This inspection took place on 17 and 18 January 2018 and was unannounced. This was the provider’s first inspection since changes to their registration on 17 January 2018. This inspection found improvements were required across each of the five key questions and the provider was in breach of the regulations.

Chestnut Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide personal care and accommodation for up to 15 older people. At the time of our inspection, there were 12 people living at the home and one person on respite stay.

We found concerns which put people at risk of unsafe care and support. Some areas of the home were not kept clean or well maintained. We identified risks of poor infection control and tripping hazards which health and safety checks had not identified. Recruitment processes were not always completed as required to assess and ensure the suitability of all staff.

We identified some good examples of safe practice and people told us they felt safe. People were supported to take their medicines safely and there were enough staff to meet their needs. Incidents at the home were reviewed to prevent future reoccurrences and help ensure people’s safety. Safeguarding training and policies had recently been updated to help all staff become confident on how to recognise and report abuse.

People spoke positively about their care. Staff told us they felt supported and equipped for their roles, although improvements were needed to ensure support remained effective as people’s needs become more complex. Most staff were familiar with people’s needs and how to support them well although some staff knowledge was inconsistent. Further support and guidance would help build on training provided in relation to people’s individual needs. Although the provider was making continued improvements in this area, the design and décor of the home was not always safe or developed according to the needs of some people living with dementia.

We have made a recommendation about dementia care, including activity planning, care planning and the design of the home to help meet all people’s needs.

People were offered some choices and the provider had recognised requirements of the MCA. People were supported to have their health needs monitored and to access additional healthcare support as needed. Although people spoke positively about meals at the home, they were not involved in deciding what should be on the menu to ensure this could always reflect their preferences. People told us they had enough to drink and expressed satisfaction with the meals and drinks on offer.

People told us staff were kind and caring, and we saw caring interactions and good relationships between people and staff. However, the approach of some staff, although well intended, did not always promote people’s dignity, privacy and independence as far as possible. We also found systems were not in place to enable people to regularly discuss and make decisions about their care. This did not help ensure people’s needs and wishes would always be met. This meant the service was not consistently caring.

We saw good examples of how people’s support needs and preferences were met and people’s feedback reflected this. However, care planning systems were not in place to review and discuss people’s care with them. This did not help ensure people would always receive care and support that was responsive to their needs. Although some people enjoyed spending time as they wished, improvements were also required to the individual and group activities on offer as some people showed and expressed they did not meet their preferences.

People told us they had no complaints about the service and no complaints had been logged. People and relatives told