We carried out a review of the data available to us about Chestnut Lodge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Chestnut Lodge Care Home, you can give feedback on this service.
Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people living with dementia. There were 57 people living in the service at the time of our inspection visit.
People’s experience of using this service and what we found
Risks to people were not well managed. We found where people had known health conditions such as diabetes, risk assessments were not robust enough to give staff the information they required. Risk assessments were not always up to date and reflect a person’s current needs.
People had medicines prescribed as and when they were required ‘PRN’ however, it was not clear these had been effective. Appropriate recording was not carried out to identify why these medicines were given and if they had the desired effect. PRN protocols were not in place for all medicines.
Lessons were not always learnt when things went wrong. Audits were carried out on accident and incidents that occurred however, patterns and trends were not looked at to try and reduce falls.
The management team were responsive to the concerns highlighted to them on the inspection and acted quickly to rectify shortfalls found.
Staff were recruited safely. Some feedback we received highlighted that at times the service can appear busy especially the sound of the call bells. A dependency tool was used to assess how many staff were required to look after people safely. However, the registered manager identified where some improvements could be made to make the tool more effective.
People and relatives told us they felt safe using the service. Staff knew how to recognise signs of abuse and knew where to report any concerns. The registered manager referred concerns to the local authority safeguarding team.
Infection control procedures were followed in the service. We observed regular cleaning being carried out and relatives felt the home was clean when they visited.
There was a positive culture within the service and people, staff and the relatives spoke highly of the management team. Staff felt the manager was approachable and always had their door open if they had concerns.
Quality assurance audits were being carried out and some improvements have been made since our inspection to ensure a more effective oversight at the service. Actions were taken to make changes to the call bell system after feedback about the noise for people. People, relatives were encouraged to feedback about the service through questionnaires and meetings. This encouraged the management team to make changes where necessary.
The registered manager was clear about their roles and responsibilities. Notifications were sent into the care quality commission in line with regulations. The service was open and transparent and followed the duty of candour when things went wrong.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 January 2020)
At our last inspection we recommended that the provider consult national guidance about the safe administration of medicines, due to medicines not being given as prescribed. At this inspection we found medicines were being administered according to prescription guidelines. Improvements were made and medicine errors were not occurring as they were.
Why we inspected
We received concerns in relation to staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chestnut Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people who live with dementia. There were 38 people living in the service at the time of our inspection visit.
People's experience of using the service and what we found
People and their relatives were positive about the service. A person said, “I like the staff as they’re kind to me.” A relative said, "The staff are absolutely brilliant with my family member, know their little ways and can get on with them better than I can.”
Medicines had not always been administered in the right way. However, no one had experienced harm and robust steps had been taken to put things right. We have made a recommendation about the safe management of medicines.
People were safeguarded from the risk of abuse. People received safe care and treatment in line with national guidance from care staff who had the knowledge and skills they needed. There were enough care staff on duty and safe recruitment practices were in place. Lessons had been learned when accidents and near misses had occurred and infection was prevented and controlled. People had been assisted to obtain medical advice when necessary.
People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.
People were assisted to eat and drink enough and the accommodation was homely.
People were treated with kindness and their privacy was respected. People were supported to express their views about subjects important to them.
People were consulted about their care and had been given information in an accessible way. People were supported to pursue their hobbies and avoid the risk of social isolation. People were treated with compassion at the end of their lives so they had a dignified death.
Quality checks had been completed and people had been consulted about the development of the service. Good team work was encouraged and joint working was promoted.
For more details, please read the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Requires Improvement (published 22 January 2019).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people who live with dementia. There were 33 people living in the service at the time of our inspection visit.
The service was run by a company who was the registered provider. The former registered manager had left her post shortly before the inspection. The registered provider had appointed a new manager who was in post and who had applied to us to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
At the last inspection on 3 April 2018 the overall rating of the service was, ‘Inadequate’ as a result of which the service was placed into ‘special measures’. We found that there were seven breaches of regulations. This was because there were serious shortfalls in the arrangements that had been made to provide people with safe care and treatment. This included oversights that had reduced the level of fire safety protection in the service and in the arrangements to prevent avoidable accidents. There were also shortfalls in that sufficient care staff had not always been deployed to enable people to promptly receive all the care they needed and had the right to expect. In addition to this, the registered provider had not robustly completed background checks on all new members of staff to ensure that they were suitable and trustworthy people to be employed in the service. Another breach of regulations had occurred because there were defects in the accommodation that had resulted for poor maintenance. Further breaches of regulations had occurred because people had not always received person-centred care and had not always had their dignity promoted. The last breach of regulations was because there were serious shortfalls in the systems and processes used to monitor and improve the service including consulting with people to obtain feedback about suggested improvements.
We told the registered provider to send us each month an action plan stating what improvements they had made and intended to make to address our concerns. The registered provider complied with this requirement.
At the present inspection we found that sufficient progress had been achieved to meet all of the breaches of regulations. Sufficient provision had been made to provide safe care and treatment. However, more progress still needed to be made to ensure that one person’s medicines were administered in the right way. In addition to this, further developments were needed to enable the service to learn from the occurrence of accidents and incidents so that steps could be taken to reduce the likelihood of the same thing happening again. Although on most days the number of care staff on duty had been increased there were still occasions when the registered provider had not deployed all of the care staff they considered to be necessary. Suitable arrangements were in place to recruit and select new members of staff. Although on most occasions people received person-centred care that promoted their dignity more needed to be done to address shortfalls. In practice, people were consulted about the care they received. However, more still needed to be done to provide people with user-friendly information to support them to make and review decisions about their care. Significant improvements had been made to the accommodation but additional improvements were still required. The systems and processes used to assess and monitor the operation of the service had been strengthened. However, additional steps needed to be taken to ensure the progress made in the service was further developed and sustained.
Our other findings were as follows. Suitable arrangements had not been made to ensure that three medicines were managed in line with national guidelines. Good standards of hygiene were achieved to prevent and control the risk of infection.
Appropriate arrangements were in place that were designed to assess people’s needs and choices so that care achieved effective outcomes. This included providing people with the reassurance they needed if they became distressed. Care staff knew how to provide practical assistance for people in the right way and had received training and guidance. People were helped to eat and drink enough to maintain a balanced diet. Suitable provision had been made to help people receive coordinated care when they moved between different services. People had been supported to access all of the healthcare services they needed. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.
People had been supported by relatives and representatives to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.
People received practical assistance to complete everyday tasks and suitable arrangements had been made to promote equality and diversity. There were arrangements in place to investigate and resolve complaints as quickly as possible. Suitable steps had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.
The manager had promoted an open and inclusive culture in the service. Suitable arrangements had been made to ensure that regulatory requirements were met. The manager was actively working in partnership with other agencies to support the development of joined-up care.
Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people who live with dementia. There were 41 people living in the service at the time of our inspection visit.
The service was run by a company who was the registered provider. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.
At the last comprehensive inspection on 14 December 2015 the overall rating of the service was, ‘Good’. However, after this we received concerning information that people were not always receiving safe care and treatment. We completed a focused inspection on 21 June 2017 to check that people were being kept safe. We found there were two breaches of regulations. This was because suitable arrangements had not been made to ensure that people consistently received safe care and treatment. Also, the registered persons had not suitably assessed, monitored and improved the quality and safety of the service given the shortfalls that had occurred in the provision of safe care and treatment.
We told the registered persons to take action to make improvements to address each of our concerns. However, the registered persons failed to submit written information to us saying what action they intended to take to enable the breaches of regulations to be met.
At the present inspection we found that sufficient steps had not been taken to address either of these breaches. This was because there were serious shortfalls in the arrangements used to provide people with safe care and treatment that had significantly increased the risk of people experiencing harm. There were also serious shortfalls in the systems and processes used by the registered persons to assess, monitor and improve the quality and safety of the service. This had resulted in the persistence of a large number of problems in the running of the service that had reduced people's ability to receive the high quality care to which they were entitled. In addition, the registered manager did not appreciate the seriousness of the concerns we had identified and there was no realistic prospect of them quickly being put right.
There were five additional breaches of the regulations. Robust recruitment checks had not been completed to ensure that that only people of good character were employed to work in the service. The accommodation was not designed, adapted and decorated to meet people’s needs and expectations. Care staff had not received all of the training and guidance they needed in order to know how to care for people in the right way. People had not always had their dignity respected and suitable provision had not been made to ensure that people always received person-centred care.
As a result of these breaches of regulations the overall rating for this service is ‘Inadequate’ and the service is therefore in, ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered persons’ registration of the service, will be inspected again within six months. The expectation is that registered persons found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of ‘Inadequate’ for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. When necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of ‘Inadequate’ for any key question or overall, we will take action to prevent the registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
We also found that there were other shortfalls in the service. Sufficient care staff had not always been deployed. We have made a recommendation about the deployment of care staff. Suitable provision had not been made to ensure that people consistently received care in line with national guidelines. This included supporting people who lived with dementia if they became distressed. We have made a recommendation about ensuring that care staff have the knowledge and skills to provide enriched care for people who live with dementia. Complaints and concerns had not consistently been managed in the right way to reassure people that issues would be addressed. We have made a recommendation about the systems and processes used to respond to complaints and concerns. In addition, care staff had not identified as a cause for concern the numerous examples of poor practice we identified. This lack of insight had contributed to people not always receiving the safe and person-centred care to which they were entitled.
Our other findings were as follows: Medicines were managed safely and people were safeguarded from situations in which they may experience direct abuse. There were suitable arrangements to obtain consent so that people only received lawful care. People receive coordinated care when they moved between different services and they had been helped to obtain any healthcare they needed.
People had been supported to make decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential written information was managed in the right way.
Arrangements had been made to promote equality and diversity. This included promoting the citizenship rights of people if they chose gay, lesbian, transgender and bisexual life-course identities. Provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.
Care staff had been helped to understand their responsibilities to develop good team work. The registered persons were actively working in partnership with other agencies to support the development of joined-up care. The quality ratings we gave the service at our last inspection had been displayed and the registered persons had told us about significant incidents that had occurred in the service.
At this inspection seven breaches, including two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. Full information about CQC’s regulatory response to the breaches of regulations relating to the breaches will be added to our report after any representations and appeals have been concluded.
This inspection was carried out on 21 June 2017. The service was registered to provide accommodation with care to older people and those living with dementia. At the time of our inspection there were 45 people using the service.
There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At this inspection we found that the registered provider had not ensured adequate fire safety measures in the service. An action plan to address a number of remedial actions identified by Kent Fire and Rescue Service was underway. Whilst immediate risks were reduced by action they had taken the full action plan was not yet complete.
Some risks to individuals’ welfare and safety had been assessed and minimised. Other areas of risk had not been identified. This included risks associated with people being unable to use the call bell in their bedroom to seek assistance.
The registered provider did not have effective systems in operation for identifying shortfalls in the safety of the premises.
The registered manager had not always ensured that accurate and complete records were maintained to enable the delivery of care and changes in individual’s needs to be monitored.
People told us they felt safe using the service. Staff knew what action they needed to take to keep people safe from harm and abuse.
There were enough staff working in the service to meet people’s needs. Staff responded quickly when people asked for, or needed support. Staff were recruited following robust procedures to ensure they were safe and suitable to work with people.
The service was kept clean and hygienic to reduce the risk of infection. Equipment used when providing care was properly maintained and in working order.
People were supported to manage their medicines safely.
The registered manager provided staff with clear and directive leadership. Staff understood their responsibilities and were clear about the standards of care they were expected to provide.
There was an open and positive culture that focussed on people. Staff knew people well and supported them in a way that respected their individuality.
You can see what action we told the provider to take at the back of the full version of the report.
This inspection was carried out on 14 December 2015 by three inspectors. It was an unannounced inspection. There were 28 people using the service at the time of the inspection.
There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff were exceptional in providing a caring service that treated people with kindness and compassion and recognised their individuality. They knew each person well and understood how to meet their support and communication needs. People spoke extremely highly of the staff and the registered manager. One person told us, “The manager and care staff are wonderful. They really care for the people they look after.” Another person commented, “It’s the staff that make the difference. They just glow!” People’s privacy was respected and people were assisted in a way that respected their dignity.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.
Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to address patterns in falls and to reduce the risks to people’s safety. There were usually sufficient staff on duty to meet people’s needs, however, staff sickness on the day of the inspection left the service short. We have made a recommendation about this. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place to ensure staff were suitable to work with people.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
The service was well maintained and designed to meet the needs of the people that used it. The use of signage had helped people find their way around and had increased their independence.
Staff were knowledgeable and skilled in meeting people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and had an annual appraisal of their performance. Staff felt supported in their roles and were clear about their responsibilities. This ensured they were supported to work to the expected standards.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. Staff sought and obtained people’s consent before they helped them.
The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.
People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend reviews that were scheduled. People were at the heart of the service. Clear information about the home, the facilities, and how to complain was provided to people and visitors.
People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.
People were involved in the planning of activities that responded to their individual needs. A broad range of activities was available that ways to keep people occupied and stimulated. The planning of activities took account of latest research on dementia care. Varied outings were available and attention was paid to individual social and psychological needs.
Staff told us they felt valued by the registered manager and supported to provide a high quality service. The registered manager was open and transparent in their approach. Emphasis was placed on continuous improvement of the service.
The registered manager kept up to date with any changes in legislation that might affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.