Chestnut Lodge

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

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

Staff understood what was meant by person centred care and knew people well. This was confirmed by people and their relatives.

The service complied with the Accessible Information Standard by meeting people’s information and communication needs.

The provider had policies and processes in place which enabled them to continuously seek feedback from people, however some improvements were needed in how the service assured people their feedback was being followed.

When necessary, people received good and compasionate end of life and support.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff knew their needs well, had a good understanding of their individual needs and made sure those needs were met. One person told us, “When I first came, they asked me a lot of questions about everything. Things like what foods I prefer, what I like and don’t like. They wrote it all down and they do stick to it – but they also ask me every day what I’d prefer to do, they don’t assume they know.” A relative also told us, “They really do listen and are very person centred, they’ve learned about (Name of person’s) needs and quirks and he has care when he wants it and as he wants it. If that’s a drink of cold milk, or an ice pop, a spoonful of yoghurt, or ice cubes to suck (as he wants very cold things), that’s what he has. They’ll offer a shave but if he doesn’t want it, they’ll say, ‘maybe later’ and will ask him again”.

Staff understood what was meant by person centred care. Comments included, “We don’t make people do things, it’s not institutionalised here. We prompt, we encourage, and we ask, but it’s about choice, the resident’s choice”, “We had one person who other homes couldn’t support, but he is now very settled here. We are a small home compared to other homes. It’s all about giving time and getting to know people” and, “Person centred care is based on their needs, what they need.”

The management team told us the service had sought additional support via translators when needed for complex decisions, to ensure people were fully involved.

We saw people received care and support specific to their needs, preferences, and routines. For example we observed people being offered a choice of meals using ‘show plates’ with the two main course options dished up and we observed staff discussing with a person where they would like to have a care review meeting that was planned for later that day.

People received care from a range of relevant health professionals to support their individual needs. People were supported to attend appointments when required.

People's care plans contained information about who was involved in their care and how and when they should be consulted.

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.”

Staff told us they knew how to escalate any changes in people's needs in order to ensure referrals were made to the relevant health professionals promptly.

A visiting health professional told us they visited regularly for review meetings with the person they supported, the staff at the service and other professionals involved in the person’s care and support.

The provider had a process in place for making referrals to and working alongside other services to support people's needs. Relevant information was documented in people's care plans.

The provider and registered manager gave us examples of positive feedback they received from a healthcare agency and the local GP.

People and their families told us they had access to information in their preferred communication format. One relative explained how the service used google translate to ensure their relative understands.

Records showed people’s families were invited to attend care plan review meetings.

When people’s health deteriorated, records showed staff contacted family members and kept them informed.

Staff gave examples of how they supported people with their communication needs. This included using 2 objects to support people to make choices, using written words for a person who was deaf and using google translate where English was not a person’s first language.

People’s communication needs were assessed. The service was proactive in finding ways to support people whose first language was not English.

The service used picture cards and translation services when needed, to support people to be able to communicate effectively with staff.

People, their families and advocates were involved in care planning and were invited to attend care plan reviews.

Records showed people chose what time to get up and when to go to bed. If people chose to sleep in during the day.

People and their families described positive relationships with the staff and expressed confidence that they could speak to someone in the team, if they experienced any problems. One person told us, “I feel comfortable, the carers are very good, and I feel safe with them. If I had a worry, I’d speak to someone in authority, probably one of the ladies, who are all very pleasant.” A relative told us, “I’d feel comfortable raising a concern or complaint. I know it would be investigated and followed up. It would never be ignored.”

Two people told us when they’d experienced a problem with staff, which had been reported, the concerns were dealt with.

Staff told us they listened to and involved people. Comments included, “People are treated right, they have got their say if they don't like or want something, if they don't want something they don't have to have it” and, “Theres a plan in place, tell them what it means and give time to think, people have a right to be informed every step of the way.”

The provider had systems in place to manage complaints. Complaints were logged, investigated, and resolved. Lessons learned from complaints were shared with staff and processes were reviewed accordingly.

People and their families told us they could access the care, support, and treatment they needed when they need it. One relative told us, “I’m very happy with the medical care and the access to the GP.”

People were not discriminated against. Staff told us and records showed people were offered choices and that staff respected those choices.

The provider worked with other professionals to ensure people had equal access to care. A visiting professional told us they were invited to attend meetings to review a person’s support needs.

The provider had processes in place to ensure people were able to access the care, support and treatment they needed when they needed it.

When people’s health deteriorated, staff acted promptly and sought medical advice when needed.

The service supported people to attend other appointments as needed.

People told us their feedback was sought, although some people didn’t always feel that actions were always carried through. Comments included, “They give you a questionnaire for your views, and they ask if you’re happy regularly. They listen to your views, I feel they really do”, “ We talk about care about once a week, they ask you if you’re happy and if everything is alright, just with whichever staff is on duty. We have a meeting sometimes, they’re alright, they do listen to you and ask about things like what we’d like on the menu. I don’t think they always do a lot about it” and, “They have meetings, they’re quite good and they ask you what you’d like changed. I said I’d like steak and kidney pie, but I haven’t had it on the menu yet. They’re about every 6 months, I think. They talk to you about the care plan, I’m happy with all of that.”

Staff gave examples of how they supported people with their communication needs to support understanding and ensure equity in experiences and outcomes.

The provider had processes in place which enabled them to seek feedback from people, although people told us they felt feedback given was not always followed through.

Processes were also in place to ensure people’s rights and choices were promoted. This included communication support guidelines for each individual. These provided details regarding how best to communicate with people to ensure they were not disadvantaged because of communication needs.

People and their relatives told us they were supported to make decisions about their preferences for end-of-life care. Comments included, “We have discussed the care plan and I’m happy with it; the tough decisions (about End of life care planning) I made with my son, and they helped me a lot, to think about that” and “We’ve talked about End of Life and planning, both with the staff and with (family member).”

Staff told us they supported people to plan for important life changes. The management team told us a referral had been raised with a translator to support a person to communicate their wishes in relation to end-of-life.

The registered manager was passionate about delivering compassionate end of life care. They told us; “If you can’t do death and beyond you should not be in the job.” They talked to us about a person they supported to arrange a funeral for as they did not have anyone involved in their life and no means to organise this.

Processes were in place to ensure people and their families were involved in end-of-life planning. End of life plans were in place that included information about people’s cultural and spiritual preferences.

The service worked closely with the GP practice to ensure palliative care medication was prescribed in advance.

The service had a good relationship with the local hospice.