CQC report explained · a residential care home
What the CQC found at Chestnut Lodge Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Some risks were not properly assessed, updated or reflected in care plans. PRN and insulin medicines were not always recorded safely, and accident audits did not analyse falls for patterns and trends.
- Effective?
- Good
- People had person-centred care plans, suitable staff training and access to healthcare professionals. Staff supported people with food, drink, oral health and their legal rights.
- Caring?
- Good
- This question was not included in the focused inspection.
- Responsive?
- Good
- This question was not included in the focused inspection.
- Well-led?
- Good
- People, relatives and staff spoke positively about the management team. Audits and feedback systems were in place, and managers acted quickly on problems found during the inspection.
What inspectors found, April 2023
Rated Good overall, but inspectors found the home was not always safe and rated Safe Requires Improvement.
Inspectors visited the home unannounced between 2 and 7 March 2023. They spoke with people, relatives and staff, observed care, and checked care records, medicines, staffing and management records.
The overall rating was Good. Effective and Well-led were rated Good. However, Safe was rated Requires Improvement because some health risks and medicines were not recorded or managed well enough. Inspectors also found that accident records did not always show whether lessons had been learned.
The management team responded quickly during and after the inspection. They updated risk assessments, added medicine protocols and improved records. People and relatives said they felt safe, the home was clean, and staff were caring and supportive.
Safeguarding
Staff knew how to recognise abuse and report concerns. The home made safeguarding referrals when needed.
“Staff we spoke to were able to tell us how they would recognise signs of abuse and where they would report concerns.” from the report
Care and training
Care plans included people's preferences, routines and interests. Staff received training, induction and regular supervision.
“People's care plans were person centred. Information such as hobbies and interests, likes and dislikes and preferences to daily routine were included.” from the report
Management response
The management team acted quickly when inspectors raised concerns. They updated records and introduced new checks.
“The management team were responsive to concerns found during our inspection and staff gave us assurances they were aware of people's risks.” from the report
Clean environment
Inspectors saw regular cleaning and found the home clean and without unpleasant smells.
“The home was clean and free from odour. We observed regular cleaning taking place throughout our inspection.” from the report
Risk assessments
seriousSome health risks were not assessed in enough detail or kept up to date. This included risks linked to diabetes, epilepsy, medicines and pressure wounds.
“Risk assessments were not always up to date and reflect a person's current needs.” from the report
Medicine records
seriousRecords did not always explain why PRN medicines were given or whether they worked. Insulin injection sites and administration records were also not consistently recorded.
“When required medicines PRN were not appropriately recorded. The reason they were given and if they had the desired affect were not always recorded.” from the report
Learning from falls
needs fixingMonthly accident and incident audits did not look for patterns or trends. Inspectors could not be sure that repeated falls were being reduced because of lessons learned.
“An accident and incident audit were completed each month, however, this did not include an analysis for patterns and trends.” from the report
Busy periods
needs fixingSome feedback suggested the home could feel busy, with call bells ringing constantly. The manager changed shift times and was reviewing the staffing assessment tool.
“Feedback we received reflected that at times the home appeared busy and call bells were constantly ringing.” from the report
- 01How do you now assess and update risks for diabetes, epilepsy, pressure wounds and other changing health needs?
- 02How do you record why PRN medicines are given and whether they have the desired effect?
- 03How are insulin injection sites recorded, and how do you check that insulin administration records are complete?
- 04What changes have been made to identify and reduce patterns of falls?
- 05How do you check staffing levels during sickness and busy periods, including times when call bells are ringing frequently?
This was a focused inspection of Safe, Effective and Well-led, with infection prevention and control also checked; Caring and Responsive were not assessed and their ratings are not given in this report. This explanation was written from the published report of 6 April 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, January 2020
Rated Good overall, but inspectors found medicines were not always given safely and rated the home Requires Improvement for safety.
Inspectors visited on 16 and 17 January 2020. The first day was unannounced and the second was announced. They spoke with people living in the home, relatives and staff, and reviewed care records, medicine records, recruitment, training, complaints and quality checks.
The overall rating was Good. Inspectors found kind and respectful care, enough staff, personalised support, suitable activities and good management. The ratings for Effective, Caring, Responsive and Well-led were all Good.
Safety remained Requires Improvement because medicines had not always been given as prescribed. There had been 22 occasions when medicines were not given or were given at the wrong time. No direct harm was recorded, and the home had taken steps to reduce the errors. Inspectors recommended reviewing national guidance on safe medicines administration.
Kind and respectful care
People and relatives spoke positively about the care. Inspectors found that privacy, dignity, equality and personal choices were respected.
“People were treated with kindness and their privacy was respected.” from the report
Enough staff
Inspectors found enough care staff on duty. Call bells were answered quickly and planned shifts were reliably filled.
“There were enough care staff on duty.” from the report
Personalised support
People could choose when to get up, go to bed, bathe or shower. Care plans described the support people wanted and needed.
“People received personalised care responding to their changing wishes.” from the report
Activities and family contact
People were offered individual and group activities, trips and seasonal events. The home also helped people keep in touch with their families.
“People had been supported to keep in touch with their families.” from the report
Improved management
Quality checks had improved since the previous inspection. People, relatives and staff were asked for feedback, and suggestions were acted on.
“At this inspection quality checks were being completed in the right way.” from the report
Medicines errors
seriousMedicines were not always given in line with doctors' instructions. There were 22 occasions involving missed medicines or medicines given at the wrong time, although records showed no direct harm.
“Since the last inspection there had been 22 occasions when medicines had not been administered in line with a doctor's prescribing instructions.” from the report
Medicines systems still needed checking
needs fixingThe new training, reminders, audits and two-person checks had reduced errors, but inspectors said the home needed to monitor these arrangements closely to make sure medicines were consistently given correctly.
“However, the registered manager said no errors at all should occur in the administration of medicines.” from the report
- 01How many medicines errors have there been since the inspection on 16 and 17 January 2020?
- 02How are the two-person medicines checks carried out, and how are the results reviewed?
- 03What further changes will be made if a medicine is missed or given at the wrong time?
- 04How will you make sure there are enough staff during the busiest times of day?
- 05How will my relative's activities and personal choices be recorded and reviewed?
This was a planned inspection based on the previous rating and looked at the accommodation and care across all five key questions. This explanation was written from the published report of 25 January 2020 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 Lodge Care Home
5 rated inspections over 7 years: the service has held its Good rating throughout.
- April 2023Goodcurrent ratingstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2020Goodup from Requires improvementSafe: Requires improvementEffective: GoodWell-led: Good
- January 2019Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2018InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2017Inspected but not ratedSafe: Requires improvementWell-led: Requires improvement
- January 2016GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- April 2015
Registered with the Care Quality Commission on 10 April 2015.
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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