CQC report explained · a nursing home
What the CQC found at Chestfield House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks to health and welfare were not consistently assessed, and care plans did not always give staff enough guidance. Medicines were not always managed safely and records were sometimes incomplete.
- Effective?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Management checks and audits had not identified important shortfalls in care plans and risk assessments. The report says the registered persons had failed to effectively assess, monitor and improve service quality.
What inspectors found, January 2023
Requires Improvement; inspectors found kind care and enough staff, but risks, medicines records and quality checks were not managed reliably.
This was an unannounced inspection on 10 November 2022. One inspector spoke with four people, two relatives and five staff. They observed staff interactions and checked four care plans, all medicines records and management audits.
The home was rated Requires Improvement overall. Safe was Requires Improvement because risks had not always been assessed properly, care plans were sometimes inaccurate, and medicines records and instructions were not always safe. Inspectors found no evidence that anyone had been harmed.
Well-led was also Requires Improvement. Audits gave perfect scores but had missed the problems found during the inspection. People said they felt safe and were treated kindly, staff understood safeguarding, infection controls were satisfactory, and relatives felt able to raise concerns.
Kind and respectful care
People said they felt safe and were treated with kindness and respect.
“People told us they felt safe living at the service and staff treated them with kindness and respect.” from the report
Staff available
Inspectors saw staff spending time with people and relatives said there were enough staff. Staff supported people with meals without rushing them.
“We observed staff spending time with people and chatting to them.” from the report
Infection control
Inspectors were assured that infection prevention measures, personal protective equipment and visiting arrangements were being managed appropriately.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Respect for choices
Staff asked people about their choices and supported them to spend their time as they wished. The home was working within the principles of the Mental Capacity Act.
“We observed staff asking people what they would like to do or the meals they would like. Staff respected their decisions.” from the report
Risk information was incomplete
seriousSome care plans and risk assessments were inaccurate or lacked important instructions. Examples included catheter care, diabetes monitoring, thickened fluids, blood-thinning medicines and epilepsy.
“Potential risks to people's health and welfare had not been consistently assessed.” from the report
Medicines records were not reliable
seriousSome 'when required' medicines lacked clear instructions. Some handwritten medicine directions were not checked by two staff, and some administered medicines were not recorded on the charts.
“Records of medicines administered were not accurate. Some people had been given their medicines, but the MAR charts had not been signed by staff to confirm this.” from the report
Audits missed problems
needs fixingThe home's checks and audits had not picked up the shortfalls found by inspectors. All completed audits had been given a perfect score.
“The audit system required scores to be given if a standard had been met or not. All the audits completed had been given a perfect score meaning no issues had been found.” from the report
- 01What changes have you made to risk assessments and care plans since the inspection, especially for catheters, diabetes, thickened fluids, blood-thinning medicines and epilepsy?
- 02How do you make sure 'when required' medicines have clear instructions and that every dose is recorded accurately?
- 03Who now completes audits, and how do you check that audits identify problems rather than giving automatic perfect scores?
- 04Can you show me the action plan sent to CQC and explain which improvements have already been completed?
- 05How will you keep families informed if a medicine, health risk or care plan problem is found?
This was an unannounced inspection focused on Safe and Well-led; the other key-question ratings were not inspected and carried over from the previous inspection. 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.
What inspectors found, November 2017
Rated Good overall; inspectors found safe, kind care, but the home needed to improve its quality checks.
This was an unannounced comprehensive inspection over two days. The inspector reviewed care plans, risk assessments, staff recruitment and training records, medicines records, staffing rotas and quality checks. They spoke with people living in the home, relatives, staff and managers, and observed care and activities.
The home had improved since its previous inspection in May 2016, when it was rated Requires Improvement and had five legal breaches. Those breaches had been met. Inspectors found good care in four areas: safe, effective, caring and responsive.
The well-led rating was Requires Improvement. Some audits had failed to identify shortfalls, including an incorrectly set pressure-relieving mattress, copied DNACPR forms and incomplete guidance about prescribed creams. The home was asked to improve its audits, but no current legal breaches were identified.
Enough staff
Inspectors found consistent staffing levels, with staff able to respond to people without appearing rushed. Call bells were answered in good time.
“People were now supported by sufficient numbers of staff who knew them and their preferences well.” from the report
Kind relationships
Staff had strong relationships with people and their relatives. Inspectors saw a cheerful atmosphere and respectful interactions.
“Staff had developed strong, caring relationships with people and their relatives.” from the report
Skilled staff
Staff received regular training and supervision, including training related to dementia, diabetes, strokes and other health needs.
“People received effective care from staff who had the skills and knowledge to carry out their roles.” from the report
Food and activities
People were offered food choices, support with nutrition and activities based on their interests. Their suggestions about meals and activities were acted on.
“People were supported to take part in social activities.” from the report
Quality checks missed problems
needs fixingSome audits did not identify problems found by inspectors. The provider was asked to include these areas in its checks.
“Some audits and checks had not been consistently effective and shortfalls found during the inspection had not been identified.” from the report
Pressure equipment and cream guidance
seriousOne pressure-relieving mattress was set incorrectly and guidance about prescribed creams did not explain where or how much to apply. The mattress was corrected during the inspection, but the guidance needed improvement.
“People had charts in their rooms which noted what creams they needed to have applied to keep their skin healthy.” from the report
Care plans not all personalised
needs fixingSome care plans remained generic. They did not always explain how people who could not communicate verbally showed pain, sadness or anxiety.
“Other care plans remained generic and the registered manager and deputy manager were working with people and their relatives to update them.” from the report
- 01What changes have been made to the auditing system since inspectors found that some shortfalls were not identified?
- 02How do you now check that every pressure-relieving mattress is set correctly?
- 03How are staff told where to apply prescribed creams and how much to use?
- 04Have all care plans been rewritten and personalised, including guidance about how each person shows pain or anxiety?
- 05How do you make sure DNACPR forms are current and are not photocopied?
This was an unannounced comprehensive inspection covering all five key questions and checking improvements required after the May 2016 inspection. This explanation was written from the published report of 3 November 2017 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 Chestfield House
3 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- January 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2017Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 24 January 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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