CQC report explained · a residential care home
What the CQC found at Chetwynd House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, November 2021
Chetwynd House is rated Good; inspectors found safe, caring management, with some improvements made after concerns about falls, medicines and pressure area care.
This was an unannounced focused inspection on 15 and 30 September 2021. Inspectors looked only at Safe and Well-led, after concerns about pressure area care, medicines and falls. They spoke with people, relatives and staff, and reviewed care, medicine, recruitment and management records.
Inspectors found that medicines were managed safely, risks were assessed and infection control arrangements were in place. Staff were recruited safely and knew how to report abuse. The provider had made changes after incidents, including new monitoring and care planning.
The home was rated Good overall, with Safe and Well-led also rated Good. The overall rating stayed the same as at the previous inspection, published on 7 September 2019. The other three areas were not inspected during this visit, so their earlier ratings were carried forward.
Medicines managed safely
Inspectors found that medicines were stored and given safely, and that people received them on time. Audits identified issues and action was taken.
“Medicines were managed safely, and people received their prescribed medicines on time.” from the report
Risks were assessed
The home assessed and monitored risks, including pressure area care. Care records reflected people's needs and included risk reduction measures.
“Risk associated with people's pressure area care had been fully assessed and monitored.” from the report
Learning after incidents
The provider reviewed incidents, strengthened monitoring and updated care plans. Inspectors found that specialist advice was used to reduce the chance of incidents happening again.
“Lessons were learnt, and action taken following incidents” from the report
Improved outcomes
Inspectors found that changes had improved people's outcomes, including a significant reduction in falls.
“People's outcomes had improved as a result of the changes introduced.” from the report
Good infection control
Inspectors were assured that the home had arrangements for preventing and managing infection, including safe use of protective equipment and arrangements for visits.
“We were assured that the provider was using PPE effectively and safely.” from the report
Medicines refresher training
needs fixingNot all staff had completed their yearly medicines training update. The manager dealt with this immediately, but families should check that refresher training remains up to date.
“Staff received training in the safe administration of medicines, however we found that not all staff had received a yearly update, this was addressed, and action was taken immediately by the manager.” from the report
Waiting for moving equipment
needs fixingPeople generally said call bells were answered quickly, but some had waited for care because moving and handling equipment was being used elsewhere.
“People told us calls bell were answered quickly but that sometimes they waited for care due to waiting for moving and handling equipment to become free.” from the report
Manager registration
minorThere was no manager registered with the CQC at the inspection. A new manager had started the registration process.
“The service did not have a registered manager registered with the Care Quality Commission, however there was a new manager in place who had begun the registration process.” from the report
- 01Has the new manager now completed the CQC registration process?
- 02How do you make sure all staff complete their yearly medicines training update?
- 03Have you increased or reviewed the moving and handling equipment to reduce waiting times?
- 04How are falls, pressure area care and safeguarding incidents monitored now?
- 05How are relatives told about incidents and the actions taken afterwards?
This was a focused inspection of Safe and Well-led following concerns about pressure area care, medicines and falls; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 5 November 2021 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, December 2020
Inspected but not rated; inspectors were assured that infection prevention and control measures were in place during a COVID-19 outbreak.
This was an unannounced, targeted inspection on 16 December 2020. It followed concerns about infection prevention and control. The home was closed to visitors because of a COVID-19 outbreak.
Inspectors found good practice in preventing infection. They were assured about visitor arrangements, social distancing, admissions, PPE, testing, cleaning, outbreak management and the infection control policy.
The home had outdoor visiting facilities and extra staff to support safe visits when possible. Staff had COVID-19 training, weekly testing and guidance about PPE. People were tested and isolated when admitted.
The home was inspected but not rated. This means the visit did not give an overall quality rating or a rated judgement for Safe.
Infection control
Inspectors were assured that the home was taking steps to prevent infections and manage the outbreak.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
PPE and staff training
Staff received COVID-19 guidance and there was a good supply of PPE. Their use of PPE and handwashing was monitored.
“Staff had received training and ongoing guidance about COVID - 19 and how to safely provide care and support to people.” from the report
Visiting arrangements
The home had developed outdoor visiting facilities and employed extra staff to support safer visits when visits were allowed.
“The provider had developed outdoor facilities to enable people to receive visitors safely when able to do so.” from the report
Cleaning and policies
Cleaning of frequently touched areas had increased, and the provider's infection control policy and contingency plan reflected COVID-19 guidance.
“Cleaning of frequent touch points had been increased and cleaning fluids had been changed in response to COVID -19.” from the report
Inspectors raised no specific concerns in this report.
- 01How are outdoor visits arranged now, and what extra support is available for people and relatives?
- 02How are staff trained and checked on using PPE and washing their hands?
- 03How often are staff and residents tested now, and what happens after a positive result or exposure?
- 04How often are frequently touched areas cleaned, and which cleaning products are used?
- 05When was the infection prevention and control policy and outbreak plan last reviewed?
This was an unannounced targeted inspection of infection prevention and control measures during a COVID-19 outbreak; the home was inspected but not rated and the other areas of care were not covered. This explanation was written from the published report of 30 December 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 Chetwynd House
2 rated inspections over 2 years: the service has held its Good rating throughout.
- November 2021Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2020Inspected but not ratedSafe: Inspected but not rated
- September 2019GoodSafe: GoodWell-led: Good
- November 2017
Registered with the Care Quality Commission on 27 November 2017.
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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