CQC report explained · a nursing home
What the CQC found at Chestnut Lodge Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unsafe management of choking risks, incomplete checks on some agency staff, and fire safety shortfalls. They also found safe medicines management, infection control and staffing levels that met people's needs.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was carried forward.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was carried forward.
- Responsive?
- Good
- This key question was not inspected during this visit. Its previous rating was carried forward.
- Well-led?
- Requires improvement
- The provider's quality checks had not identified problems with thickener, agency staff checks or fire drills. Inspectors also found an open culture and partnerships with health and social care professionals.
What inspectors found, March 2023
Chestnut Lodge Nursing Home was rated Requires Improvement because inspectors found risks around choking, agency staff checks, fire safety and oversight.
This was an unannounced focused inspection on 6 February 2023. One inspector visited, spoke with four people and five staff, and reviewed care records, medicines records and other records about how the home was run.
The home was not always safe. Thickener had been used without advice from the Speech and Language Therapy Team, checks on some agency staff were incomplete, and fire drills and evacuation training did not meet the home's policy. Some fire safety documents were also not readily available.
There were also weaknesses in the home's checks on quality and safety. The provider had not identified these problems. Inspectors found some positive practice, including safe permanent staff recruitment, enough staff, safe medicines management, infection control and kind, responsive care.
The overall rating changed from Good at the previous inspection to Requires Improvement. This inspection looked only at Safe and Well-led. The other ratings were carried over from the previous inspection.
Enough staff
Staffing levels were calculated using people's needs. People said staff responded quickly when they asked for care.
“People told us staff responded quickly to their care requests.” from the report
Medicines
Inspectors found that trained staff managed, stored, gave and disposed of medicines safely. People received medicines as prescribed.
“Medicines were managed safely. Competent trained staff followed guidance for the management, storage, administration and disposal of medicines.” from the report
Infection control
The home was clean and tidy. Inspectors were assured that infection prevention and control measures were in place.
“We were assured that the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
Kind and responsive care
People said they were happy and that staff were kind and caring. Professionals said staff responded to changing needs.
“People told us they were happy living at the home. People told us staff were kind and caring and response to their needs.” from the report
Choking risks
seriousThickener had been introduced without advice from the Speech and Language Therapy Team. Inspectors said this placed people at risk of harm.
“Choking risks had not been managed safely.” from the report
Agency staff checks
seriousOn two occasions, agency staff had access to vulnerable people without the home having information about their recruitment, training and identity checks.
“Agency staff were allowed access to vulnerable people on 2 occasions when the home did not have information about their safe recruitment, training and identity.” from the report
Fire safety
needs fixingFire drills had not been completed in line with the home's policy. Staff had not completed simulated evacuation training and fire safety documents were not readily available.
“Staff had not completed simulated evacuation training.” from the report
Weak quality checks
seriousThe provider and manager had not identified the problems found during the inspection. Inspectors said the quality assurance systems were ineffective.
“The provider did not have effective systems in place to monitor and improve the quality and safety of the service.” from the report
- 01What has changed to ensure thickener is only introduced following advice from the Speech and Language Therapy Team?
- 02How do you now check the identity, recruitment and training records of every agency worker before they work with residents?
- 03When was the most recent fire drill and simulated evacuation exercise, and are the records now available?
- 04How are you checking that the action plan from this inspection has been completed and remains effective?
- 05How do you monitor people who have choking risks and make sure their care plans reflect current professional advice?
This was an unannounced focused inspection of Safe and Well-led only; the other ratings were carried over from the previous inspection. 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 2018
Rated Good overall, but inspectors found the home was not always well-led because some records and staffing checks needed improvement.
Inspectors visited on 28 November and 4 December 2017. The first visit was unannounced. They spoke with people living there, relatives, staff and healthcare professionals. They also checked care records, staff files, medicines records and management records.
They found safe medicines handling, suitable recruitment checks, detailed risk assessments and a clean environment. People were supported with food, healthcare, personal care, activities and end of life care. People and relatives said staff were kind, respectful and welcoming.
The main weaknesses were in management records. Some care and training records were incomplete. The home also did not use people's changing dependency levels to work out staffing needs. The overall rating was Good, but Well-led was rated Requires Improvement.
Medicines safety
Medicines, including controlled drugs, were stored, administered and disposed of correctly. Inspectors found no unexplained gaps in medicines administration records.
“Medicines, including controlled drugs, were stored safely, administered appropriately and disposed of correctly.” from the report
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw calm, patient interactions that protected privacy and dignity.
“Staff treated people with dignity and promoted independence wherever possible.” from the report
Personalised support
Care plans contained detailed information about people's communication, interests and individual needs. Staff used this information to tailor care.
“People were receiving care that was tailored to their individual needs and staff were responsive to any changes in need.” from the report
Food and health support
People's dietary needs were understood and their weight was monitored. Staff involved dieticians and other health professionals when needed.
“People's weights were monitored regularly and expert advice sought from dieticians if there was any cause for concern.” from the report
Staffing planning
needs fixingPeople's dependency levels were recorded but were not used to decide how many staff were needed. Some people and staff said there were times when staff were too busy or shifts were not covered.
“The extra shifts are not always covered on a morning. I'd say once or twice a week there is a shift missed.” from the report
Incomplete care records
needs fixingInspectors found missing care plans for epilepsy and mental health needs. The home acted on these issues during and after the inspection, but sustained improvement in record keeping was still needed.
“However, there were some records that still required improvement.” from the report
Mental capacity records
needs fixingBest interest decisions were recorded, but the assessments showing whether a person could make each particular decision were not recorded.
“decision specific mental capacity assessments were not being recorded.” from the report
Training records
minorMost staff training was up to date, but the training matrix did not fully show all medicines training. This made it harder to check when training was due.
“Training records did not fully reflect all aspects of staff training.” from the report
- 01How do you now use people's dependency assessments to decide staffing levels on each shift?
- 02How do you check that all staff, including bank staff, have current medicines training and competency records?
- 03Have the missing epilepsy and mental health care plans been completed and kept up to date?
- 04How are decision-specific mental capacity assessments recorded before best interest decisions are made?
- 05What checks are in place to make sure care records remain complete and accurate?
This was an inspection of the overall service, including the premises and care provided, and inspectors rated all five key questions. This explanation was written from the published report of 20 February 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 Lodge Nursing Home
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- March 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2018Goodup from Requires improvementSafe: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- January 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- October 2010
Registered with the Care Quality Commission on 1 October 2010.
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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