Chandos Lodge Nursing Home

Updated 28 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector, one Expert by Experience on-site and two Experts by Experience who contacted relatives for their feedback by telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Chandos Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Chandos Lodge Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of a direct monitoring activity that took place on 28 June 2022 to help plan the inspection and inform our judgements. A direct monitoring activity involves a call between the service and an inspector to gain assurance about the quality of the service. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and 17 relatives about their experience of the care provided. One additional relative provided feedback via email. Where people were unable to speak with us, we spent time observing people’s body language, facial expressions and vocalisations, to help us understand their experiences of using the service.

We spoke with 14 members of staff, including three healthcare assistants including two regular agency staff, three senior health care assistants, two nurses, one chef, two domestic staff, two maintenance staff and the manager. The manager was known internally as the ‘floor manager’ and provided day-to-day management support. The registered manager was absent during our inspection due to unavoidable circumstances beyond their control.

We reviewed a range of records. This included 13 people's care records, either in full or in part, and five people's medicine administration records. We looked at four staff files in relation to recruitment and supervision. A variety of records relating to the management of the service were reviewed, including files relating to compliments and complaints, accidents and incidents, safeguarding, staff training, minutes of staff, relative and resident meetings, audits, staff handover records, and evidence relating to the health and safety of the premises.

After the inspection

We continued to seek clarification from the

Updated 28 September 2022

About the service

Chandos Lodge Nursing Home is a care home providing personal and nursing care to older people and people living with dementia. The home can accommodate up to 31 people in one adapted building. At the time of our inspection 30 people were living at the home.

People’s experience of using this service and what we found

People were safeguarded from the risk of abuse or neglect, however we have made a recommendation in relation to the reporting and recording of safeguarding concerns. We have also made a recommendation in relation to systems for managing risk and learning from accidents and incidents. Systems were in place to assess a range of risks. Staff received training to equip them with skills to work safely and respond to risks.

People were supported by sufficient numbers of trained staff to meet their needs, however robust recruitment practices were not evidenced. Systems were in place for the safe administration of medicines, however we identified concerns in relation to the storage of topical creams and thickeners, and systems for the stock control of prescribed medicines. We also identified concerns in relation to arrangements for infection control including the use of personal protective equipment (PPE).

People told us they felt safe and we received compliments regarding staff approach and the quality of food. People’s comments included, “There’s absolutely nothing wrong in this place”, “The food is lovely” and “I don’t mind it here.” A relative commented, “[Staff] are kind and caring…they have got to know me as well. I can see that they have a good rapport with my relative.”

Some people provided more mixed feedback, with one person commenting “There’s a carer here who’s adopted me, like a mum…[however] the only way you can get any attention [at night] is to shout for it.” Another person commented, “The staff are wonderful…the building can be very hot and uncomfortable…it gets very noisy in here sometimes; the shouting.” People were encouraged to use the communal lounge where planned activities took place. We observed positive interactions between staff and people.

Governance systems were in place, however audits had failed to identify all of the concerns we found. People provided positive feedback regarding the manager. One person commented, “I know [name of manager]. He’s very nice”. Staff provided positive feedback about the management of the service and told us they felt supported. Most relatives also provided positive feedback regarding the service management and described examples of open and effective communication.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider arranged training in the management of Legionella and consider guidance about calculating staffing levels in accordance with people’s level of dependence. We found the provider had acted on these recommendations and made improvements in these areas.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance and safe recruitment procedures.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chandos Lodge Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe recruitment, managing risks and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.