose.

We observed some kind and caring interactions between people and staff. We also observed some more task-based interactions with some staff at busier times. Feedback from people and relatives was mostly positive about staff. Our observation outcomes were mixed in relation to care and support in relation to treating people with respect and dignity. Some people did not always look well kempt and had unclean fingernails, teeth and unclean clothing. We were not assured that care records were accurate in relation to people receiving baths and showers on a regular basis.

Risk assessments were in place for most people; however, we found one person had been living at the service for two weeks and there was no evidence of risk assessments carried out or care plans in place. We had concerns relating to the management of people’s individual risks, such as hydration, safe eating, distress and the safe use of bed rails. We were not assured that staff had the detailed, person-centred guidance and specific training to ensure staff were able to effectively respond to someone’s distressed behaviour.

Medicines were not always managed and administered safely. We found concerns with the completion of Medicine Administration Records (MARs) which meant we could not be assured that people were receiving their medicines as prescribed. Medicines were not always stored safely, and documentation was not always contemporaneous. Care plans were not in place for the management of high risk medicines, and we were not assured staff had up-to-date medication competency checks and training in place at the time of our inspection.

We found concerns in relation to the safety of the internal and external environment. We were not assured about fire safety, the security of the building and people’s access to areas that posed a risk to them. The home was not always clean, and we had concerns about infection prevention and control (IPC) practices. Some areas of the home required refurbishment and a deep clean; some communal wash and toilet areas and some people’s bedrooms had malodour.

The provision of activities at the home required improvement. There was no activity co-ordinator in place and no daily programme of activities to enhance people’s wellbeing. The home benefitted from a large outside space; however, this was unkempt and in poor condition; people told us they did not get to access the garden very often. There was no provision of person-centred and meaningful activities for people, particularly 1 to1 activities for people who were cared for in their room.

We saw evidence that people were supported to improve their physical health and wellbeing as the service worked well with the local GP and district nursing teams. People’s weights were generally stable. Care plans and assessments were in place for most people.

Although there was a manager registered with CQC, we were not assured of a regular and consistent management presence at the home. We received conflicting information about who was in charge at the service and when: this has led to a lack of consistent oversight of operations of the service and delays in retrieving information during this inspection. We found some audits were being carried out by different members of staff; however, they had not always identified or actioned the concerns we found on this inspection. For example, we were not assured that actions from the service’s 2024 Fire Risk Assessment had been followed up and completed. The home’s Statement of Purpose (SoP) was not reflective of the service they were providing. A SoP is a legal document that sets out the details and particulars of the service. At the time of the inspection, we found the service was supporting people with a learning disability/autism; however, we saw no evidence the provider had regard to ‘Right support, right care, right culture’ and we were not assured staff had completed the required training.

We received positive feedback from staff about the support they received at work, and we received mostly positive feedback from people and their relatives about living at the home.

We have asked the provider for an action plan in response to the concerns found at this assessment.