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Archived: Chestnut Lodge Care Home Inadequate


Inspection carried out on 17 April 2019

During a routine inspection

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 e

Inspection carried out on 17 January 2018

During a routine inspection

This inspection took place on 17 and 18 January 2018 and was unannounced. This was the provider’s first inspection since changes to their registration on 17 January 2018. This inspection found improvements were required across each of the five key questions and the provider was in breach of the regulations.

Chestnut Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide personal care and accommodation for up to 15 older people. At the time of our inspection, there were 12 people living at the home and one person on respite stay.

We found concerns which put people at risk of unsafe care and support. Some areas of the home were not kept clean or well maintained. We identified risks of poor infection control and tripping hazards which health and safety checks had not identified. Recruitment processes were not always completed as required to assess and ensure the suitability of all staff.

We identified some good examples of safe practice and people told us they felt safe. People were supported to take their medicines safely and there were enough staff to meet their needs. Incidents at the home were reviewed to prevent future reoccurrences and help ensure people’s safety. Safeguarding training and policies had recently been updated to help all staff become confident on how to recognise and report abuse.

People spoke positively about their care. Staff told us they felt supported and equipped for their roles, although improvements were needed to ensure support remained effective as people’s needs become more complex. Most staff were familiar with people’s needs and how to support them well although some staff knowledge was inconsistent. Further support and guidance would help build on training provided in relation to people’s individual needs. Although the provider was making continued improvements in this area, the design and décor of the home was not always safe or developed according to the needs of some people living with dementia.

We have made a recommendation about dementia care, including activity planning, care planning and the design of the home to help meet all people’s needs.

People were offered some choices and the provider had recognised requirements of the MCA. People were supported to have their health needs monitored and to access additional healthcare support as needed. Although people spoke positively about meals at the home, they were not involved in deciding what should be on the menu to ensure this could always reflect their preferences. People told us they had enough to drink and expressed satisfaction with the meals and drinks on offer.

People told us staff were kind and caring, and we saw caring interactions and good relationships between people and staff. However, the approach of some staff, although well intended, did not always promote people’s dignity, privacy and independence as far as possible. We also found systems were not in place to enable people to regularly discuss and make decisions about their care. This did not help ensure people’s needs and wishes would always be met. This meant the service was not consistently caring.

We saw good examples of how people’s support needs and preferences were met and people’s feedback reflected this. However, care planning systems were not in place to review and discuss people’s care with them. This did not help ensure people would always receive care and support that was responsive to their needs. Although some people enjoyed spending time as they wished, improvements were also required to the individual and group activities on offer as some people showed and expressed they did not meet their preferences.

People told us they had no complaints about the service and no complaints had been logged. People and relatives told