CQC report explained · a nursing home
What the CQC found at Chesford Grange Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2023
Rated Requires Improvement; inspectors found kind, effective care but medicines, safeguarding oversight and management systems needed improvement.
This was the home’s first inspection. It was unannounced and took place on 16 and 21 November 2022. Inspectors spoke with people, relatives and staff, and reviewed care records, medicines records, staff files and management documents.
The home was rated Good for Effective, Caring and Responsive. Inspectors saw kind and dignified care. People had access to healthcare, food and activities, and their needs were generally met.
The home was rated Requires Improvement for Safe and Well-led. Medicines records were not always accurate, some safeguarding referrals had not been made, and some care records and audits were not up to date or effective.
The home had a new manager who had been in post for six weeks and was applying to register. The management team had started an improvement plan, but CQC said it would continue to monitor the service.
Kind and dignified care
Inspectors saw warm interactions. Staff supported people respectfully and encouraged independence.
“During the inspection we observed warm and meaningful interactions between people and staff.” from the report
Healthcare support
People could access healthcare when needed. The home worked with health and social care professionals.
“People had access to healthcare as needed.” from the report
Personalised activities
Activities were adapted to people's interests and groups. Activity staff were working to improve the programme.
“People engaged in activities which were tailored to the individuals and groups taking part.” from the report
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including the safe use of protective equipment.
“We were assured that the provider was using PPE effectively and safely.” from the report
Medicines records
seriousThe electronic medicines system was not always used correctly. Recorded stock levels did not always match the medicines actually held, so inspectors could not be assured that medicines were managed safely.
“The electronic system to record stock levels and administration of medicines had not been used correctly” from the report
Safeguarding referrals
seriousSome safeguarding concerns recorded inside the home had not been referred to the correct external authorities. Retrospective referrals were made after this was raised.
“Some safeguarding concerns which had been identified and recorded internally, had not always been reported to the correct external authorities.” from the report
Management oversight
needs fixingManagement changes meant audits and other checks did not always identify problems. Some accidents and incidents had not been referred to the relevant authorities.
“Audits had not always been completed, and where they were, these audits were not always effective.” from the report
Communication with families
needs fixingSome people and relatives were unsure who the new manager was and did not know enough about the management structure. Meetings with residents and relatives had not been held consistently.
“Some people and relatives told us they were unsure who the new manager was and were not familiar with the new management structure.” from the report
- 01What changes have you made to the electronic medicines system, and how do you now check that stock records match the medicines held?
- 02How do you make sure every safeguarding concern is referred promptly to the correct external authority?
- 03How often are care records, audits and incident records now reviewed, and who checks that actions have been completed?
- 04Who is currently responsible for managing the home, and has the manager’s registration application been approved?
- 05How are residents and relatives now involved in care reviews, meetings and raising complaints?
This was the first comprehensive inspection of the newly registered home and covered all five CQC questions, including infection prevention and control under Safe. This explanation was written from the published report of 5 January 2023 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 Chesford Grange Care Home
Each visit the CQC has published, newest first, back to the day the home was registered.
- January 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2022
Registered with the Care Quality Commission on 27 January 2022.
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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