CQC report explained · a nursing home
What the CQC found at The Chiswick Nursing Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, February 2023
Rated Good; inspectors found improvements in medicines, safe care and management, but noted a burn risk from temporary heaters and unclear information for families.
This was an unannounced focused inspection. Inspectors visited on 17, 24 and 25 January 2023, and also reviewed information and records after the visits. They spoke with people living in the home, relatives and staff, and checked care, medicine and management records.
The home was rated Good overall, with Safe and Well-led both rated Good. Inspectors found that medicines were now managed safely, after earlier concerns. They also found suitable arrangements for staffing, safeguarding, risk management, infection control and learning from incidents.
People said they felt safe and respected. Families said communication was good and staff responded promptly to call bells. Inspectors found that managers used audits, meetings and an action plan to improve the service.
This was a focused inspection of Safe and Well-led only. The other ratings were carried forward from the last comprehensive inspection.
Medicines improved
The home had acted on the previous inspection findings. Inspectors found medicines were stored, given and recorded safely, including controlled medicines.
“Medicines were safely managed. There were known systems for ordering, administering and monitoring medicines.” from the report
People felt safe
People said they felt safe, and staff understood how to report suspected abuse. The home also had plans and checks to manage risks such as falls, pressure damage and mobility problems.
“People told us they felt safe living in the service and felt well respected by staff.” from the report
Enough staff
Inspectors found enough staff and a suitable mix of nurses and healthcare assistants. People and relatives said staff responded promptly to call bells.
“There were enough staff to meet people's needs.” from the report
Supportive leadership
Staff said managers supported them and communication between teams had improved. The home used meetings, audits and reviews to monitor quality.
“Staff told us they felt well supported in the service.” from the report
Good family communication
Relatives said the home kept them updated about their family member's wellbeing and that they could raise concerns with managers.
“People's family members told us the service communicated well with them.” from the report
Temporary heaters
needs fixingSome parts of the heating system were not working. Temporary heaters had been placed in rooms, but inspectors identified a risk that people could burn themselves if they touched them.
“The provider told us they would purchase fire guards in the event these remained in place.” from the report
Information was not clear enough
minorInformation for people and families was not always easy to use. There were no clear noticeboards identifying staff and managers, and information about advocacy and complaints was not displayed prominently.
“There were no noticeboards to identify staff and responsible managers, and we did not see information on accessing advocacy services or making complaints displayed prominently.” from the report
- 01Have the temporary heaters been removed, or have fire guards been fitted to prevent people being burned?
- 02How can residents and relatives now identify the responsible manager and find information about complaints and advocacy?
- 03What changes were made to medicines management after the previous warning notice?
- 04Which areas of the building were due for refurbishment, and has that work now been completed?
- 05How will you monitor that the improvements found at this inspection continue?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the last comprehensive inspection. This explanation was written from the published report of 15 February 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, June 2022
The Chiswick Nursing Centre is rated Requires Improvement; inspectors found repeated medicines failings and issued a Warning Notice.
This was an unannounced focused inspection. Inspectors visited on 17, 18 and 31 March 2022, and inspection activity ended on 22 April 2022. They spoke with people, relatives and staff, reviewed care and staff records, checked 20 medicine charts and examined the home's systems.
The main problem was medicines management. A time-critical Parkinson's medicine was given late on five occasions. An opened controlled drug was not recorded on the electronic system. There were also seven missed medicines recorded in the two weeks before the inspection. The home remained in breach of Regulation 12 and received a Warning Notice.
Inspectors found strengths in safeguarding, risk assessments, staffing, infection control and working with health professionals. People and relatives also described staff as caring and supportive. However, the home's checks had not found the medicines problems, so the well-led rating also remained Requires Improvement.
The overall rating remained Requires Improvement. This was the third consecutive inspection with that rating. Only Safe and Well-led were inspected in this visit. Ratings for the other key questions were carried over from the previous inspection.
Safeguarding
People were protected from abuse and avoidable harm. Staff understood how to recognise and report safeguarding concerns.
“People were protected from the risk of abuse, harm and neglect as the provider had implemented appropriate systems.” from the report
Risk planning
Risks such as falls, pressure damage, malnutrition and reduced mobility were assessed. Staff had guidance and training to manage these risks.
“Risk assessments with associated guidance for staff to follow were in place, monitored regularly and updated as necessary.” from the report
Infection control
Inspectors were assured that the home had suitable infection prevention arrangements, including the use of protective equipment and outbreak planning.
“We were assured that the provider was using PPE effectively and safely.” from the report
Activities and partnership working
People were supported to take part in activities and outings. The home also worked with health and social care professionals to support people's needs.
“People and relatives told us they were pleased the service was now gradually and carefully returning to traditions in place before the pandemic, for example communal activities and outings.” from the report
Late time-critical medicine
seriousA medicine for Parkinson's disease was not given within the agreed times on five occasions over three consecutive days. This could reduce its effectiveness and symptom control.
“However, we found this medicine was not administered within the agreed timescales on five occasions on three consecutive days in March 2022.” from the report
Controlled drug recording
seriousAn opened controlled drug was stored without being recorded on the electronic medicine system. Inspectors said this did not meet legal requirements for receiving and storing controlled drugs.
“We found an opened bottle of a controlled drug which was not recorded on the electronic medicine system.” from the report
Missed medicines and weak audits
seriousSeven missed medicines were recorded in the two weeks before the inspection. Some were linked to a lack of stock or possible recording errors, and some were not reported through the home's incident system.
“We found examples of seven occasions when people had missed a prescribed medicine in the two weeks prior to the inspection” from the report
Comfort and dignity
minorOne person said staff did not always deal with important comfort and dignity needs, such as keeping the call bell within reach.
“they did not always attend to aspects of their care that were important for their comfort and dignity” from the report
- 01How do you now make sure time-critical medicines, including Parkinson's medicines, are given within the prescribed times?
- 02How are controlled drugs received, recorded and stored, including medicines brought in when someone is admitted?
- 03How do you check medicine stocks, missed doses and electronic medicine records, and how quickly are errors reported and investigated?
- 04What evidence can you show that medicine audits now identify problems before they put people at risk?
- 05How do you make sure call bells and other items important for comfort and dignity are kept within each person's reach?
This was an unannounced focused inspection of Safe and Well-led only; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 22 June 2022 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 The Chiswick Nursing Centre
7 rated inspections over 8 years: the service has held its Good rating throughout.
- February 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015Goodstayed GoodSafe: GoodEffective: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- March 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 6 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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