We inspected the service on 19 November 2018. The inspection was unannounced. Chestnut Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people who live with dementia. There were 33 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. The former registered manager had left her post shortly before the inspection. The registered provider had appointed a new manager who was in post and who had applied to us to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last inspection on 3 April 2018 the overall rating of the service was, ‘Inadequate’ as a result of which the service was placed into ‘special measures’. We found that there were seven breaches of regulations. This was because there were serious shortfalls in the arrangements that had been made to provide people with safe care and treatment. This included oversights that had reduced the level of fire safety protection in the service and in the arrangements to prevent avoidable accidents. There were also shortfalls in that sufficient care staff had not always been deployed to enable people to promptly receive all the care they needed and had the right to expect. In addition to this, the registered provider had not robustly completed background checks on all new members of staff to ensure that they were suitable and trustworthy people to be employed in the service. Another breach of regulations had occurred because there were defects in the accommodation that had resulted for poor maintenance. Further breaches of regulations had occurred because people had not always received person-centred care and had not always had their dignity promoted. The last breach of regulations was because there were serious shortfalls in the systems and processes used to monitor and improve the service including consulting with people to obtain feedback about suggested improvements.

We told the registered provider to send us each month an action plan stating what improvements they had made and intended to make to address our concerns. The registered provider complied with this requirement.

At the present inspection we found that sufficient progress had been achieved to meet all of the breaches of regulations. Sufficient provision had been made to provide safe care and treatment. However, more progress still needed to be made to ensure that one person’s medicines were administered in the right way. In addition to this, further developments were needed to enable the service to learn from the occurrence of accidents and incidents so that steps could be taken to reduce the likelihood of the same thing happening again. Although on most days the number of care staff on duty had been increased there were still occasions when the registered provider had not deployed all of the care staff they considered to be necessary. Suitable arrangements were in place to recruit and select new members of staff. Although on most occasions people received person-centred care that promoted their dignity more needed to be done to address shortfalls. In practice, people were consulted about the care they received. However, more still needed to be done to provide people with user-friendly information to support them to make and review decisions about their care. Significant improvements

We inspected the service on 3 April 2018. The inspection was unannounced. Chestnut Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Chestnut Lodge Care Home is registered to provide accommodation and personal care for 60 older people and people who live with dementia. There were 41 people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 14 December 2015 the overall rating of the service was, ‘Good’. However, after this we received concerning information that people were not always receiving safe care and treatment. We completed a focused inspection on 21 June 2017 to check that people were being kept safe. We found there were two breaches of regulations. This was because suitable arrangements had not been made to ensure that people consistently received safe care and treatment. Also, the registered persons had not suitably assessed, monitored and improved the quality and safety of the service given the shortfalls that had occurred in the provision of safe care and treatment.

We told the registered persons to take action to make improvements to address each of our concerns. However, the registered persons failed to submit written information to us saying what action they intended to take to enable the breaches of regulations to be met.

At the present inspection we found that sufficient steps had not been taken to address either of these breaches. This was because there were serious shortfalls in the arrangements used to provide people with safe care and treatment that had significantly increased the risk of people experiencing harm. There were also serious shortfalls in the systems and processes used by the registered persons to assess, monitor and improve the quality and safety of the service. This had resulted in the persistence of a large number of problems in the running of the service that had reduced people's ability to receive the high quality care to which they were entitled. In addition, the registered manager did not appreciate the seriousness of the concerns we had identified and there was no realistic prospect of them quickly being put right.

There were five additional breaches of the regulations. Robust recruitment checks had not been completed to ensure that that only people of good character were employed to work in the service. The accommodation was not designed, adapted and decorated to meet people’s needs and expectations. Care staff had not received all of the training and guidance they needed in order to know how to care for people in the right way. People had not always had their dignity respected and suitable provision had not been made to ensure that people always received person-centred care.

As a result of these breaches of regulations the overall rating for this service is ‘Inadequate’ and the service is therefore in, ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered persons’ registration of the service, will be inspected again within six months. The expectation is that registered persons found to have been providing inadequate care should ha

We carried out an unannounced comprehensive inspection of this service on 14 December 2015. After that inspection we received concerns in relation to fire safety. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to the key questions 'Is this service safe?' and 'Is this service well led?'.You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chestnut Lodge Care Home on our website at www.cqc.org.uk

This inspection was carried out on 21 June 2017. The service was registered to provide accommodation with care to older people and those living with dementia. At the time of our inspection there were 45 people using the service.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the registered provider had not ensured adequate fire safety measures in the service. An action plan to address a number of remedial actions identified by Kent Fire and Rescue Service was underway. Whilst immediate risks were reduced by action they had taken the full action plan was not yet complete.

Some risks to individuals’ welfare and safety had been assessed and minimised. Other areas of risk had not been identified. This included risks associated with people being unable to use the call bell in their bedroom to seek assistance.

The registered provider did not have effective systems in operation for identifying shortfalls in the safety of the premises.

The registered manager had not always ensured that accurate and complete records were maintained to enable the delivery of care and changes in individual’s needs to be monitored.

People told us they felt safe using the service. Staff knew what action they needed to take to keep people safe from harm and abuse.

There were enough staff working in the service to meet people’s needs. Staff responded quickly when people asked for, or needed support. Staff were recruited following robust procedures to ensure they were safe and suitable to work with people.

The service was kept clean and hygienic to reduce the risk of infection. Equipment used when providing care was properly maintained and in working order.

People were supported to manage their medicines safely.

The registered manager provided staff with clear and directive leadership. Staff understood their responsibilities and were clear about the standards of care they were expected to provide.

There was an open and positive culture that focussed on people. Staff knew people well and supported them in a way that respected their individuality.

You can see what action we told the provider to take at the back of the full version of the report.

Chestnut Lodge Care Home is a residential care home that provides accommodation and personal care to up to 32 older people. The service is able to meet the needs of people living with dementia and other age associated conditions, including reduced mobility and sensory impairments. The service is provided in a large detached building close to the centre of Tonbridge. The premises was converted from a hotel and refurbished in two phases. Half of the premises had been completed and was in use whilst the other half was undergoing refurbishment ready for use in March 2016. The service is currently registered for 32 people and the registered provider intends to apply to increase this number once the refurbishment works are complete.

This inspection was carried out on 14 December 2015 by three inspectors. It was an unannounced inspection. There were 28 people using the service at the time of the inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were exceptional in providing a caring service that treated people with kindness and compassion and recognised their individuality. They knew each person well and understood how to meet their support and communication needs. People spoke extremely highly of the staff and the registered manager. One person told us, “The manager and care staff are wonderful. They really care for the people they look after.” Another person commented, “It’s the staff that make the difference. They just glow!” People’s privacy was respected and people were assisted in a way that respected their dignity.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to address patterns in falls and to reduce the risks to people’s safety. There were usually sufficient staff on duty to meet people’s needs, however, staff sickness on the day of the inspection left the service short. We have made a recommendation about this. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place to ensure staff were suitable to work with people.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The service was well maintained and designed to meet the needs of the people that used it. The use of signage had helped people find their way around and had increased their independence.

Staff were knowledgeable and skilled in meeting people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and had an annual appraisal of their performance. Staff felt supported in their roles and were clear about their responsibilities. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. Staf