Chestnut Lodge

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring - this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

This is the first inspection for this newly registered service. This key question has been rated requires improvement. We identified a breach of regulation in relation to person-centred care. People did not always get access to activities that were meaningful to them and dementia friendly activities were extremely limited. Care records did not consistently reflect people’s likes, dislikes and preferences. There were times when people did not have their care and support needs met in a timely manner. However, people were supported by staff who were kind, caring and respectful. Staff knew people well and had developed positive relationships with the people they cared for and their relatives.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us that staff were kind and caring. Feedback included, “They are good at looking after you. I couldn’t say a bad thing about them,” “They do a top-notch job. They always help me,” “They look after me and are kind,” “They are lovely. They always talk to me. They seem kind and helpful” and “I’m impressed by the staff. They are always kind and gentle."

Staff had a very compassionate approach, and they spoke highly of the people and families they supported. They were respectful of people’s dignity.

We did not receive any negative feedback from partners in relation to people being treated with kindness, compassion and dignity.

We observed staff being kind and caring towards people throughout the inspection. Staff knew people well and their approach was consistently considerate. For example, we observed a staff member holding the hand of 1 person who was distressed and offering words of comfort.

People’s individual preferences and unique backgrounds were not always considered, and care records did not consistently reflect this. However, some people told us they were cared for by staff that knew them well. One relative told us, “They have a good relationship with [Name] and know [them] well."

Staff knew people’s preferences, likes and dislikes. One staff member told us, “I know the residents really well. They are like my family."

Activities on offer were not always suited to people’s individual needs and not everyone had the opportunity to participate and engage in something that was meaningful to them. However, we did observe staff giving people a choice. For example, during mealtimes and regarding what they might want to watch on TV.

People’s care records were not always reflective of their individual needs. They did not always include people’s wishes, preferences, likes and dislikes.

People and relatives gave mixed feedback regarding activities on offer. Comments included, “We have different craft things to do. We have entertainers, some of them are good,” “There’s lots to do. I like playing ball,” “There’s nothing to do,” “There doesn’t seem to be any [activities]” and “There should be something going on. [Name] would like to go for a pint or for a coffee.” We found some people had no access to activities that were meaningful to them, or access to fresh air and outdoor space. One person who was unable to independently move from their bed told us they felt isolated in their room and would like to go into the lounge.

There was 1 activities staff member employed to cover the 4 units within the service. Staff were assisting and facilitating some activities where possible. However, there were limitations around this. Staff told us, “There are [activities] but the coordinator is struggling as they are on their own,” “We need more activities. We used to have two staff, but it is now one. It is a big home for one person” and “Carers are needing to do [activities] which takes away from care.” The provider told us they had advertised and were looking to recruit another activities staff member.

The registered manager told us they had formulated good links and relationships with a local school. Children visited people at the service, and they participated in activities together.

Activities were not always tailored to suit people’s individual needs and interests. Therefore, people were not consistently engaged. For example, a game of skittles was taking place and some people sitting in the immediate area had no interest in taking part.

There was a lack of opportunity for people to have purpose in their day. We observed some people spending all day in the lounge in front of the television, at times with the same movie playing. There were limited offerings of dementia friendly activities and people did not have regular access to fresh air and outside space to support their wellbeing.

Systems and processes had failed to identify areas requiring improvement in relation to people having choice and control over their care and wellbeing. There was minimal evidence of people having a choice and being involved in making decisions about activities they wanted to engage in. Care records demonstrated that some people had participated in little to no activities and were not going outside. For example, 1 person had not been outside for a whole month.

People told us some staff were more responsive than others and at times they had to wait for support. Feedback included, “Some staff don't always bother too much. I have to wait to be seen. One staff member comes in and says your pad is dry without checking, others are not too bad” and “When I buzz someone comes always. I was buzzing for an hour this morning; I needed my feet covering up.” However, 1 person told us, “They come when I press [the call bell], quite quickly when I need changing."

Staff gave mixed feedback regarding being able to respond to people’s needs without delay and without rushing people. Feedback included, “Sometimes [we are rushing to meet people’s needs] but not often. If it comes to a point we are rushing, we will leave this until the next day,” “We will prioritise cares and then respond to buzzers,” “When short staffed I can feel rushed, but this does not happen often,” “If they are in the bedroom and the carers are busy, they cannot always hear [call bells]. A senior or nurse will respond to this if staff do not,” “Sometimes it can be a while, but now we have more staff, we respond immediately so people don’t wait” and “We don’t rush people but when we are busy, things take longer."

People did not always have their needs met in a timely manner or receive appropriate support. For example, we observed people seated in chairs for long periods of time. Three people were not seated on a pressure cushion or supported with pressure relief. People had also been sat for long periods of time without receiving support for continence care. One person stood up with staff support to go to the table for food, and it was evident that they had been incontinent whilst sitting in the chair. This was pointed out to the staff by the inspector. In addition, a person was seen to be seated in wet clothing, having been incontinent of urine. Staff only noticed this when they attempted to support them with transferring into a wheelchair.

People did not always have a call bell in place to alert staff if they needed support. For example, 1 person was sitting in a chair in their room with no access to a call bell. When asked, staff confirmed that the person didn’t have one, but that maintenance would sort it out. We also observed a person with a call bell in place that they were unable to access. Some people had risk assessments in place stating that having a call bell was inappropriate for them. However, other measures to mitigate risks and check on people, for example, hourly checks, were not always completed.

Staff did not always feel their wellbeing was considered and did not consistently feel supported by the leadership team. Feedback included, “[Staff] need more support from management” and “There is no praise for staff.” However, 1 staff member told us, “[The managers] always make sure we are ok."

Systems and processes in place to support staff wellbeing and enablement were not always effective. There was a process in place for staff supervision. However, supervision documents sometimes evidenced a prescriptive rather than supportive supervision session. The systems in place required improvement to ensure that staff consistently felt their wellbeing was appropriately supported.