Chester House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments of people’s needs were not always consistently completed or fully reflected in care planning. While care plans contained a large range of information about people’s health and wellbeing, some key areas were inconsistent or not fully reflective. Records showed care plans were reviewed regularly and additional checks, such as weight records were being completed. However, where people’s conditions required additional monitoring, this was not always in place and completed. Further work was needed to ensure records consistently reflected a person-centred approach to assessing and planning care. People had communication plans in place. We did not see evidence in assessments and care plans that people and relatives had been meaningfully involved in writing plans and reviewing health and wellbeing needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We observed people were given cordial at mealtimes and hot drinks, and water was served to people in the lounge areas. However, we noted people in their bedrooms did not always have access to drinks as they were not available or they had been placed out of the person’s reach.

We were not assured people were receiving their diet in a way that had been assessed by a professional. One person had their food modified and was being provided with full assistance and another person had a medical condition where choking was a risk. We did not see evidence in care documentation of whether or not these people had been assessed by a Speech and Language Therapist (SALT). We asked the management to follow this up and confirm the people’s specific needs.

There was no cook employed at the home and staff had to perform the cooking and serving of meals. We received mostly positive feedback about the meals, one person told us, “The food is good. Sometimes they [staff] ask you what you want. It varies if there is a choice.” Another person told us, “The food isn’t too bad.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

There was evidence of partnership working with external professionals such as GPs, pharmacists and district nurses to support people’s health needs. People’s weights were generally stable. We received positive feedback from one visiting professional who told us staff at the home worked really hard and were responsive to people’s needs and would contact them if they were concerned.

People’s care plans were long, with immediate needs and risks not always accurately reflected. The management told us each person had a Health and Care Passport in place; however, when we asked for evidence of this the only document that accompanied people outside of the home was a snapshot of the care plan. Therefore, the provider would be unable to share an accurate and detailed assessment with other services, for example the hospital if this was required.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

There was not always a clear, person-centred guidance for staff on how to monitor and respond to changes in people’s conditions. For example, when to escalate concerns to healthcare professionals, or where information was stated, this was not always followed by staff. For example, one person required monitoring to take their medicines; however, we observed them left alone to take their medicines. Another person required close monitoring of their hydration intake; however, we found this was poorly done or not done at all.

We were not assured people were receiving good oral care. Although records indicated people received support with oral care, some people’s teeth were unclean, and we saw several people did not have ready access to toothbrushes or toothpaste.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Not all care plans we reviewed included details of people’s goals or aspirations. Although we received mostly positive feedback from people about the care they received at the home, we were not assured people were always experiencing positive outcomes in their daily lives. For example, we were not assured people were receiving 1:1 person-centred activities that were meaningful to them or that they were always receiving enough support with personal care to maintain good health. Daily records were not person-centred, reflected only basic tasks and indicated people watched television most days.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We saw some consent forms had been signed by people; however, there was limited evidence to demonstrate consent forms had been signed on behalf of people without the legal safeguards in place. For example, we saw one person’s care plan had been signed by a family member, but we were not assured they had the legal right to do so as there was no evidence they had a Power of Attorney for Health and Welfare in place. We were not assured appropriate best interests decisions were being made when a person lacked the capacity to consent to care and treatment, including that of restrictive practice. For example, we did not see where consent had been considered for the use of bed rails.

During our site visits, we observed staff mostly asking people for consent before providing care and support.