We carried out a review of the data available to us about Cheverton Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cheverton Lodge, you can give feedback on this service.
Cheverton Lodge is a care and nursing home providing care and accommodation for up to 52 predominantly older people with one floor accommodating younger adults with long term disabilities. There were 44 people living at the home at the time of this inspection. Each person had their own room and shared communal facilities which provided people with a suitable amount of space in different lounge and dining areas, as well as in the garden.
We found the following examples of good practice.
The service understood people’s needs and emotional wellbeing and the need to keep in contact with those most important to them. People could speak with and see their loved ones online using digital technology at times when relatives were unable to visit.
Staff engaged with people and encouraged participation in activities. We saw a group session taking place with people in a lounge, with social distancing being maintained.
The home asked visitors as they entered the building to have their temperature taken and to sanitise their hands. The registered manager informed us that a face mask could be provided when visitors arrived. There were clear guidelines displayed in the reception area of the home for visitors about what was expected of them when visiting to promote everyone’s safety.
There was a lounge on the ground floor that had been adapted to create a secure physically separated area in which people could see their visitors to minimise the potential spread of infection.. If it was not possible for people to come down to the ground floor visitors could visit people in their room in particular circumstances.
People’s and staff individual needs, health and wellbeing had been considered to ensure they lived and worked in an environment that was safe from infection. Each person using the service had an individualised risk assessment, including specific risks for people of Black and Minority Ethnic heritage and this was also considered for visitors to people. The risk assessments reflected individual risks, personal protective equipment (PPE) required when providing care and specific risk management strategies to provide safe care.
Staff had been trained and were provided with clear guidance about the use of PPE depending on the nature of the personal care task they were undertaking at any given time.
A cleaning regime was in place that helped to protect people and staff from infection or cross-contamination. Domestic staff were deployed to ensure daily and weekly cleaning schedules were completed, including regular cleaning and disinfecting of high touch areas, for example, door handles.
The provider and the home’s management team had ensured all staff were kept up to date with the latest government guidelines and best practice on how to provide safe care during the pandemic.
We were partially assured that the provider’s infection prevention and control policy was up to date with the exception that Covid 19 risk assessments for staff of black and minority ethnic heritage had not been fully completed for all relevant staff. This was subsequently addressed by the registered manager who confirmed that risk assessments had been updated shortly after our inspection visit.
Further information is in the detailed findings below.
Cheverton Lodge is a residential home providing care for up to 52 predominantly older people with one floor accommodating younger adults with long term disabilities. There were 50 people living at the home at the time of this inspection. Each person had their own room and shared communal facilities which provided people with ample space in different lounge and dining areas, as well as in the garden.
People’s experience of using this service and what we found
People were kept safe from harm and if any concerns about people’s wellbeing arose the service took the necessary steps to respond. Staff knew what they should do to minimise the risks that people faced but did not restrict people’s right to take reasonable risks.
The service understood people’s needs and planned their care well. The care provided was inclusive of people using the service and their families and care was planned in consultation with people.
Staff were caring. People we spoke with told us this and we observed the easy and relaxed way in which people using the service, their relatives and visitors all interacted with staff.
The service was responsive to people’s current and changing needs. People were respected as individuals.
Management of the home was complimented repeatedly and the way in which the service was run received a lot of praise from people, their relatives and stakeholders. The way in which the service operated was kept under review by the provider. There was recognition of when things needed to improve and change, action was taken, and there was also recognition of when things went well.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (Inspection report published on 9 May 2017). At this inspection the service remained good.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Cheverton Lodge is a 52 bed nursing home which provides nursing and personal care for up to 46 older people and 6 young people with physical disabilities. Each person had their own bedroom and there were communal lounges and dining areas on each floor of the home.
The home did not have a registered manager. However, a manager had been appointed in September 2016 and they had submitted an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Care plans described people’s support needs but the care and support provided was not clear in some cases. Updating care records to reflect the level of personal care required, for example how frequently they wished to have a bath or shower, for some people needed to be more accurate and also reflect positive changes in care as people’s conditions improved. However, we noted that this issue had recently been recognised by the provider who told us of the steps they were taking to address it.
The turnover of managers within the home had previously led to an unstable management structure. Information we had previously received from a healthcare professional and relatives indicated that the lack of consistent management had impacted on communication with them. The situation had improved. More effective communication had been established with health and social care professionals, which we had been told by professionals, for example commissioning and nursing and assessment team members in the local authority. Feedback at the most recent relative’s meeting was also positive and the issues around communication that had arisen last year were improving.
Medicines were managed well and safely. However, there had been an error on the typed medicines audit for January 2017, which was later clarified.
There had been several staff vacancies within the home from the middle of 2016. The recruitment programme which the provider had focused on had achieved success with almost all permanent staff posts now filled. There was much less reliance on temporary staff. Staff were recruited safely. There were enough staff on each floor during our visits and we saw that staff were able to spend time with people at other times when not supporting people with care tasks.
The staff team had access to the organisational policy and procedure for protection of vulnerable adults from abuse. They also had the contact details of the local authorities who largely placed people at the service. Staff said that they had training about protecting people from abuse and we were able to verify that this training did occur. Staff we spoke with had a good knowledge and understanding of their responsibilities to keep people safe from harm.
Risk assessments had improved and these were being recorded and updated in a timely way, which is an improvement to what we had found at our previous focused inspection. Information provided at handovers between staff was also clear.
People were provided with a wide choice of food and this reflected people’s preferred choice with other options being readily available. Most people and their relatives were complimentary about the standard of meals provided at the service.
There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service had applied the principles of the MCA and DoLS appropriately and had made the necessary applications for assessments when these were required.
People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. People told us they felt that healthcare needs were dealt with well and we saw that staff supported people to make and attend medical appointments when necessary.
Improved systems had been established to assist clear communication between staff and management at the home, and this received praise from staff.
People’s views were respected and we received positive comments about how caring and attentive staff were. We observed respectful and considerate interactions between staff and those using the service and there was a relaxed atmosphere around the home.
All staff we spoke with did know people well and what their current needs were. However, signed consent to evidence people, and / or their relatives, involvement in care planning, including end of life advanced care planning, required improvement. The provider was taking action to address this.
The service complied with the provider’s requirement to carry out regular audits of all aspects of the service.. The provider sought people’s feedback on how well the service performed and responded to feedback about areas of improvement that people thought may be required.
As a result of this inspection we found that the provider was not in breach of any regulations but improvement was required in the area of responsive.
Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounges and dining areas on each floor of the home.
The home did not have a registered manager. However, there was an interim manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The previous registered manager had left the service in May 2016. Since this time there had been three interim managers at the home. The current interim manager was leaving in September 2016 and a further interim manager was due to take over. We were advised that the new interim manager would be applying to be the registered manager.
The turnover of managers within the home has led to an unstable management structure. Information received from a healthcare professional and relatives that we spoke with indicated that the lack of consistent management had impacted on communication with them.
There were several staff vacancies within the home, specifically around nursing staff. However, the home had recently recruited to these posts and were waiting for staff to start. Seconded nurses from other Barchester homes, regular agency staff and bank staff were being used to ensure consistency of care.
One person that had been diagnosed with a terminal illness three weeks prior to our visit did not have a risk assessment of care plan in place about this.
Most risk assessments were appropriate and information about risks had been carried over into people’s care plans. However, for two people with known risks, there were no risk assessments in place.
Information provided at handovers was not always clear and some people’s monitoring charts were not always completed. People had files in their bedroom with information on care tasks that had been or needed to be completed by staff. Information from these files was not always carried over onto handover sheets kept in the offices on each floor of the home. Staff did not always have up to date information when handing over between shifts to ensure continuity of care.
People were provided with enough food and drink. Food looked and smelled appetising, was of good quality and offered choice. People that were on special diets such or had swallowing difficulties were given appropriate food, although on occasions, one person who had a specific diet did not receive food that met their dietary needs.
The home was currently undergoing refurbishment. This was due to be completed by the end of September 2016. The home was clean and tidy on the days that we inspected.
Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounge and dining areas on each floor of the home.
This inspection took place on 10 and 18 December 2015 and was unannounced.
We also carried out a focused unannounced out of hours inspection on 5 October 2015 in response to whistleblowing concerns raised. At that visit we did not find that the concerns were substantiated.
At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our last comprehensive inspection on 14 and 16 April 2015 the service was not meeting all of the regulations we looked at in respect of Regulation 18 (1) (Staffing) and Regulation 10 (2) (a) (Dignity and respect). At this inspection we found that the service had addressed the previous breaches of regulation.
The staff of the service had access to the organisational policy and procedure for protection of vulnerable adults from abuse. They also had the contact details of the London Borough of Islington which is the authority in which the service is located and other authorities who also placed people at the service. Staff said that they had training about protecting people from abuse and this training had recently been updated, which we verified on training records. Staff were able to describe the action they would take if a concern arose.
We found there were the designated numbers of staff on each floor during our visits, and we saw that staff were able to spend time with people other than when only engaging in care tasks. Staff were regularly present in communal areas to identify and respond to immediate assistance that people required.
Risk assessments concerning falls and those associated with people’s day to day included instructions for staff about how to minimise risks and were clear. Staff showed a detailed knowledge of the people they supported and their unique preferences about how care was provided.
There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.
People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. People told us they felt that healthcare needs were dealt with well and we saw that staff supported people to make and attend medical appointments.
Everyone we spoke with who either used the service, relatives or other visitors, praised staff for their positive and caring attitudes. The care plans we looked at were based on people’s personal needs and wishes and some miner matters needed attending to but overall care plans reflected the care and support that people required.
People’s views were respected as was evident from conversations that we had with people using the service, relatives and staff. We saw that improved systems had been established to assist clear communication between staff at the home. They were updated of changes in the service and were able to feedback their views and opinions through staff handover and other meetings.
The service complied with the provider’s requirement to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service and sought people’s feedback on how well the service performed and outlined any the areas of improvement that were necessary to maintain the quality of the service.
We carried out an unannounced focused inspection of this service on 5 October 2015 as a result of anonymous concerns that we received. The concerns related to a lack of staffing, care and welfare of people with emerging healthcare needs and the times at which medicines were being administered to people.
After the previous comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to two breaches of regulations that we identified at that time. This report only covers our findings in relation to the concerns recently raised and does not include the previous two regulation breaches, which we will review at our next comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Cheverton Lodge Nursing Home’ on our website at www.cqc.org.uk’.
Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounge and dining areas on each floor of the home.
The home’s registered manager has worked in this role since February 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We found there were the designated numbers of staff on each floor during our visit, with staff on duty for the night and morning shifts as outlined in the duty roster and bed status plan.
We found that referrals were being made to other healthcare professionals by the service when the need arose although speedier action had been found to be needed when the local authority had responded to a concern raised in July 2015. Morning medicines had been administered to everyone that required them at a reasonable time.
Cheverton Lodge is a 52 bed nursing home which provides nursing and personal care for up to 46 older people and six young people with physical disabilities. Each person has their own bedroom and there are communal lounge and dining areas on each floor of the home.
This inspection took place on 14 and 16 April 2015 and was unannounced. At our last inspection in June and July 2014 the service was meeting the regulations we looked at.
At the time of our inspection a manager was employed at the service and had recently submitted the application to register with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
There were systems and processes in place to protect people from the risk of harm. These included appropriate staff recruitment processes, staff training, policies and systems to protect people from abuse. Staff were able to demonstrate knowledge of safeguarding and what they would do if a concern arose.
We found there were the designated number of staff on each floor during our visits, however, they were often rushed and constantly engaged in care tasks and on occasion there were none in the communal areas at all. Staff were constantly required in people’s rooms to carry out care tasks with little leeway for staff to be present in communal areas to identify and respond to immediate assistance that people required.
Risk assessments were in place in relation to falls and those associated with people’s day to day care. The instructions for staff were detailed and clear. However, in one example a care plan said a person should be checked hourly as they were at risk of falling as they had refused to have a bed rail on their bed. Hourly checks were not being recorded.
We saw there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.
People were supported to maintain good health. Nurses were on duty at the service 24 hours a day and a local GP visited the home each week, but would also attend if needed outside of these times. Staff told us they felt that healthcare needs were met effectively and we saw that staff supported people to make and attend medical appointments, for example at hospital.
Most of the people we spoke with who either used the service, and relatives, praised staff for their caring attitudes. The care plans we looked at were based on people’s personal needs and wishes. Everyday things that were important to them were described so that staff could provide care tailored to meet their needs and wishes. Details were recorded of what people were able to do for themselves to enable them to maintain their independence. However, we found that not everyone’s care records were being held securely and confidentially as we found two instances where care records were left accessible to people in a lounge and at a nursing station.
People’s views were respected as was evident from conversations that we had with people using the service, relatives and staff. We saw that staff were involved in decisions and kept updated of changes in the service and were able to feedback their views and opinions through daily staff handover meetings.
The service complied with the provider’s requirement to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service, sought people’s feedback on how well the service performed, and outlined any the areas of improvement that were necessary to maintain the quality of the service.
At this inspection there were two breaches of regulations relating to regulations 10 and 18. You can see what action we told the provider to take at the back of the full version of the report.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
Staff worked in cooperation with health and other professionals to ensure that the service had good practices in place to reduce the risks to people from falls, prevention of pressure sores and nutrition. The service had an action plan they were working towards to improve these practices.
CQC monitors the implementation of the Deprivation of Liberty Safeguards (DoLS), which apply to people who live in care homes. While the service did not have anyone subject to DoLS for their own safety, the manager showed a good understanding of the process used to apply for DoLS. The provider was making plans to train staff in DoLS, in light of a recent Supreme Court ruling, and guidelines were available for staff should they be faced with a decision of this nature.
Is the service effective?
We saw care plans were being improved and were reviewed regularly by the nursing staff. At our previous inspection we had found that care plans were being amended to reflect people's cultural and religious diversity and we found this work had been completed on the care plans that we looked at.
Care and treatment was planned and delivered in a way that was intended to ensure
people's safety and welfare.
Is the service caring?
People we spoke with who used the service were all highly complementary about the care provided and felt safe with the staff who worked with them. One person told us 'I have been here for three months. I came straight from hospital and staff were so kind and welcoming, they still are.' Another person told us 'I can't fault the carers, they are very good and they do what I need help with.' A visiting relative said 'oh the staff are very good.'
People told us that they enjoyed the activities available at the home, and a weekly programme of events and activities was provided by the two activities coordinators.
Is the service responsive?
We found that care plans showed the degree of involvement that each person, with the help of their relatives if necessary, had with reviewing their care needs. They also showed what action had, and was, being taken to address the views people had about their care.
People told us that they knew about activities that took place. Some people told us that they found it difficult to leave their room for activities, and specifically for people who were bedbound, but they were visited for one to one time by an activities coordinator.
Is the service well-led?
The provider kept records, which we viewed, showing which training staff had completed, when refresher training was due in core skills and plans to include additional training in specialised areas.
The provider had a system in place to monitor the quality of care. We were provided with a copy of the most recently published customer satisfaction survey from the end of 2013. This showed that 90% of people agreed that they were happy living at the home and 89% were satisfied with the whole service as a whole. We were told by the area manager and registered manager that the 2014 ' 2015 business plan was currently being written and this would include areas for action where people had indicated that there were improvements they felt were needed.
We talked to a local General Practitioner who visited the home weekly. They told us that they would be "more than happy to have a relative living at this home." They told us that it was "A genuinely good service", that relatives seemed happy with the quality of care received and that people who moved into the home appeared to settle quickly.' They said "people are respected."
We spoke with a local Occupational Therapist (OT) who supported people who used the service. They told us that communication between staff in terms of information being handed over could improve but said that the quality of the service was "generally quite good." They said that when a person had fallen at the home the local community team which the OT works in had been informed very quickly.
We found that people experienced a high quality of care and treatment when they used this service and that people were treated with dignity and respect. We also found that people were kept safe from the risk of abuse and abuse occurring, however the deprivation of liberty which arose as a result of the use of bed rails and a lap strap was not properly explored or documented as evidence that the person's deprivation of liberty and best interests had been fully considered.
We found that the equipment people used was safe and effective and that people had enough qualified, experienced and skilled staff to support them at all times.
We found that the home carried out various internal quality checks which helped to keep people safe and that these were well documented across a wide range of checking and auditing tools.
They told us they were able to see the doctor when they needed to, and that they were asked if they needed pain relief, so were not left in pain. They told us that their medicines were always available for them.
People using the service felt there were enough staff at the home. They told us staff were available when they needed support. They said staff always responded to call bells. We saw staff were present to assist people when they needed support with their meals, personal care or other needs.
People told us they had no concerns about the service. They indicated they knew how to make a compliant and who to contact if they were not happy with their care.
The home ran organised activities for people during the week, for example, gentle exercise, discussion around current affairs, games and puzzles, music events and a weekly religious service. Outings were arranged from time to time usually for small groups. Places recently visited included Arsenal football club, Kenwood House and local shops. One person spoke with us about how much they had enjoyed the visit to Arsenal.
The home sought feedback from people using the service, relatives and visitors. For example, there was a visitor's book in reception which was checked daily by staff. We saw that suggestions had been acted on. Most comments praised the home, for example, one entry read: "This is a wonderful place. My partner is treated with kindness and respect."