CQC report explained · a nursing home
What the CQC found at Chestnut Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found risks were assessed and managed, medicines were handled safely, safeguarding systems were effective and infection controls were in place. Staffing was sufficient, although staff were sometimes busy.
- Effective?
- Good
- People's needs and preferences were assessed and reflected in regularly reviewed care plans. Staff had relevant training and supervision, and people received support with food, drink and healthcare.
- Caring?
- Good
- This question was not inspected during this visit, so the previous rating was carried forward.
- Responsive?
- Good
- This question was not inspected during this visit, so the previous rating was carried forward.
- Well-led?
- Good
- Inspectors found robust quality checks, an established management team and a positive, person-centred culture. People, relatives and staff had opportunities to give feedback.
What inspectors found, March 2023
Chestnut Lodge rated Good; inspectors found safe, effective and well-managed care, with staffing sometimes busy.
Inspectors visited without notice on 7 February 2023. They spoke with 11 people, two relatives and staff, observed care, and checked care records, medicines records, recruitment files and management records.
The home was rated Good for Safe, Effective and Well-led. Inspectors found personalised care plans, safe medicines support, enough staff to meet people's needs, suitable training, a clean environment and better systems for checking quality.
The previous rating was Requires Improvement, published in February 2022. The provider had been asked to improve safe care and treatment and management systems. Inspectors found enough improvement had been made and the home was no longer breaking those regulations.
This was a focused inspection. Caring and Responsive were not inspected during this visit, so their previous ratings were carried forward when calculating the overall Good rating.
Personalised care
Care and risk plans reflected people's individual needs and preferences. They were reviewed regularly and relatives were involved.
“People had personalised care plans and assessments in place that set out possible risks to them and actions for staff to mitigate these.” from the report
Safe medicines
Medicines were ordered, stored, given and disposed of safely. Staff training and regular checks supported safe medicines practice.
“There were suitable systems in place to support people to receive their medicines as prescribed and these were managed well.” from the report
Staff support and training
Staff received induction, training, supervision and appraisals. They told inspectors managers were supportive and approachable.
“Staff were inducted, trained and supervised so they could support people well.” from the report
Quality management
The manager and provider used audits and daily checks to identify issues and take action. This was an improvement since the previous inspection.
“The registered manager had robust quality assurance systems in place, monitored and supported by the provider.” from the report
Positive culture
People and relatives spoke positively about the care. Inspectors observed a lively and person-centred atmosphere.
“There was a positive, person-centred culture at the service and we observed people having a fun and lively experience during our visit.” from the report
Staff could be busy
minorInspectors said there were enough staff, but staff were busy at times. One relative felt staffing numbers were sometimes low, so families should ask how staffing levels are decided.
“There were enough staff to meet people's needs, although they were busy at times.” from the report
- 01How many staff are usually on duty in each unit, including at night and during busy periods?
- 02How will you make sure my relative's care and risk plans are reviewed when their needs or preferences change?
- 03How do you check that medicines are given safely, including medicines prescribed only when needed?
- 04What improvements were made after the previous Requires Improvement inspection, and how are you checking that they continue?
- 05What were the previous ratings for Caring and Responsive, which were not inspected during this visit?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 9 March 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, February 2022
Chestnut Lodge was rated Requires Improvement; inspectors found kind, personalised care but safety and management systems were not reliable enough.
This was an unannounced inspection on 29 November 2021. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records. They also checked infection prevention and control measures.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also Requires Improvement. Inspectors found unsecured cleaning products, medicines and tools, missing COVID-19 risk assessments, weaknesses in medicine records, and incomplete records about fortified food.
The home was rated Good for Caring and Responsive. People were treated with kindness and respect. Care plans were personalised, people's choices were respected, and staff supported communication, activities, family contact and end of life care.
The provider was in breach of Regulation 12 on safe care and treatment and Regulation 17 on good governance. CQC asked for an action plan and said it would monitor progress and return to inspect again.
Kind and respectful staff
Inspectors observed warm, patient interactions. People and relatives said staff were supportive and understood people's needs.
“People and their relatives told us people were cared for by kind and supportive staff who knew the needs of the people they cared for.” from the report
Personalised care
Care plans included people's preferences, history, communication needs and detailed guidance for staff.
“Care plans were personalised and recorded people's preferences, so staff knew how to respond to people's needs appropriately.” from the report
People's choices respected
People were supported to make everyday decisions about meals, getting up, activities and going outside. Staff also supported independence with eating and personal care.
“We observed care workers give people a choice of drinks and asked if they wished to eat or not.” from the report
Good support at the end of life
End of life plans recorded people's wishes and preferences. Staff worked with other professionals and supported relatives to be present.
“People were well cared for at the end of their life to be comfortable.” from the report
Uncontrolled environmental risks
seriousCleaning products, medicines and tools were not always secured. This increased the risk that people could access potentially harmful items.
“We found no evidence that people had been harmed however, the provider had failed to robustly assess the risks relating to the safety and welfare of people.” from the report
Weak quality checks
seriousThe home's audits and monitoring did not identify several safety, medicine, COVID-19 and nutrition problems found by inspectors.
“Failure to effectively operate systems and processes for monitoring the quality of the service and identifying risks was a breach of Regulation 17” from the report
Medicine records and storage
needs fixingSome creams were out of date or not securely stored. Records for applying creams and recording storage temperatures were incomplete.
“Medicines were generally managed safely but we found that barrier creams were not always stored securely.” from the report
Nutrition records
needs fixingRecords did not clearly show who needed fortified food or when it had been added. Inspectors could not confirm that one person's dietician's instructions were being followed.
“We found no evidence of harm and the impact was minimal but the recording systems for fortified diets were not robust enough.” from the report
Limited activity variety
minorPeople said there were not always enough varied activities. Inspectors did not see activities being provided for people confined to their bedrooms in the nursing units.
“People told us they had the opportunity participate in activities if they wanted to, but that there were not always enough varied activities available for them.” from the report
- 01What has been done to secure cleaning products, medicines cupboards and tools, and how is this checked now?
- 02How are individual COVID-19 risks and staff COVID-19 assessments recorded and reviewed?
- 03How do you record fortified food and confirm that dietician instructions are being followed?
- 04What changes have been made to medicine storage, cream records and weekend temperature checks?
- 05What varied activities are now available, including for people who stay in their bedrooms?
This was an unannounced inspection of the whole care home, covering all five CQC questions and infection prevention and control measures. This explanation was written from the published report of 5 February 2022 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
3 rated inspections over 4 years: the service has held its Good rating throughout.
- March 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- October 2018GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2020
Registered with the Care Quality Commission on 10 March 2020.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Ealing
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.
Most charge £980 to £1,300 a week. 77 can care for a couple. 11 years' experience on average.
“I can truly say that Peter always put Dad at the centre of everything and I know that they found a great friendship in difficult times.”
“She has an unusual combination of kindness and firmness, is quite unflappable, physically strong, extremely savvy”
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.