Updated 9 April 2025
Date of assessment: 30 April to 20 May 2025.
We undertook this responsive assessment to check on concerns about peoples' safety, well-being and the environment. We found a breach of the legal regulations in relation to governance and record keeping. Governance systems and audits were not effective in identifying or addressing areas for improvement. Records were not always in place or sufficiently detailed to provide effective guidance for staff.
A new registered manager had been in post for approximately 5 months at the time of our inspection. People and staff were positive about their capability and approach. The registered manager recognised the shortfalls in the service, had made improvements and had plans to continue with their action plan. However, time was needed to implement and sustain these.
At our last inspection we identified a breach in relation to safeguarding. At this assessment, improvements had been made, and the provider was no longer in breach of regulation. However, the principles of the Mental Capacity Act 2005 were not always followed when restrictive practice took place. The registered manager addressed this following our inspection.
Care and medicines records needed improvements, but staff knew people well. People and relatives told us risks and medicines were safely managed.
Recruitment processes needed improvements to ensure staff were suitable to work with vulnerable adults. The registered manager implemented a robust process after our inspection. There was enough skilled and competent staff to meet people’s needs.
The provider took appropriate action to reduce environmental risks. Appropriate action to reduce potential environmental risks was taken. The environment was clean and effective infection control processes were in place.
People and staff described an open and positive culture. Staff told us they felt valued and enjoyed working at Chatterwood Nursing Home.