Chestnut Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first inspection for this newly registered service. This key question has been rated requires improvement. People were not always involved in planning and reviewing their care and they did not have readily available access to this information. People were not consistently empowered and supported to manage their own health, care and wellbeing needs and they were not supported to access fresh air and outdoor space to promote their health and wellbeing. Action was not always taken to improve outcomes for people. Oversight of Deprivation of Liberty Safeguards (DoLS) required improvement. However, staff had good knowledge of the mental capacity act and sought consent from people prior to providing support. People had enough to eat and drink, and they gave positive feedback about the food available. Staff worked together as a team and referred people to other health professionals when required.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always involved in assessing and reviewing their care and support needs. Care plans were not made available to people. However, 1 relative told us they had been involved in a care plan review. They told us, “When we first came, we did a care plan and after 12 months discussed it again on the phone."

Leaders and staff did not always ensure people’s needs were fully assessed prior to admission and some people did not have a completed admission assessment. This meant staff did not have the information needed to deliver person-centred care. When staff were reviewing people’s care plans and risk assessments there was limited evidence of people being involved in this process. In addition, information included in the records was at times inaccurate and conflicting.

The provider had systems and processes in place to monitor and assess people’s needs, but they were not always effectively implemented. For example, resident of the day was in place, which meant that every day 1 person’s care records should be reviewed and updated. However, this did not always take place and when it did, accurate reviews and updates were not consistently completed within the person’s care records.

People gave positive feedback regarding food and fluids. Comments included, “The food is beautiful. It’s lovely and fresh,” “I have cheese and biscuits from the trolley in the afternoon. The food is OK, I like everything” and “The food is alright; I don’t like the mash or the coffee.” Two relatives told us “[Name] gets snacks and things which is good as food is important” and “[Name] is eating a lot better than [they] did in hospital.” However, people’s care and treatment was not planned in collaboration with them. Not all people had their choices and preferences included in their care records.

Staff knew people’s dietary needs and they mostly supported people well during mealtimes. For example, during lunch 1 person was distressed, staff provided continual support and reassurance and offered solutions for after lunch which helped the person. However, some people were not positioned effectively to be able to reach their meals properly. For example, 1 person was unable to successfully reach their soup from an armchair.

Systems and processes to support the collaborative planning and delivery of evidence-based care and treatment were not always effective. People were not fully involved in their care and best practice initiatives were not implemented for all people.

People did not raise any concerns regarding the effectiveness of teamwork within the service or with external services. However, staff did not consistently work together to ensure people’s needs were fully assessed and accurately documented. This meant there was a risk that when information was shared it was not accurate or fully complete.

Staff knew how to make referrals to other health professionals when required. We saw some good examples of teamwork. However, there were some improvements required to ensure consistent and effective teamwork to ensure people’s safety.

Improvements were needed regarding partnership working with professionals such as communicating effectively and responding and acting on feedback. However, one professional told us, “Staff are cooperating with me sometimes. [There are] issues especially in the morning when the shift is starting, and they are concentrating on whatever they are doing” and “They are quite good. In terms of email, you don’t hear from them much. It’s easy to get hold of them face to face."

Systems and processes were in place to support partnership working with other health care professionals. However, omissions and inaccuracies in people’s records meant that we could not be assured that when information was being shared it was fully complete and accurate.

People had access to health services when they needed. One person told us staff were supporting them to be healthier stating, “[Staff] give me lots of fruit instead of sweets to keep me healthy.” However, we found some people were not supported to access fresh air and outdoor space to promote their health and wellbeing. People were not consistently empowered and supported to manage their own health, care and wellbeing needs as there was a lack of collaboration when planning and reviewing care.

Leaders and staff lacked a consistent and collaborative approach to ensure everyone was encouraged and supported to maintain their health and wellbeing in a way that was meaningful to them.

Systems and processes were not always effective in identifying shortfalls relating to people being supported to live healthier lives. For example, people not having access to fresh air and outdoor space. However, people were supported to access appointments and external health professionals.

People were not always involved in their care planning or goal setting. However, 1 relative told us they had been involved in care planning and a review.

Leaders and staff had failed to identify and take action regarding people who had experienced significant weight loss. No action had been taken to improve outcomes for those people.

Systems and processes were not effective in routinely monitoring people’s care and treatment to continuously improve it. Oversight was often lacking with regards to learning lessons, taking action, and improving outcomes for people. For example, 5 people’s weights were not always being adequately monitored and action was not taken where significant changes were evident.

People felt consent was gained prior to staff supporting them. One person told us, “They always ask before they do anything."

Staff received training and had good knowledge of the Mental Capacity Act and seeking consent from people. They had a good understanding of people’s individual capacity to make decisions, and who to refer to if there were any concerns. Comments included, “I will ask them. I will ask what help they want, and I will respect their views” and “We are trained to always seek consent."

Consent to care and treatment was accurately detailed in people’s care records. People’s mental capacity was appropriately assessed. However, there was insufficient management and provider oversight of DoLS. Audits of people’s DoLS were not dated and there was inconsistent information recorded to be able to identify actions taken to safeguard service users subject to DoLS.