Chestnut Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This was the first assessment of the service since their registration with CQC. We found some improvements where needed in relation to the management of safety checks and the cleanliness of the home. Improvements were also needed to ensure all identified risks were assessed and measures were in place to reduce any risk identified and that people had the necessary protocols in place for their when required medicines. Additional areas of improvement included processes to ensure effective analysis of accidents and incidents and in relation to the induction, training, ongoing support, and monitoring of staff to ensure they had the skills and necessary knowledge to meet people's needs and provide good quality care. The majority of people felt safe at the home and with the staff who supported them. The service had safe systems for pathways and transitions in place.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were given examples of how people’s experience had been improved after learning from accidents. For example, the provider had identified a high number of falls had occurred during a specific time of day and was recruiting an additional member of staff to cover this period.

We received mixed feedback regarding staff awareness of the incident and accident reporting process. The registered manager explained to us that staff would report any incidents and accidents to the nursing or management staff who would follow the provider’s processes. Staff told us learning from incidents was shared amongst the team. Comments included, “We discuss incidents as a team and in handover” and “We review how the incident happened, and discuss how can we stop it happening again, and then review the care plan. Handover is on the handheld device, so staff see this daily, and they click to confirm they have read it.

The service had a process in place for staff to report and record accidents and incidents. However, we were not assured that this process ensured effective analysis of accidents and incidents. This meant opportunities might have been missed to use this information to minimise the potential risk to people from future accidents and incidents. For example, falls were being quantified however records did not always indicate these had been analysed for all possible trends. We discussed this with the registered manager who told us they would ensure all possible trends would be analysed.

People and relatives told us the provider worked well with other agencies and partners to deliver safe care. One person told us that there was a smooth transition when they moved to the service, they said, “I feel settled here and I’ve settled after moving (from another care home).”

To ensure people received safe and continuous care, pre-assessments were carried out before people moved to the service. This included obtaining information from health care professionals. 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.”

A visiting professional told us the staff worked well with them. They told us, “They [staff] were keen to learn from me about [name of person] rather than rely on the paperwork. I told staff all about [name of person’s] nuances and staff have worked with that.”

People were supported to access care and support from other healthcare providers when necessary. Staff referred people to other professionals such as speech and language (SALT), dietician and tissue viability nurse.

Records showed staff responded when people became unwell and sought advice appropriately and in a timely manner.

When people were admitted to hospital for treatment, staff kept in touch with the hospital for regular updates.

People told us they felt safe at the home, with the exception of 1 person who was unable to tell us why they didn’t always feel safe and raised concerns with us about how staff supported them. The registered manager advised this would be investigated. Comments included, “I get on well with everyone here, I feel safe, and I’ve never had any worries. If I did, I’d talk to any of the staff. I know they’d help me, and they’d sort it out, but I’ve never had an issue with anyone or anything” and “I like the staff, I like ribbing them – they do it back. They’re all nice. If I had a problem, I’d tell somebody. They listen, oh yes and they’d sort it out, no problem.” Family members told us they were happy with the care their loved ones received and they felt they were safe. Comments included, “Yes (Name of person) is safe, because they (staff) are looking after her very well, and she gets on with everybody. They put their arms around her, make jokes and (Name of person) responds to them. It’s very pleasing to see, and it makes it easier for me when I have to leave” and “(Name of person) needed to be somewhere safe, as she was unable to care for herself anymore. We’ve no concerns, she is in safe hands and the staff are very good.”

Staff spoken with understood their responsibilities to keep people safe from avoidable abuse, and knew how to report any concerns. Comments included, “If I see somebody doing something to a resident or a procedure that is not being done correctly, something that could cause harm. I would report it. It’s about keeping people safe” and, “If I saw bruising; I would check to see if it had been reported. If not, I would tell the nurse because it might be abuse. Staff said they felt confident to raise any concerns about poor care. One staff member said, “I would log any concerns as an incident, then write a statement to [registered manager and deputy manager]. They both act on things as soon as it happens. If it didn’t happen, I would go to [Operations Manager]. But here it is always dealt with as you would want it to be.”

People were observed to be comfortable in the presence of staff. There was a relaxed and happy atmosphere at the home.

The service had safeguarding policies and procedures in place for staff to follow.

People and their families told us staff supported people to be involved in the support they received. One person said their skin was at risk of becoming sore, but with staff support this was managed well and a family member told us, “I’ve got no concerns or worries. I can see that the staff love (Name of person), I can’t find fault at all. They phone up immediately if something happens.”

People’s families confirmed risks were discussed with them and relevant information was shared. One family member told us the number of falls their family member had experienced were reduced by the level of supervision and support the service provided.

The concerns we identified regarding risk management were discussed with the management team who started to address the issues during the assessment.

Staff knew about identified risks to people. One member of staff told us information about risk was always passed on at handover.

People were observed to be supported in line with their risk assessments. For example, when supporting people with their eating and drinking risk assessment.

We found risk assessments were not always in place when risk was identified. For example, people had not been assessed for the use of flammable creams that would be applied to people’s skin. By day 2 of our assessment, these were in place.

People had not been assessed for the increased risk of bleeding from falls because they had been prescribed anti coagulants. By day 2 of our assessment, these were in place.

People had been assessed for risks such as falls, skin damage, choking and malnutrition. Assessments had been regularly reviewed.

When risks were identified, care plans provided information for staff on how to reduce the risk of harm. For example, some people had been assessed as being at risk of falls. These care plans detailed any mobility aids people used and whether they needed staff support to use them, the importance of keeping rooms clutter free and ensuring people wore well-fitting shoes.

When people were at risk of skin damage, the plans contained information about any pressure relieving equipment in place, and how often staff needed to support people to change position. Position charts we looked at showed people had their position changed in line with care plan guidance.

People spoken with did not raise any concerns with the safety of the building, or the equipment used to support them.

The concerns we identified regarding the environment were discussed with the management team during the assessment who told us they were aware of them. They had a plan to improve the environment for people and would ensure all safety checks were carried out in line with legislation and/or good practice guidance.

The home was a generally pleasant environment. The management team were aware of fixes needed to the environment and they had a plan to improve the this for people.

The service had a system in place to carry out environmental checks and these were generally well maintained.

One staff member went through the checks on the environment they carried out to ensure people’s safety. These included checks on any physical hazards, hot water outlets, shower head descaling, fire prevention and detection equipment and portable electrical appliances.

However, when they were on leave the checks were not carried out. Therefore some checks, such as the weekly fire safety checks, had been missed.

Two staff had been trained to test the safety of portable electrical appliances. Despite these staff testing some items, it was difficult to fit full testing into their other duties. This meant not all electrical items had been tested for safety and this potentially placed people at risk.

People and their families told us they felt there were enough staff most of the time to meet needs, although 2 people told us staff don’t always have time for a ‘chat’. Comments included, “ I get enough help, including at night. I don’t wait long. They (staff) are good, they know what they’re about”, “I get enough help when I need it. I don’t wait very long” and “The ‘girls’ are busy people. Some have a chat, and others will say ‘I’ll come back and talk to you later’ but they don’t.”

People and their families described staff as being skilful in managing care needs, and identified that they were particularly knowledgeable about dementia care. Comments included, “There seem to be enough staff, there are usually 2 or 4 staff around, seemingly for a low number of residents. They have the right skills; in fact they seem to know before I ask them. They anticipate exactly what’s needed. They’re very good” and “(Family member) is in safe hands with dementia (care). They specialise in supporting people with dementia, so they know how to deal with situations and have the right approach. They’re trained to look for things, for changes, they’re switched on. There are always quite a few staff around and some are usually in the sitting room with people.”

During the assessment we discussed training with the management team who explained to us how training completion is monitored and about the process of induction. Following our feedback, the provider told us they made some changes to their systems and processes related to this. Staff told us they felt there were always enough staff on duty. Comments included, “Yes, there are enough staff on duty. If we’re short, the management team are very good at bringing an extra staff member in. Weekends are the same” and, “Yes, since I’ve been here it feels like enough staff.” Staff told us they were happy in their roles and felt well supported.

We observed there were enough staff available to respond to people’s needs. Where people required support, we saw staff were quickly available and anticipated people's needs. We saw call bells were responded to quickly. Staff looked relaxed and not rushed.

Improvements were needed in the induction, training, ongoing support, and monitoring of staff to ensure they had the skills and necessary knowledge to meet people's needs and provide good quality care.

The providers induction and onboarding policy and procedure did not provide clear details regarding the process for this. The operations manager advised this had been addressed during the assessment.

Staff had not always received the training required. Staff had received training in areas considered by the provider as mandatory. Staff had not completed training in person specific areas to enable them to meet people's needs safely. This included catheter care and diabetes training.

The provider did not have a system of oversight to ensure staff accessed training in a timely manner upon commencement of their employment. One newer staff member confirmed they were supporting people alone and had not completed a number of the mandatory training courses.

This staff member, who was new to care, was unaware being enrolled on the care certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme.

Recorded evidence was also not available that this staff member had received an induction when they first started working within the service.

Records showed that some staff competencies and spot checks had been completed in relation to areas such as personal care and medication. These were not available for all staff, and there was not a system of oversight in place to monitor when these required updating.

Staff rotas were based on a dependency tool. The provider had their own team of temporary staff to fill any gaps which meant consistency of care was provided.

There was a safe recruitment process in place.

Although we observed several areas which were not thoroughly clean and hygienic, people told us that they felt cleanliness within the home was very good. Comments included, “It’s lovely and clean here, they keep the room very nice, and I think they wear aprons and gloves when they wash me” and, “The cleaning is adequate, they come in every day and I’ve no complaints about that at all.”

The concerns we identified regarding infection prevention and control were discussed with the management team who started to address the issues during the assessment.

Staff said they had completed training in infection prevention and control.

Staff knew when to wear personal protective equipment (PPE) and when to change it, however our observations did not support this. Staff also knew how to dispose of PPE safely.

During our visits to the home we saw several areas which were not thoroughly clean and hygienic. For example, there was evidence of a poor cleaning regime such as cobwebs being visible in several areas and dead insects on windowsills, bathroom floors were in a poor state of repair and 1 floor was an infection control risk due to it being split. Our observations also determined that staff were not always completing hand hygiene, wearing Personal Protective Equipment (PPE), or putting on/ taking off PPE correctly.

Improvements were needed in the service’s infection prevention and control processes. On the first day of the assessment an infection control risk assessment was not in place. The registered manager actioned this during the assessment. Cleaning schedules were not always in place to ensure effective cleaning of the home. For example, there was no cleaning schedules in place for the stairwells. Other cleaning schedules that were in place were not always detailed to ensure effective cleaning. For example, the communal areas schedule stated to clean the specific communal rooms. Individual tasks to be completed were not recorded. There were gaps in the cleaning schedules for a number of bedrooms. For example, records stated 1 bedroom had not been cleaned for 10 days, and another had not been cleaned for 6 days. The service was recruiting additional housekeeping staff to ensure significant improvements were made to cleaning regimes.

People’s medicines were seen to be given in a safe and caring way.

Staff were knowledgeable about people, their medicines and their preferences.

People’s medicines were kept under review by the pharmacist from the surgery.

Staff told us they were well supported with medicines by the managers, and that generally the systems worked well. One said they had ‘never felt so well supported’. They liked the electronic system being used now that they had got used to it.

Staff told us they received medicines training updates, including the use of the electronic system before it was implemented. They said that they had competency assessments (and we saw records that showed these had been completed).

Electronic MAR charts were used and showed that medicines were given as prescribed.

There were suitable arrangements in place for the storage, and disposal of medicines, including those needing cold storage and controlled drugs.

Regular audits took place to identify areas for improvement.

Detailed PRN protocols were not always in place for these medicines, however the manager ensured these had been completed during the assessment.