CQC report explained · a nursing home
What the CQC found at Chalfont Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2019
Chalfont Lodge rated Requires Improvement; inspectors found caring staff and activities, but unsafe medicines management, incomplete care records and weak oversight.
This was an unannounced comprehensive inspection on 10 and 11 July 2019. Inspectors spoke with people, relatives and staff, observed care, and checked medicines, care plans and other records.
The home met people's basic needs, and inspectors saw kind interactions, activities and access to healthcare. However, staff did not always have enough time for people beyond essential tasks.
Medicines were not always available or safely managed. Some risk assessments and care plans lacked important detail or were out of date. The provider's checks had not found these problems.
The overall rating was Requires Improvement. All five areas were rated Requires Improvement. This was the fourth consecutive inspection with this rating, and the report found breaches of regulations about safe care and treatment and good governance.
Kind interactions
Inspectors observed people being treated with kindness and respect. Staff used friendly conversation while providing care.
“We observed people were treated with kindness and respect.” from the report
Activities and community links
People could join activities, trips and local events. There was also regular input from a music therapist and physiotherapist.
“A music therapist worked three days each week running groups or individual sessions.” from the report
Food and drink support
People were offered choices, and staff supported those who needed help with eating. People said they had enough to eat and drink.
“People we spoke with confirmed they were offered enough to eat and drink throughout the day.” from the report
Some recent improvement
The report says staff and relatives felt things had improved since the manager took over, although important problems remained.
“Staff and relatives, we spoke with told us things had improved since the registered manager took over.” from the report
Missed and unsafe medicines
seriousSome medicines were unavailable for several days, putting people at risk of complications. Inspectors also found medicines left at a bedside and a medicine record signed as given when it had not been given at that time.
“We found some people had not received their medicine due to lack of stock.” from the report
Complex risks not fully assessed
seriousA person with frequent seizures had no risk assessment or care plan explaining what staff should do. Inspectors said this could put the person at risk of harm.
“One-person experienced frequent seizures and did not have a risk assessment in place to guide staff what to do in the event of a seizure occurring.” from the report
Out-of-date care plans
needs fixingSome care plans did not reflect people's current needs. This could lead to staff providing inconsistent care, including repositioning that did not meet a person's needs.
“Care plans were not consistently person centred and were not always reflective of people's current needs.” from the report
Limited time with people
needs fixingStaffing was enough for basic needs, but inspectors and people said staff did not have enough time for meaningful contact. People sometimes waited for help.
“Although there were enough staff to meet peoples' basic needs, people and staff told us there were not enough staff to ensure staff were able to spend quality time with people.” from the report
Weak quality checks
seriousThe provider's audits did not identify problems with medicines, risk assessments and care planning. The home had also not sustained improvements required after the previous inspection.
“Effective systems were not in place to assess, monitor and improve the quality and safety of the service.” from the report
- 01What changes have been made to prevent medicines running out, and how are missed doses checked and followed up?
- 02How are risk assessments kept up to date for people with seizures, pressure damage, mobility problems or other complex needs?
- 03How do you check that care plans accurately describe the care being delivered, including repositioning and communication support?
- 04What staffing levels are in place at different times of day, and how do you ensure people have time for social contact as well as basic care?
- 05What evidence can you show that the breaches and the problems found at the previous inspection have been fully addressed?
This was an unannounced comprehensive inspection covering all five CQC questions, including the premises and the care provided. This explanation was written from the published report of 27 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Rated Requires Improvement; inspectors found kind and effective care, but staffing and management arrangements were not reliable enough.
Inspectors made unannounced visits on 13, 14 and 19 March 2018. They spoke with people living in the home, visitors, relatives, staff and a professional. They also looked at care records, medicines, recruitment files, training and quality checks.
The main concern was staffing. Inspectors found that staff were sometimes unavailable, especially on some units and at night. People and relatives described waiting for help, including help to use the toilet. The home was rated Requires Improvement for Safe.
Care was rated Good in the Effective, Caring and Responsive areas. Inspectors found suitable training, respectful care, involvement in care decisions, activities and support at the end of life.
The home was rated Requires Improvement for Well-led. There was no registered manager, several managers had changed, and internal checks had not found some problems. The provider had improved its quality monitoring since the previous inspection and was meeting the regulation previously breached.
Kind and respectful care
Inspectors observed staff reassuring people, communicating clearly and protecting their dignity and privacy.
“We observed good caring approaches with people; staff provided reassurance and communicated in a way people could understand.” from the report
Staff training
Staff had training for their roles, including relevant clinical training for nurses. Records also showed regular supervision.
“People received care and support from staff that were provided with the training they needed to support people effectively.” from the report
Activities and independence
The home offered group and one-to-one activities, physiotherapy and music therapy. Inspectors saw examples of people developing or using their abilities.
“The activity team at Chalfont Lodge had a strong emphasis on ensuring the individual needs of people were met.” from the report
Medicines and risk management
Medicines were given as prescribed and controlled medicines were correctly recorded. Risk assessments covered areas such as falls, nutrition, hydration and skin protection.
“Medicines were managed effectively. People received their medicines as the prescriber intended.” from the report
Not enough staff at times
seriousInspectors found staff were not always available to meet people's complex needs. Some people reported long waits for help, including help to use the toilet, creating risks such as falls.
“The overriding theme which emerged was there was insufficient staff available to meet the complex needs of people using the service.” from the report
Unstable management
needs fixingThere was no registered manager when inspectors visited, and several managers had changed. This meant the home did not have a solid management structure.
“The service did not have a registered manager in post. Several management changes meant the service did not have a solid management structure.” from the report
Checks missed some problems
needs fixingThe home carried out audits, but care plan checks had not identified some do-not-attempt-resuscitation orders that needed GP review.
“However, the care plan audits had not highlight issues we found.” from the report
Mixed experience of complaints
minorThe formal complaints process was being used and six of seven complaints had been resolved. However, some people and relatives said they had lost confidence that issues raised through forums would be acted on or explained.
“We received mixed views about raising issues or concerns with the service.” from the report
- 01What staffing levels are now provided on each unit during the day and at night, and how are they adjusted for people's complex needs?
- 02How do you make sure people who need one-to-one support receive it throughout the day, including when staff take breaks?
- 03Who is the registered manager now, and how has management stability improved since the inspection?
- 04How are care plan audits checked to make sure issues such as do-not-attempt-resuscitation orders are identified and reviewed by the right clinician?
- 05How are concerns raised in family forums recorded, followed up and reported back to families?
This was an unannounced inspection covering all five key questions and the overall rating; the report also checked whether improvements had been made after the previous Regulation 17 breach. This explanation was written from the published report of 13 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Chalfont Lodge
5 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- November 2019Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- July 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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