CQC report explained · a nursing home
What the CQC found at Cheswardine Hall Nursing & Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable staffing, safe premises, infection control and safeguarding arrangements. Medicines were managed safely, but there were minor recording issues and some clinical risks were not always included in care plans.
- Effective?
- Good
- Staff were described as skilled and knowledgeable, with training suited to people's needs. People received support from health professionals, were offered choices and had their dietary needs managed.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people well, supported communication and involved people in decisions about their care and daily life.
- Responsive?
- Requires improvement
- Care records did not always contain enough detail about people's needs. End of life planning was not clear enough, although activities were person-centred and people knew how to raise complaints.
- Well-led?
- Good
- The home had quality checks, audits and a positive, open culture. Managers responded to the inspectors' feedback and planned improvements to care planning.
What inspectors found, August 2019
Cheswardine Hall Nursing & Residential Home was rated Good overall, but inspectors found care planning was not always detailed enough and rated Responsive Requires Improvement.
This was an unannounced planned inspection on 12 July 2019. Inspectors spoke with 13 people living in the home, a family member, staff, managers and visiting professionals. They reviewed four care records and other records about medicines, staff, training, quality checks and the premises.
People generally said they felt safe, respected, listened to and well cared for. Inspectors found suitable staffing, safe premises, trained staff, good support with meals and positive relationships. The home had systems for managing medicines, although there were minor recording problems.
The main weakness was care planning. Some important health needs were missing or difficult to find in care records. End of life care did not have a specific plan with enough detail about the person's current care, wishes and family communication. The overall rating stayed Good, but Responsive fell from Good to Requires Improvement.
Kind and respectful care
People described staff as caring and supportive. Inspectors saw warm relationships and found that privacy, dignity and individuality were respected.
“People were treated with kindness and were positive about the caring attitudes of staff.” from the report
Staffing and skills
There were enough suitably trained staff, and people were supported by familiar staff who understood their needs.
“Sufficient numbers of suitably qualified and trained staff were deployed to meet people's needs.” from the report
Activities and social life
The home offered a range of activities based on people's interests. People reported improved opportunities to go out and take part in events.
“The activities co-ordinator found out people's individual interests and the activities were very person centred.” from the report
Positive management
Inspectors found effective quality checks and a positive culture. Managers acted promptly on the issues raised during the inspection.
“These were overall effective in managing the home and were based on getting feedback from the people living there.” from the report
Care records lacked detail
needs fixingSome important care and health needs were missing from care plans or were difficult to find. This could make it harder for staff to monitor and consistently provide the right support.
“The formal assessment and planning of people's care in care records lacked detail in some instances with some important care needs omitted and not referenced.” from the report
End of life planning
needs fixingOne person's end of life care did not have a specific plan setting out the current stage of care, wishes, medicines and important family communication. Inspectors recommended that this planning be reviewed.
“There was no specific care plan to monitor this care and provided guidance for staff.” from the report
Minor medicines recording issues
minorMedicines were given safely, but some records did not follow the home's policy. The provider reviewed and updated the records after the inspectors raised this.
“There were some minor recording issues on medication administration records [MAR] which did not follow the provider's policy guidelines or best practise.” from the report
- 01How have you updated care plans so that every important health need is recorded clearly and can be easily found by staff?
- 02How do you record and review a person's end of life wishes, current care, anticipatory medicines and family communication?
- 03What checks are now made on medicines administration records, including checks by two staff where required by your policy?
- 04What changes have been made since the inspection to improve the Responsive rating?
- 05How are people and their families involved in regular care reviews and decisions about activities and daily life?
This was an unannounced planned inspection covering all five CQC questions, and the previous overall rating was Good. This explanation was written from the published report of 28 August 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, January 2017
Rated Good; inspectors found safe, kind and personalised care, with a shortfall in some do-not-resuscitate records.
This was an unannounced inspection on 5 and 9 December 2016. One inspector spoke with people living in the home, staff, a visiting health professional and managers. The inspector also checked care plans, medicines, accidents, recruitment and quality checks.
The home was rated Good in all five areas: safe, effective, caring, responsive and well-led. Inspectors found enough staff, safe medicines support, suitable training, respectful care and care plans that reflected people's needs and preferences.
The previous inspection found that staff and managers did not fully understand the law about helping people make decisions. Inspectors found this had improved. They also found that some do-not-resuscitate forms did not explain the reasons for decisions or show consultation with people or those close to them.
Enough staff
Inspectors found enough staff to meet people's needs. Staff also had time to talk and do activities with people.
“People were supported by enough staff to safely meet their needs.” from the report
Personalised care
Staff knew people's likes, dislikes, important relationships and preferred routines. Care plans were reviewed when needs changed.
“People were supported by staff members who knew them as individuals and were knowledgeable about their personal needs.” from the report
Kind and respectful support
People described staff positively, and inspectors saw staff giving reassurance and taking time with people. Privacy, dignity and independence were respected.
“They all have a smile on their face and they treat us all with kindness and respect.” from the report
Improved decision-making practice
The home had improved its understanding and use of the law about helping people make decisions since the previous inspection.
“At this inspection we found that improvements in this area had been made.” from the report
Open management
People and staff said managers were approachable. The home used feedback, incidents and checks to identify improvements.
“The management team had systems in place to monitor the quality of service provision.” from the report
Do-not-resuscitate records
needs fixingThe forms inspectors checked did not explain the reasons for the decisions or show consultation with people or those close to them. The manager said action would be taken immediately.
“However, the DNACPR forms we looked at did not follow the guidance provided.” from the report
- 01What action was taken to correct the do-not-resuscitate forms after the inspection?
- 02How do you now record the reasons for do-not-resuscitate decisions and discussions with the person or their representatives?
- 03How will you make sure risk assessments and care plans are updated quickly when someone's mobility or other needs change?
- 04What activities are available when the activities coordinator is absent?
- 05How can residents and relatives give feedback, and what changes have been made as a result?
This was an unannounced inspection covering all five CQC questions and the overall rating; the inspector spoke with six people and reviewed three care plans, among other records. This explanation was written from the published report of 4 January 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 Cheswardine Hall Nursing & Residential Home
3 rated inspections over 4 years: the service has held its Good rating throughout.
- August 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
Read what inspectors found at Cheswardine Hall Nursing & Residential Home →
- January 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Cheswardine Hall Nursing & Residential Home →
- June 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 25 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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