Chestnut Lodge

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

This was the first assessment of the service since their registration with CQC.

Systems were in place to seek consent from people; however this was not always sought in line with guidance.

Improvements were required to ensure people received a personalised mealtime experience.

People received care that was based on their assessed individual needs in line with evidence based guidance.

People’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people and their families said they were involved in an assessment when they first came to the service. Comments included, “We had an assessment discussion, it covered everything about (Name), her needs, likes and dislikes about food and drink, and what she enjoys doing. They know her well”, “(Name) had been here for respite care and now is here permanently, so they already knew us. We discussed all (name’s) needs before she came here, and they’ve been learning more about her as she settles” and “When I first came to look around, I knew this was where I wanted (family member) to come. I was able to talk to (the manager) about (family member’s) needs and he helped me to get him here. When they did the assessment, (family member) and I sat together, but I let him answer, because his voice matters. They were respectful of that.”

Staff told us pre-assessments were carried out face to face. One staff member said, “All the nurses do the assessments. We check through all their needs. If they’re at home the family are really informative, we get GP summaries. We then discuss it as a team whether we can or not meet the person’s needs.”

The registered manager told us that as well as considering the individual needs of a person they are considering for admission; they also consider the impact it would have on the others already living at the home.

Records showed pre-assessments were carried out and were used as a baseline of information when people moved into the service.

Care plans were regularly reviewed. When people’s needs changed care plans were updated to reflect this. There was a system in place through which all aspects of people’s care and support needs were reviewed monthly, involving the person and if appropriate their relatives.

We observed mealtimes on both days of our visits. Whilst people appeared to be appropriately supported, some people could not have a choice of where they ate their meals due to limited dining space. On the second day, a staff member was observed to be sat on the floor whilst supporting someone with their lunch also due to the limited space. We also noted people were unable to serve themselves if they were able, or add any condiments to their meals because they were not available for people to use. Each person we observed at mealtimes drank from plastic beakers. There was no clear reason for everyone to use these.

People told us the food was very good and that they had plenty of cold and hot drinks offered throughout the day. One person told us, “The food is very good, it’s nourishing and there’s always plenty to eat and to drink. I don’t eat cake, so in the afternoon, I might have a yoghurt, or some fruit instead.”

We observed that staff made hot drinks for people, on request, in the communal areas, outside of set times.

The concerns we identified regarding people’s mealtime experience were discussed with the management team who started to address the issues during the assessment. The service was routinely carrying out an audit of the mealtime experience, however our concerns had not been addressed through these.

The management team told us the provider was undertaking projects such as introducing a dementia strategy across all homes, completing observations to capture the experiences of people who may not be able to express their views. They were also completing care quality assessments to support them in meeting best practice guidance and standards.

Records viewed showed a process for staff to respond to people’s changing needs. When people became unwell for example, staff monitored people’s vital signs and sought medical advice when necessary. The service used a recognised early warning score (NEWS) to monitor when people’s health was deteriorating. NEWS is a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes.

We saw records that showed staff responded to people’s deteriorating health.

Staff were proactive at seeking medical advice when required.

Other specialist advice and support was sought when required, such as tissue viability support.

People’s nutritional and hydration needs were met.

People had their weight monitored.

Some people were having their food and fluid intake monitored and records we looked at showed people had enough to eat and drink.

Care plans included details of any adapted cutlery people used.

Some people had urinary catheters in situ. In these cases, care plans provided clear guidance for staff on how to manage the catheter and how to monitor and prevent infection.

People’s cultural needs were considered.

A visiting relative said their loved one had initially moved to the home for a temporary period of time. When it was decided they wanted to stay permanently, the home had worked well with other organisations to ensure they were able to stay living at the service.

Staff told us they worked closely as a team. There was a handover at the start and finish of each shift and staff told us they all attended this. One staff member said, “All staff attend handover including the manager and deputy. Everything we need to know is discussed.”

Staff described what they would do if someone fell for example. One staff member said, “I’ve done my seizure training. If someone had a seizure, I would ring the emergency bell, then get the resident into the recovery position with a pillow and wait with them until the nurse gets there.”

A visiting professional said, “[Name of person’s] health needs are met here. Their knee problems and eye problems have all been dealt with. From a mental health perspective, staff have managed [name of person] well. All their needs are met and monitored.”

Care plans informed staff how to monitor people with specific health conditions and when to escalate concerns. For example, when people were at risk of seizures, the plans described how people might present and the action staff should take.

The service worked well with the local GP surgery. Staff told us a member of the surgery team visited when needed. There was a process in place where nurses referred people to be reviewed.

People and their families told us that medical care was very good, and that staff picked up on any changes in people’s condition and took appropriate action. Comments included, “(Name of person) hasn’t been ill really, but they always let me know if anything changes and I feel confident they’d contact the Dr if needed” and, “If (name of person) isn’t well, 100% they pick up on any issues. For example, if his blood pressure is low.”

Staff confirmed they were aware of the support people needed in relation to supporting them to live healthier lives. One staff member said, “Everyone I look after has their teeth cleaned every day. I check people have had their teeth cleaned.”

The registered manager told us they provided people with a range of activities to support healthier lives, such as exercise and mental health classes as well as small reminiscing trips in the community.

People were supported to attend appointments when required.

The service had links with the local dementia team and referred people for a formal diagnosis if they did not already have one. One staff member said, “The type of dementia people have, affects the support they might need.”

Records showed people’s oral health was assessed.

Care plans informed staff whether people needed support with oral health and when they did, records showed support was provided.

People experienced good outcomes because of the support provided to them. One visitor said they thought their relative’s health and general wellbeing had improved significantly since being at Chestnut Lodge.

The management team gave examples of good new stories which had a positive impact on people’s health and wellbeing, and improved their quality of life.

Staff told us there was a handover at the start and finish of each shift and they all attended this, information was shared to ensure peoples experiences are improved. Comments included, “All staff attend handover including the manager and deputy. Everything we need to know is discussed” and “We try to get better all the time.”

Care plans were reviewed with people and family members to monitor their effectiveness.

People’s clinical needs were discussed at weekly nurse and clinical meetings.

During our visits to the home, we saw staff always asked people about their preferences and if they were happy to be helped. People and their families also told us they received care and support with their consent. Comments included, “They always come and ask me what I want, before they do anything” and “(Name of person) knows what is happening, what he wants and if he doesn’t want something, he refuses. The staff will offer care and if he doesn’t want it at that time, they’ll come back later. They respect his wishes.”

The concerns we identified regarding the assessment of people’s mental capacity were discussed with the management team who started to address the issues during the assessment.

Although staff spoken with understood the principles of the Mental Capacity Act 2005, they were not aware of DOL’s and who within the home was subject to these.

Staff understood the importance of gaining people’s consent. We saw staff ask people if they wanted to take part in activities for example, and heard staff ask people where they wanted to sit. One staff member said, “I always offer and ask before doing anything regardless of whether I think the person understands me. If someone refused care, I would try again and explain exactly why I thought they needed my help.”

Systems were in place to seek consent from people; however, this was not always sought in line with guidance. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests (BI) and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Although some mental capacity assessments were decision specific, not all were. For example, people had a single assessment carried out for care, sharing information and photographs, rather than 3 separate assessments. There was CCTV in communal areas. Although staff told us people were told about this when they came to the service, there was nothing documented to show people consented to this, or if they had been informed if the CCTV was recording pictures only or sound as well. Some people had bed rails and sensor beams in use. People’s mental capacity to consent to this had not been assessed. There was nothing documented to show if staff had considered other less restrictive options. We discussed this with the deputy manager who said they would review mental capacity assessments and best interest documentation for people. The service had assessed people’s capacity to take part in discussions about their future care wishes, including resuscitation decisions. This meant people’s wishes were considered in important decision-making processes. DoLS applications were being submitted for authorisation.