CQC report explained · a nursing home
What the CQC found at Tadworth
Not yet rated: the CQC has not published a rated inspection for this home, which is usual for a new registration.
What inspectors found, April 2024
Inspected but not rated; inspectors found kind, skilled care, with several records and medicines processes needing improvement.
Inspectors visited on 20 and 21 February 2024. They spoke with children, relatives and 31 staff, and reviewed 18 care and medicines records. The inspection was prompted partly by concerns about overnight monitoring.
Inspectors found that children and young people were protected from abuse, supported by trained staff and cared for in clean houses. Staff were described as compassionate and highly skilled, especially in rehabilitation. Children and families were involved in care and supported to communicate, build relationships and take part in activities.
The report identified several areas for improvement. Overnight checks were not described clearly enough in all care plans. Water temperature checks were not always recorded. Some medicines were not stored securely, some medicines records were out of date or lacked instructions, and prescription forms were not tracked adequately. Daily records did not always include the child's voice, feelings and wishes.
The service was inspected but not rated. CQC does not currently rate services that are children's homes and are also registered with Ofsted. The previous overall rating was Outstanding, published in March 2020, but that rating does not represent a new rating from this inspection.
Kind and respectful care
Inspectors saw compassionate care that respected privacy, dignity and individual needs. Families were involved and supported.
“Staff treated children, young people and their families with the upmost compassion and kindness, respected their privacy and dignity, and took account of their individual needs.” from the report
Strong rehabilitation support
Inspectors saw skilled staff helping children and young people make clear progress, including improvements in eating, communication and independence.
“The progress children and young people made was evident.” from the report
Skilled team working
Health professionals worked together around each child. Assessments and care plans were detailed and based on evidence.
“All professionals worked collaboratively and efficiently to meet the holistic needs of the children and young people.” from the report
Children's voices and activities
Children and young people were supported to communicate in different ways, join activities and maintain family relationships.
“This gave children and young people new experiences and prevented their disabilities from being a barrier.” from the report
Open leadership
Leaders were visible and staff said they felt supported. The service had an open approach to concerns, incidents and learning.
“There was an open culture where staff, children, young people, and their families could raise concerns without fear.” from the report
Medicine records and storage
seriousSome medicines were stored outside locked medicine cabinets. Some 'as required' medicines lacked instructions, and some care plans did not match current prescriptions.
“Sometimes the care plans did not match the current medicines prescribed as the care plans had not been updated when medicines had changed.” from the report
Prescription tracking
needs fixingThe medical team did not track emergency prescription forms adequately, so missing forms might not be identified.
“The medical team did not track FP10 prescriptions adequately, therefore the service would not be able to identify if any were missing.” from the report
Daily care evaluations
needs fixingDaily records did not always capture the child's voice, feelings and wishes. Inspectors recommended that these evaluations be strengthened.
“The daily evaluations did not consistently reflect the child's voice and what their feelings or wishes may have been over the day.” from the report
- 01How are overnight visual checks now described in each child's care plan, and how do you check that staff carry them out consistently?
- 02How do you now record water temperatures for every bath and shower?
- 03What has changed to make sure medicines are stored securely in every house?
- 04How do you check that 'as required' medicines have clear instructions and that care plans match current prescriptions?
- 05How are children's voices, feelings and wishes included in daily care evaluations?
This was a comprehensive inspection of the regulated treatment activity and the premises, but no new ratings were given because CQC does not currently rate children's homes also registered with Ofsted. This explanation was written from the published report of 17 April 2024 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, July 2021
Inspected but not rated; inspectors found safe, caring support, with medicines errors reduced and staffing concerns checked.
This was an unannounced targeted inspection of Chestnut House on 24 May 2021. Inspectors responded to concerns about staffing, staff training, care plans and medicines errors. They examined records for all seven children and young people, staffing rotas, training records and medicines systems.
Inspectors found children and young people were safe and well cared for by staff who knew them well. Staffing levels and staff skills were maintained, care plans were detailed, and records generally followed those plans. Medicines systems had been strengthened and errors had reduced.
The home had clean areas, good infection control and an open approach to reporting incidents and learning from them. This inspection was targeted, so the home was inspected but not rated overall. The other key questions will be assessed at the next comprehensive inspection.
Staff knew the children well
Children and young people were cared for by committed staff. A core team system helped staff understand each child's needs.
“Children and young people in Chestnut House were safe and well cared for by committed staff who knew them well.” from the report
Safe staffing arrangements
The home maintained the required staff-to-child ratio and moved staff from other houses when needed. Inspectors were assured that staff had the right training and skills.
“Leaders ensured that the optimal ratio of staff to children was always maintained in Chestnut House, moving staff from other houses when necessary instead of using agency staff.” from the report
Detailed care plans
Care plans were written from the child's perspective and were clear and easy to understand. The records inspected generally followed the guidance in them.
“Staff developed detailed and child-centred care plans from the child or young person's perspective.” from the report
Improved medicines systems
The home had introduced new processes after medicines errors. Regular audits and updates had helped reduce the number of errors.
“Effective processes had been introduced following medicines administration errors and as a result, the occurance of errors had reduced despite very complex medicine regimes and high numbers of administrations.” from the report
Learning from incidents
Incidents and near misses were reported and investigated. Managers used reflective practice and shared learning with the wider staff team.
“Incident reports were detailed, and investigations were thorough with clear analysis and action planning.” from the report
Previous medicines errors
needs fixingThe inspection was partly prompted by concerns about a high rate of medicines errors. Inspectors found that errors had reduced, but medicines remained an area needing ongoing checks because the children's medicine routines were complex.
“Effective processes had been introduced following medicines administration errors and as a result, the occurance of errors had reduced despite very complex medicine regimes and high numbers of administrations.” from the report
Care plans were not always followed
minorInspectors found some occasions when records did not match the care plans. The report says appropriate action was taken when this happened.
“The seven contemporaneous records we reviewed, generally reflected the guidance specified in the care plans. On occasions where this was not the case, appropriate action was taken.” from the report
- 01How are you checking that medicines errors remain reduced, and what happens when an error occurs?
- 02How do you make sure staff follow each child's care plan in practice?
- 03How do you maintain the right staff-to-child ratio when staff are absent?
- 04How often are staff training and competency records reviewed for the complex care provided in Chestnut House?
- 05What did the next comprehensive inspection find about the other key questions?
This was a targeted inspection of specific safety concerns in Chestnut House, with infection prevention and control also checked; all key questions will be assessed at the next comprehensive inspection. This explanation was written from the published report of 9 July 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 Tadworth
Each visit the CQC has published, newest first, back to the day the home was registered.
- April 2024Inspected but not ratedcurrent ratingSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- July 2021Inspected but not ratedSafe: Inspected but not rated
- April 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- January 2018Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- November 2016Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedCaring: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- March 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- December 2011
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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