CQC report explained · a residential care home
What the CQC found at Chestnut House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Risks, staffing, recruitment, medicines and infection control were managed safely.
- Effective?
- Good
- People's health, nutritional and support needs were assessed and met. Staff had suitable training, and people were supported to make decisions in the least restrictive way.
- Caring?
- Good
- People and relatives said staff were kind, respectful and caring. People were involved in decisions about their care and encouraged to remain independent.
- Responsive?
- Good
- Care was personalised and staff understood people's needs and preferences. People could take part in activities, maintain relationships and communicate in ways they understood.
- Well-led?
- Good
- The home had open leadership and systems to monitor quality. However, some audit records did not clearly document actions taken or lessons learned.
What inspectors found, December 2019
Rated Good; inspectors found safe, kind and personalised care, with some records still needing improvement.
This was an unannounced inspection on 20 November 2019. The inspector spoke with five people using the service, three relatives and staff, and reviewed care, medicines, recruitment and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were safe, treated with respect, supported by trained staff and helped to make choices about their lives.
The home had improved from Requires Improvement at the previous inspection in October 2018. Safe, Effective and Well-led improved to Good. Caring and Responsive remained Good.
There were two areas to improve. End of life preferences were not always recorded in care plans, and some quality audit records did not clearly show actions taken or lessons learned.
Safe care
Staff understood people's risks and how to support independence safely. Medicines were managed properly and the environment was clean and maintained.
“People's medicines were well managed and they were protected from the risks of infection.” from the report
Kind and respectful staff
People and relatives described staff as caring and respectful. Inspectors saw positive interactions and support for people's privacy and independence.
“People interacted well with staff and engaged with them confidently.” from the report
Personalised support
Care plans reflected people's needs, and staff knew how to support individual health conditions, communication needs and choices.
“People receive personalised care from staff who were knowledgeable about their needs.” from the report
Activities and choice
People were supported to enjoy activities and trips that suited their interests, including walks, film nights, exercise classes and community outings.
“People told us they enjoyed a variety of social activities.” from the report
End of life wishes
needs fixingEnd of life preferences were not always recorded in care plans. The manager accepted that people's wishes about discussing this should be recorded.
“People's end of life needs were not always recorded in their care plans.” from the report
Audit records
needs fixingSome quality audits did not clearly record what actions had been completed or what lessons had been learned. Inspectors saw evidence that some actions had still been taken elsewhere.
“the information on actions carried out or what lessons had been learned were not always clearly documented on the audit tools.” from the report
- 01How will you make sure each person's end of life wishes are recorded, including if they do not want to discuss the subject?
- 02How do you now record actions and lessons learned from audits of weights, falls and safeguarding?
- 03What staffing levels will be in place for my relative's personal care, activities and trips into the community?
- 04How will you support my relative's particular health, communication and independence needs?
- 05How can relatives raise a concern, and how will it be recorded and followed up?
This was an unannounced planned inspection covering all five CQC questions, with the previous rating of Requires Improvement used as the reason for the inspection. This explanation was written from the published report of 14 December 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, October 2018
Rated Requires Improvement; inspectors found kind, individual care, but concerns about food, cleanliness and quality checks remained.
Inspectors made an unannounced, comprehensive visit on 18 and 21 May 2018. They spoke with people using the home and staff, observed care, and checked care plans, medicines records, staff files and quality checks.
The home was caring and responsive. People described kind staff, respect for privacy and dignity, help to pursue interests, and support to stay involved in the community. Medicines were administered safely, staffing was considered sufficient, and staff had suitable training.
The home was not always safe, effective or well-led. Inspectors found out-of-date food, an unclean kitchen and poor toilet facilities. Menus were repetitive and not always nutritious, and one person was not receiving the prescribed pureed diet. Quality checks had not found these problems.
This was the second consecutive inspection rating of Requires Improvement. The registered manager had made changes since taking up the post in 2017, and the report says some improvements were made after the inspection, including upgrading the satellite kitchen and improving food arrangements.
Kind relationships
People described staff as kind and compassionate. Inspectors saw staff respond calmly and respectfully when someone became distressed.
“They are really caring staff. That's what I like about it; that they actually authentically care about you and go out of their way a lot and are generous caring people.” from the report
Personalised support
People were involved in their care planning and risk assessments. Staff supported individual interests, education, work and activities in the community.
“People were supported to develop and maintain their individual interests and hobbies, paid and voluntary work and access to education programmes.” from the report
Safe medicines
Trained and competent staff administered medicines. The new arrangements reduced interruptions and the risk of errors.
“We found that this change to dispensing and administration practice reduced the risk of interruptions and errors.” from the report
Improving leadership
The manager had introduced changes and staff said care practice had improved. People and staff had opportunities to give feedback.
“The registered manager had shared their vision for improvements to the service with people who lived there and staff.” from the report
Food safety and cleanliness
seriousInspectors found out-of-date cold meat, an unclean kitchen and a dirty toilet without hand-washing facilities. These problems created risks of food poisoning and avoidable harm.
“People were at risk of food poisoning from out of date food and cross contamination from an unclean kitchen.” from the report
Nutrition
needs fixingMenus were repetitive and relied heavily on frozen and convenience food. One person was not given the pureed diet prescribed by a speech and language therapist.
“Overall, people were not offered a nutritious and balanced diet.” from the report
Quality checks
needs fixingThe home's audits did not identify the problems inspectors found with infection control and nutritional support. This meant the management system was not reliably finding shortfalls.
“The current audit system did not identify the weaknesses we found with safe infection control practices and nutritional support.” from the report
End of life planning
needs fixingOne person who was thought to be near the end of life did not have an end of life care plan or recorded discussion of their wishes. The manager contacted health professionals to address this.
“However, the person did not have an end of life care plan and there was no recorded evidence that staff had discussed their wishes with them.” from the report
- 01What checks are now made to ensure food is within date and the kitchen and toilets are clean?
- 02How are menus planned with residents, and how do you make sure meals are nutritious and varied?
- 03How do you check that people receive any prescribed diets, including pureed diets?
- 04What changes have been made to the quality audits so they identify infection control and nutrition problems?
- 05How are end of life wishes discussed, recorded and kept up to date?
This was an unannounced comprehensive inspection covering all five CQC questions, and the report says the home had been rated Requires Improvement at the previous inspection in November 2016. This explanation was written from the published report of 23 October 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 Chestnut House
3 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- December 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2017Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.