Chandos Lodge Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant people’s needs were not always met.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Throughout the inspection we saw that person centred care was not consistently provided and that people’s choice was not promoted in relation to activities, privacy and dignity.

In one person’s care plan their ethnicity and religion was recorded but there was no information about their specific religious, cultural or dietary needs to ensure their individual needs were met and to support a person-centred approach.

Terminology used in people’s records was not respectful, person-centred or in line with best practice, with people described using terms such as ‘wandering’ or ‘attention seeking’

Care plans did not evidence people or relatives’ involvement in them. Relatives told us they were not involved in care plans or reviews. A relative commented, “I do not know anything about a care plan and there has been no mention of any kind of review of [family members name] care plan.” This meant that the person’s relative’s preferences and views were not considered in the planning of their care.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The service did not consistently provide care that met people’s diverse needs. The group of people within the service were not always compatible in terms of their levels of need, which made it difficult for staff to provide flexible care and support people’s choices. There was limited evidence that care was coordinated with other health and social care professionals to provide joined up support. For example, a person’s care plan showed they had physiotherapy recommendations for exercise. However, records did not evidence that staff were encouraging or supporting the person to follow these, which limited the continuity and responsiveness of care for the person.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication needs were identified in their care plans. However, this information was not consistently used to provide person centred support. For example, guidance for de-escalating people’s behaviours of distress were generic, and did not reflect people’s unique way of communicating.

There was little evidence that information was provided in formats accessible to people such as pictorial cues, simplified language or other personalised resources. As a result, people’s ability to understand information and make choices about their care was not consistently supported.

A relative told us that their family member is hard of hearing and they wear a hearing aid. However, on occasions staff did not ensure it was fitted correctly or in working order. This limited the person’s ability to communicate and meant their communication needs were not consistently met.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The service had a complaints procedure in place, however the registered manager stated that the service had not received any complaints. This indicates that the service may have missed opportunities to learn and improve, potentially reflecting a closed culture. During the inspection we identified 2 concerns about care. One was raised directly with the service but was not formally recorded as a compliant or referred to safeguarding. The other one was raised with the local authority and although the service responded, it was not recorded as a complaint. This indicates that while systems exist, they were not consistently effective in capturing or responding to people’s concerns, which may limit people’s opportunity to be listened to and involved in their care.

Relatives spoken with were unaware of a formal complaints process although they indicated if they had any concerns they would speak with the manager.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People’s access to care, support and treatment was not consistently audited. Staffing levels were not always sufficient, particularly in the evenings and some staff had not completed training to meet people’s needs. The environment did not consistently support equitable access, as it could not safely accommodate people’s differing needs, which limited opportunities for people to receive care and support in a safe and timely way.

A person’s care plan showed they had diabetes. However, the care plan made no reference to routine monitoring, such as annual blood tests, eye or foot care checks to ensure people accessed the treatment they needed.

Relatives told us they were unsure whether their family member had access to healthcare professionals such as dieticians, opticians or podiatrists, with limited communication with them regarding how individual health needs were monitored or met. This meant families could not be assured that people were consistently supported to access healthcare, creating potential inequality in access, experience and outcomes.

Another relative told us that they were unable to speak to their family member’s keyworker and were unclear about the keyworker’s role and responsibilities in coordinating care. This meant some families had less access to information and opportunities to engage with the service, creating potential inequalities in access.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The service recorded some information about people’s characteristics that could affect their experience of care, such as ethnicity, religion, dietary preferences and communication needs. However, that information was not consistently used to provide personalised support as referred to elsewhere in this report under other quality statements.

Staff had received training in equality, diversity, and inclusion however, training was not embedded in practice to promote equitable practice. As a result, people who may be more likely to experience inequalities did not consistently receive care and support that met their individual needs. For example, people with dementia were not provided with meaningful personalised engagement activities and staff did not adapt their communication approaches which meant people were less able to express their preferences or make decisions.

A relative commented, “[Family member] is hard of hearing and I am not sure staff always understand how that might impact them as well as the dementia." They told us there were language barriers between staff and their family member, which increased the risk of the person not being understood and led to potential inequality in their experiences and outcomes.

Another relative commented, “[Family member] did not like sitting in the communal area because of the noise and potential agitation from other residents and the TV or music always on in the background.” These environmental factors limited their engagement and comfort, meaning their experience was not consistently person centred and had the potential to lead to inequalities in experiences and outcomes.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Care plans included a section on death and dying. It indicated whether the person had a ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) in place and that people’s relatives would be involved in end-of-life care when the time comes. We saw that anticipatory medicines were prescribed for a person deemed to be at end of life, which ensured that their care was anticipated and could be provided in line with the person’s best interests.