Chestnut Lodge

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people's needs.

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’s care was not always person-centred. Some people’s rooms lacked any personalised items or decoration. Systems and processes were not always effective in ensuring people’s diverse health and care needs were appropriately supported. They were not always effective in ensuring people were supported to experience equality in the care and support they received. People did not have access to accessible or adapted information. However, people and relatives felt able to raise concerns with the registered manager and systems in place supported effective end of life care.

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’s care was not always person-centred. Some people told us they did not have their clothes returned from the laundry and some people did not have clean clothes readily available to them. Baths and showers were not always available in line with people’s preferred choices and some people did not have personal toiletries available.

Staff did not always feel care was person-centred. One staff member told us, “A nurse is very busy when running a unit and they cannot give person centred care.” Staff told us they often bought snacks, toiletries and other personal items, such as slippers out of their own money to support people with personal care.

Systems and processes had not been operated effectively to support the delivery of person-centred care. Some people’s rooms were not personalised, and some people’s wardrobes contained no clothing. For example, 1 person’s bedroom had no personalised décor and did not contain any personal items. In the wardrobe there was just 1 top hanging up and 2 odd socks in the bottom, next to a broken hanger.

Care records did not consistently reflect collaboration with people or individualised content. Inaccurate and inconsistent information was evident in many records. The person-centred care section of people’s pre-admission assessments was often left blank. However, staff appeared to know people well, this was evident in their daily interactions.

People did not raise any concerns regarding continuity of care. However, people’s information was not always up to date and their needs were not always accurately assessed in line with their preferences. Therefore, we could not be assured that people experienced good coordination and continuity when their information was being shared with other services or professionals.

Leaders and staff knew the process for referring to other health professionals to get support and advice. For example, the GP and district nurses. However, they had not always ensured people’s records were up to date and accurately reflected their care and support needs.

Partners had raised concerns about the service. Improvements were needed regarding partnership working with the local authority.

Systems and processes were not always effective in ensuring people’s diverse health and care needs were appropriately supported. There were gaps in service design which put some people at greater risk of receiving poorer care, treatment and support. For example, people with advanced dementia or people who were less able to communicate.

People did not have information regarding their care and support available to them. For example, their care plans and risk assessments. Accessible and easy read information was not available for people who needed it. For example, people living with dementia or people whose first language wasn’t English.

Leaders and staff had not adhered to the requirements of the Accessible Information Standard.

Systems and processes had not ensured the Accessible Information Standard was applied for people who needed it, in line with their needs and preferences. The processes in place had not identified this prior to the assessment.

People and relatives were not always involved in care planning and reviews of care. However, people told us the registered manager and staff were approachable and would listen to them if they had any concerns. Comments included, "If I have any concerns I go to a nurse or go to [the registered manager]. If I go to [the registered manager] with anything they sort it out straight away" and “I’d tell [the registered manager] if I wasn’t happy.”

Leaders and staff did not consistently involve people in decisions about their care and tell them what had changed following their feedback. However, the relationships the registered manager and staff had formed with people and relatives meant that any barriers people may face when raising a concern were reduced.

Systems and processes did not always support the involvement of people in their care. They did not ensure the ongoing assessment and monitoring of the experiences of people living with dementia, some of whom were unable to verbally communicate their views.

People did not report facing any barriers to accessing services. However, people requiring certain adaptations did not always have equity in accessing this. For example, people with differing communication needs.

Staff and leaders knew to be aware of possible discrimination that could disadvantage people’s access to care and treatment. However, leaders had not always driven improvements that were needed in the service regarding this.

We did not receive any negative feedback from partners regarding people’s equity in access.

Systems and processes were not always effective in ensuring people were supported to experience equality in the care and support they received. For example, information was not always available for people who needed it, in an adapted format. Further improvement was also required to ensure people’s care was person-centred, reflecting their choices and preferences.

People did not report any issues regarding having experienced any discrimination at the service. However, people were not always given choices and opportunities which would positively impact their experience. For example, some people did not have the opportunity to participate in activities that were meaningful to them. In addition, people were not provided with the opportunity to participate in their own care planning.

Staff and leaders interacted with people in a way which demonstrated an awareness of valuing differences in others. Staff approach demonstrated an understanding of how discrimination and inequality could disadvantage people. One staff member told us, “I want the residents to have more freedom. Not just walking round the corridor. They could be going out. Some of the activities are unacceptable.” However, leaders at the service had not taken sufficient action to address this.

The provider had an equality, diversity, and human rights policy in place to protect people and staff against discrimination. However, systems and processes did not consistently support equity in people’s experiences and outcomes. Care was not always individualised to reflect people’s needs and preferences.

At the time of our assessment, we were not able to obtain feedback from anyone receiving end of life care. However, during the assessment we observed the relative of a person being comforted by a staff member. The staff member was reassuring, kind and knowledgeable about the person’s care and treatment at the end of life.

Staff knew how to approach and care for people at end of life. We observed positive practice regarding this.

There were systems and processes in place to effectively support end of life care. People had appropriate care plans in place to support this.