Chestnut Lodge

Updated 4 July 2025

Date of assessment was 21 July 2025 to 12 August 2025. This included 2 site visits to the service on 21 and 28 July 2025. Chestnut Lodge is a care home providing nursing and personal care for up to 80 people, some of whom are living with dementia. At the time of our assessment there were 51 people living at the service. The assessment was a planned follow up assessment. The provider was previously in breach of 3 legal regulations in relation to person-centred care, safe care and treatment and good governance. Improvements were not found at this assessment and the provider remained in breach of these regulations. We found the quality in the service had declined since the last assessment, and found the provider was also in breach of a further 3 legal regulations in relation to safeguarding of vulnerable people, safe and effective staffing and fit and proper persons employed, as well as being in breach of the registration regulation relating to notification of other incidents.

Since the last assessment, there had been a lack of effective oversight and governance, and leaders and managers had failed to drive necessary improvements. The environment was not safe. Risks to people, including concerns around repositioning not occurring and potential inaccuracies in care records, were not managed effectively. Medicines were not managed safely. Safeguarding processes were not robust, with some notifiable safety events not reported to the Commission, and unsafe staff deployment left people at risk of harm. Care was not person-centred, and people were not always treated with dignity and respect.

This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

Updated 4 July 2025

Feedback from people using the service and their relatives was mixed. Some people told us they were happy living in the service, saying, “I am happy here, I get what I need” and “Yes I like it here.” However, others told us they did not feel well cared for. One person told us, “I am neglected here, I am just left in bed. I do not want to stay here,” and explained that their quality of life would improve if they could have more showers, be hoisted onto the toilet, and be supported to go outside into the garden. Another person told us that to make their life better, they would like, “More clothes and some toiletries.”

Relatives also gave mixed feedback. Some were happy with the care provided, describing the nurses as excellent and staff as kind. Others raised serious concerns. Themes from relatives’ feedback included there not being enough staff, particularly at weekends and in the evenings, the service not always being clean, and specific equipment for people being dirty. Several relatives also highlighted that call buzzers rang for long periods of time without being answered.

Some relatives gave positive comments about care, but others raised concerns about unsafe practice. For example, one relative told us, “There is not enough staff on an evening, or weekend, and although [person] is given their medication, I have seen other people being given medication then left. The staff did not stay to make sure they had taken it.”