Archived: Chestnut Lodge Care Home

Updated 17 September 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared by the Coroner with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks. The local authority were aware of this death at the time of our inspection.

Inspection team: This inspection was carried out by an Inspector, an Expert by Experience and an Assistant Inspector. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service, for example older people and people living with dementia.

Service and service type: Chestnut Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 15 people in an adapted building of three floors.

The service had a nominated individual who was also the manager registered with the Care Quality Commission for this service at the time of the inspection. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.’

What we did: Before our inspection visit, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. As part of our inspection planning, we also sought feedback from the local authority quality monitoring team and looked for information available from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We referred to other information we held about the service to help inform our inspection planning. This included notifications, which contain information about important events which the provider is required to send us by law. We also reviewed monthly reports submitted by the provider, which they were required to send to us as part of our enforcement action undertaken following our last inspection.

During our inspection, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with 13 people living at the home and five visiting friends and relatives. We spoke with five care staff and the registered provider who is also the registered manager. We spoke with two visiting healthcare professionals and a visiting Church of England minister. We also looked at records related to 10 people’s care and recruitment files for three staff members. We sampled records related to the quality and safety of the service including incident records, audits, training records, medicines management audits and charts, staffing, compliments and risk management.

Updated 17 September 2019

About the service: Chestnut Lodge Care Home is a residential care home that was providing personal and nursing care to up to 15 people aged 65 and over. 15 people lived at the home at the time of the inspection.

People’s experience of using this service:

Although most people and relatives told us they felt the home was safe, incidents including altercations between people were not always responded appropriately to, to help protect people from risk of harm and abuse. People’s risks were not effectively managed to keep people safe at all times. We identified a breach of the regulations due to serious concerns including around fire safety, the premises and managing people’s choking risks. The provider had failed to adequately learn from a choking incident and a person’s death in September 2018 and people were exposed to significant risk of harm. Medicines management and infection control processes were not consistently safe. We also found staff were not always suitably deployed to meet all people’s needs.

Although most people spoke positively about their care and staff told us they felt supported, people’s needs were not all effectively monitored and met. The provider had sought relevant training and had further training plans underway and often sought advice and input from healthcare professionals. However, this guidance and learning was not effectively shared with staff and embedded in people’s care in practice. Staff were not given clear guidance and information, to inform their knowledge and effective support to meet people’s needs. People’s risks were not always promptly escalated and shared with healthcare professionals to promote their health.

The provider had continued to improve the premises since the last inspection to ensure the home was safe and suitable for people. However, they had not fully considered people’s individual needs, for example, they had not addressed a recommendation we made at our last inspection to ensure the environment was tailored around the needs of people living with dementia.

People spoke positively about the food but were not involved in basic choices such as menu planning. The service was not working within the principles of the Mental Capacity Act and people’s choices and rights were not promoted as far as possible. Concerns identified at our last inspection had not been resolved, for example, people were still not routinely involved in decisions about their care. People’s independence was promoted, and we saw examples of how people’s diverse needs and preferences were recognised, however staff were still not consistently caring because people were not all treated with respect and dignity at all times.

People and relatives spoke positively about the home overall and people felt their needs were met. We saw examples of how some people’s individual needs and interests were considered in their care. Care planning and admissions processes had however failed to identify all people’s support needs and risks, and ensure these could be safely managed. The provider planned to improve their care planning processes including end-of-life care to ensure people’s needs and wishes were captured. There had been no complaints at the home, however relatives had submitted compliments.

People and relatives spoke positively about the provider’s welcoming approach. However, we identified a continued breach of the regulations due to the provider’s poor systems and oversight which failed to adequately assess, monitor and improve the service. The provider did not demonstrate sufficient understanding of good governance and had failed to identify significant shortfalls which put people at risk of harm. Sufficient improvements had not been made since the last inspection and despite previous enforcement action.

More information is in the full report.

Rating at last inspection: Requires Improvement (January 2018)

Why we inspected: We followed up on the provider’s last inspection rating and to follow up on enforcement action we carried out following the last inspection. The inspection was also prompted in part by notification from the provider and Coroner, of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared by the Coroner with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks. Further information is in the full report

Enforcement: After our last inspection, we carried out enforcement action to impose conditions on the provider’s registration, which required the provider to submit monthly reports to the Commission in relation to their quality assurance activities. These improvements had not been sufficient to drive and sustain improvements to the provider’s governance and we found further concerns at this inspection. The provider had also not always submitted their reports to the Commission as required and we prompted them to do so.

During this inspection, we took urgent enforcement action to impose further conditions on the provider’s registration. This prevented the provider from admitting any more people to the home and required the provider to have our written approval for people to be admitted or readmitted to the home, and to inform us when emergency services were called for anybody living at the home.

Follow up: During and after our inspection we raised our concerns about the provider with relevant partner agencies including the local authority. We have continued to monitor the service, to request information from the provider and to liaise with the local authority.

The overall rating for this registered provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration, if we have not taken this enforcement action already.

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 provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve and similar action may have been taken already. This service will continue to be kept under review and, if needed, could be escalated to further urgent enforcement action. Where 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 provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk