CQC report explained · a residential care home
What the CQC found at Nesfield Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2023
Nesfield Lodge rated Good; inspectors found safe, kind care and improvements since the last inspection, with some ongoing concerns about belongings and management changes.
This was an unannounced inspection. Inspectors visited on 10 May 2023, and inspection activity continued until 17 May 2023. They spoke with people living at the home, relatives, staff and healthcare professionals. They also observed care and checked care plans, medicines, staff files and management records.
The home was rated Good for Safe and Well-led. People said they felt safe and enjoyed living there. Inspectors found the home was clean, medicines were managed safely, staffing levels were suitable and checks were made on the building and equipment.
The inspection was partly prompted by concerns about infection control, nutrition and hydration, and management. Inspectors found no evidence that people were at risk of harm from these concerns. The home had improved since the previous inspection and was no longer in breach of regulations.
Clean and safer infection control
The home was clean and had regular cleaning, including deep cleaning. Staff had infection control training and access to protective equipment.
“Records confirmed cleaning was conducted regularly, included deep cleaning.” from the report
People felt safe
People and relatives generally said they felt safe. Inspectors found systems to identify and report abuse and to learn from accidents and incidents.
“People told us they felt safe and enjoyed living at Nesfield Lodge.” from the report
Staffing and call bells
Staffing levels were based on people's needs. Inspectors found that staff responded quickly to call bells.
“The service used a dependency tool to calculate the number of staff required on shift according with people's needs.” from the report
Open management culture
People, relatives, staff and healthcare professionals described the current management as approachable and supportive. Staff said they could raise concerns and would be listened to.
“There was an open culture within the service. Staff told us the registered manager and the management team were supportive, that they could raise concerns with them and they would be listened to.” from the report
Improvement since the last inspection
The previous rating was Requires Improvement. Inspectors found enough progress had been made for the home to be no longer in breach of regulations.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Belongings and laundry
minorRelatives said belongings sometimes went missing or were misplaced, and that people sometimes wore clothes belonging to others. The manager was aware of ongoing laundry problems and was addressing them.
“However, relatives also raised concerns about their loved ones' belongings not always being kept safe due to going missing or being misplaced and people using clothes that belonged to other people.” from the report
One missing nicotine patch
minorInspectors found one example where a prescribed nicotine patch was not available. The manager explained what action had been taken.
“We found one example of one person not having their prescribed nicotine patch available but the registered manager explained us the action they had taken in relation to this issue.” from the report
- 01What has changed to stop residents' clothes and other belongings going missing or being given to the wrong person?
- 02How have recent management changes affected the home, and how will you maintain continuity in the management team?
- 03How do you check that every prescribed medicine is available and given as intended, including nicotine patches?
- 04How will you monitor residents' nutrition and hydration, given that these were among the concerns prompting the inspection?
- 05What actions in the improvement plan are still outstanding, and when will they be completed?
This was a focused inspection of Safe and Well-led, prompted partly by concerns about infection control, nutrition and hydration, and management; the other key questions were not inspected. This explanation was written from the published report of 1 June 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 2021
Nesfield Lodge was rated Requires Improvement; inspectors found kind, person-centred care but problems with cleaning, infection control and records.
This was a focused inspection in January 2021. Inspectors looked only at Safe and Well-led because concerns had been raised about hygiene and management. The ratings for the other areas came from the previous comprehensive inspection.
People and relatives said they were happy with the care. Inspectors saw staff being kind, attentive and compassionate. They found enough staff, good safeguarding arrangements, suitable risk assessments and generally safe medicines management.
The main problems were cleaning and infection control. Some areas and equipment were not clean, cleaning records had gaps, and cleaning schedules were incomplete. Inspectors also found some medicines records, care records and electronic entries were inaccurate or incomplete.
The overall rating fell from Good to Requires Improvement. The home breached Regulation 12 because its systems for preventing and controlling infection were not sufficiently robust. The manager began taking action during and after the inspection, but CQC said it would monitor progress and return.
Kind, person-centred care
People and relatives consistently described good-quality care. Inspectors saw staff treating people with kindness and compassion.
“We found a person-centred culture within the home with people's individual rights promoted.” from the report
Support during the pandemic
The home worked to keep people in contact with relatives through technology, window visits and a screened visitor room. Staff were observed using protective equipment appropriately.
“A great deal of effort had been made to help people and relatives keep in touch during the COVID-19 pandemic.” from the report
Staffing and safeguarding
Inspectors found enough staff to provide care and supervise communal areas. Staff understood how to identify and report safeguarding concerns.
“We concluded there were enough appropriately skilled staff deployed to ensure people received appropriate care.” from the report
Learning from incidents
Incidents were investigated and reviewed for patterns. Care plans and risk assessments were updated when needed.
“Incidents and other adverse events were subject to analysis to look for themes and trends.” from the report
Cleaning and infection control
seriousSome areas and equipment were not properly clean. Cleaning records had gaps, schedules did not cover all relevant items, and some equipment was stored on the floor or alongside clean protective equipment.
“We were not assured that the home was consistently kept in a clean and hygienic state.” from the report
Cleaning issues not resolved promptly
needs fixingSome problems had already been identified in an infection control audit in August 2020 but had not been addressed by the inspection.
“Some of the areas for improvement we found had also been identified on a local authority infection control audit in August 2020 but had not yet been actioned.” from the report
Inaccurate care records
needs fixingSome electronic records contained contradictory or inaccurate information. Inspectors also found a few examples where care was not recorded as matching people's plans.
“We found some inconsistencies with instances of staff recording contradictory or inaccurate information.” from the report
Medicines records
needs fixingThe quantities of three medicines did not match the records, and one liquid medicine did not have its opening date recorded. Instructions for some as-needed bowel medicines needed more detail.
“We did find the quantity of three medicines in stock did not match with records.” from the report
- 01What changes have been made to cleaning schedules, and do they now include communal bathrooms, touch points and equipment?
- 02How do you check that cleaning is completed every day, and can we see recent cleaning records?
- 03How are lifting equipment, pressure cushions and slings now cleaned and stored?
- 04What checks ensure care records are accurate and match the care people have received?
- 05What action was taken after the three medicines did not match their records, and how are as-needed medicine instructions kept up to date?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 18 February 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.
Every inspection of Nesfield Lodge
3 rated inspections over 4 years: the service has held its Good rating throughout.
- June 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- December 2018GoodSafe: GoodWell-led: Good
- December 2017
Registered with the Care Quality Commission on 28 December 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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