Archived: Chestnut Lodge Care Home

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

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 us that any issues they raised were addressed to their satisfaction. Improvements were required to ensure that the complaints process was accessible to all to ensure this was consistently responsive.

The service was not consistently well-led because the provider’s systems and processes failed to always effectively assess, monitor and improve the quality and safety of the service. We identified various concerns that these processes had not addressed which put people at risk of unsafe or poor care. The provider’s caring approach towards people was recognised and valued by people and relatives. Staff also showed they welcomed the support they were given. The provider was supported by a mentor and had sourced some good practice guidelines to help aid their ongoing development. The provider had developed audits to help support the running of the service, but these were not yet fully effective.

You can see what action we told the provider to take at the back of the full version of the report.