Chesham Bois Manor

Chesham Bois Manor is a residential care home providing accommodation and personal care to up to 48 people. The service provides support to older people, including people with dementia. At the time of our inspection there were 35 people using the service.

Chesham Bois Manor accommodates people across three units, with two of the units providing care to people living with dementia. The service has a mix of bedrooms with en-suite facilities and other bedrooms where people access the communal bath/ shower facilities. Each unit has its own communal lounge and dining area. The service is set in well-maintained grounds with a secure outside area for people to access.

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

People and relatives were generally happy with their care. People told us they felt safe and described carers as “Kind, caring and obliging.”

Relatives told us they were happy with their family members care and that most people had good access to health care professionals. They felt the service had improved with regular better trained staff. They commented “[Managers name] and their team are doing a superb job and you can tell they really do care with everything they do,” “Care is good and attentive. There is attention to detail,” and “Family member has lived in this home for some time now. I think that the home is looking after them well and I think things have been improving. The staff seem happier and are all pulling together better.”

A number of relatives felt communication with them and activities available to their family member needed to improve. A second engagement lead had recently been appointed with the aim to develop activities.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had been proactive in recruiting staff to provide consistent care to people. Staffing levels had improved and were sufficient, with agency use decreased. Staff told us the training provided had improved, however key training was overdue and competency assessments were incomplete and others unavailable.

Auditing and monitoring of the service was taking place which showed the provider had identified, shortfalls in the service provided. Improvements had been made to records, however further improvements were required to ensure records were accessible, accurate and suitably maintained.

Most risks to people were identified and mitigated, with staff aware of people’s risks and how to support them. Where risks were not mitigated this was immediately addressed. Safe medicine practices were promoted.

Systems were in place to safeguard people with evidence of learning from incidents to prevent reoccurrence and safeguard people.

People’s nutritional and hydration needs were identified, monitored and action taken where records did not evidence people had the required food and fluid.

The manager had been proactive in making improvements to the service, which included creating a more positive culture which promoted positive outcomes for people.

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 inadequate (published 13 January 2022). 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 improvements had been made, however further improvements were required to be fully compliant with the regulations reviewed.

The service had been in Special Measures since December 2021. During this inspection the provider demonstrated improvements have been made and their audits had identified the areas that still needed improving. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 9,10 and 17 November 2021. 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 safe care and treatment, safeguarding, recruitment, staffing, training, good governance and need for consent.

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, Effective and Well-Led which contained those requirements and warning notices.

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 has changed from inadequate to 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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well- Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chesham Bois Manor on our website at www.cqc.org.uk.

Enforcement

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 continued breaches in relation to training, consent and records at this inspection. However, in view of the progress made within the service we have taken a proportionate response to the continued breaches.

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.

Chesham Bois Manor is a residential care home providing personal care to 44 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

Chesham Bois Manor accommodates people across three units, with two of the units providing care to people living with dementia. The service has a mix of bedrooms with en-suite facilities and other bedrooms where people access the communal bath/ shower facilities. Each unit has it's own communal lounge and dining area. The service is set in well-maintained grounds with a secure outside area for people to access.

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

People and the majority of relatives were happy with the care provided. However, we found safe and effective care was not consistently provided.

Risks to people were not mitigated and people were not safeguarded from abuse. There was no evidence of learning from incidents to prevent reoccurrence and promote safe care. Medicines were given as prescribed however, discrepancies in medicines were not identified and protocols were not in place for other medicines.

Staff were not suitably recruited, inducted, trained and supervised. Sufficient staff were not maintained to ensure people got the care they required. The impact of the staffing levels meant people’s care was rushed and/or omitted.

People were happy with the meals provided. However, we found people were not supported with their meals in a timely manner and their nutrition and hydration needs were not met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not effectively managed and monitored to ensure safe and effective care was provided. Records were not accurate, always dated, secure and fit for purpose.

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

Rating at last inspection

The last rating for this service was good (published 26 July 2018). The service had an infection control inspection in January 2021 (published 8 February 2021), which did not result in a review of the rating and the overall rating remained unchanged at that time.

Why we inspected

The inspection was prompted in part by concerns raised about people’s nutrition, hydration and personal care needs not been met. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well- led sections of this full report. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chesham Bois Manor on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding people, management of risks, medicine practices, recruitment, induction and training of staff, staffing levels, record management, auditing of the service and failing to work to the principles of the Mental Capacity Act 2005.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice:

People had been supported to keep in touch with their families throughout the COVID-19 pandemic. Staff provided support where necessary so that people could phone or video call their families. Visits at the service had recently been suspended. When visitors had been able to come to the service, they used a designated area with its own booking system and designated entrance and exit top manage the flow of visitors. The visitor area was thoroughly cleaned between each use. The expectations and procedures for visitors to the service were clear.

The service was receiving professional visitors to the unit with robust infection control procedures in place. Visitors entered via a buzzer system, were received into the reception area on arrival where they were provided with guidance, personal protective equipment (PPE) and health screening was completed. Each visitor also had their temperature checked by staff on arrival.

The provider had developed policies and procedures in response to the coronavirus pandemic. These policies had been adapted to reflect differences between the different care homes. The management team had drafted guidance and information for staff with detailed safe systems of work for the unit. Daily checks and 'walkarounds', alongside regular infection prevention and control audits were in place.

At the start of the pandemic, the group (B&M Investments Limited) and the individual homes appointed small teams of COVID-19 champions and specialists, these role were referred to as 'Rainbow Leads'. Chesham Bois Manor had three designated 'Rainbow Leads' and they supported the Registered Manager to ensure correct infection control standards and protocols were in place and being adhered to. The role also included regular communication with the Head Office to ensure full supplies of PPE and ensure the home was using the most up to date guidance and aware of best practice in an ever changing care environment. Furthermore, should an COVID-19 outbreak be confirmed the Rainbow Leads were responsible for the implementation of the outbreak action plan which included isolation and zoning.

Staff told us the provider and management team had been and continued to be supportive of staff, and risk assessments had been completed with staff who identified as facing higher risks. Managers were positive about the commitment staff had shown throughout the pandemic. Staff were regularly tested for COVID-19 and had received COVID-19 vaccinations in January 2021.

Chesham Bois Manor is a care home which is owned by B&M investments Limited. It provides care for up to 48 older people with a variety of physical disabilities and mental health issues. At the time of the inspection there were 37 people living at the 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.

At our last inspection in December 2016 we found breaches of Regulations 11 and 12 Health and Social Care Act (Regulated Activities) Regulations 2014 and Regulation 18 Care Quality Commission (Registration) Regulations 2009. These related to the service not always working to the principles of the Mental Capacity Act 2005, risks and emergency evacuation plans not always being appropriately managed and not ensuring all required notifications were made to the Care Quality Commission (CQC). At this inspection we found action had been taken and improvements made.

Staff worked to the core principles of the Mental Capacity Act (MCA) 2005. Mental capacity assessments had been conducted and people were supported to make decisions.

Risks to people’s safety were well managed. Risk assessments were carried out and promoted positive risk taking, which enable people to live their lives as they chose. Personal emergency evacuation plans (PEEPS) were in place, accurate and up to date.

The service submitted appropriate and timely notifications. A notification is information about important events which the provider is required to tell us about in law.

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. On the day of our inspection the registered manager was on annual leave. The service was being led by the deputy manager.

Staff supported people with kindness and compassion and went the extra mile to provide support at a personal level. Staff knew people well and many referred to them as family. Staff respected people as individuals and treated them with dignity whilst providing a high level of emotional support. People and their relatives, were fully involved in decisions about their care needs and the support they required to meet those individual needs.

People were positive about the food and told us they enjoyed the meals. Where people had specific dietary needs, these were met.

People were safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. The service had safe, robust recruitment procedures to ensure staff were safe to work with vulnerable people. People received their medicines safely.

People received effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People had access to information about their care and staff supported people in their preferred method of communication.

The service was responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care and support and promote a positive culture that was person-centred, open, inclusive and empowering which achieved good outcomes for people. The registered manager was robustly supported by the deputy manager and the provider.

We previously inspected the service on 28 January 2016. The service was meeting the requirements of the regulations at that time.

Chesham Bois Manor is a care home for older adults some of whom are living with dementia. It is registered to provide accommodation for 48 people. At the time of our inspection 41 people lived at the home.

The service had 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.

People were not always protected from avoidable harm. Some risk assessments had been completed for instance, for falls and moving and handling. However, we saw where risk assessments had been completed for pressure damage, these were not always accurate. This meant people may not have had access to the correct support to prevent damage to skin.

People were not always protected from the risk of fire. At the time of our inspection the home was undergoing major refurbishment work. As a result some people had moved bedrooms. One person had moved bedroom as their needs had changed and they could not access their existing room due to reduced mobility. Another person’s needs had changed as they were no longer able to walk. On day two of the inspection we checked the details regarding what support people required in the event of a fire. This information had not been updated, which meant staff did not have the correct information on how to support people in the event of a fire. We acknowledged that permanent staff did have knowledge of how people needed to be supported.

The service did not always follow the core principles of the Mental Capacity Act 2005. Where people had been assessed as incapable of consenting to care and treatment, the service did not always obtain documentary evidence to confirm people acting on behalf of residents had the legal authority to do so

The service was not always well led. The service failed to notify CQC of some events when it was legally required to do so.

We found records were not always well maintained. At times we found it difficult to find information as it was not readily available. We have made a recommendation about this in the report.

We found people had access to food and drink. People gave us positive feedback about food. Comments included “The food is fantastic” and “The food is not bad.” However, staff did not always ensure people received the support they required at meal times.

Staff were appointed following a recruitment process; however, the service did not always ensure risk assessments for staff were completed when necessary. We have made a recommendation about this in the report.

People told us they felt safe, we received positive feedback from people who lived at the home. Comments included “I feel safe and they check on me during the night,” “I’m safe here and I’m not shouted at” and “I have no complaints and feel safe.”

People and their relatives told us how caring the staff were, comments included, “I like it here, it’s a nice place, the staff are alright and the people are quite nice,” “This is a nice hotel, and people would give their right arm to be here” and “My mother is looked after very well, and she’s happy with the staff, who are more caring than in another home we’ve seen.”

People had access to a wide range of activities. The home actively encouraged people from outside to visit the home. An entertainer visited the home on a regular basis. People were supported to have the right care and support as the service monitored people’s progression through a mapping process.

Staff had improved the environment to ensure it provided opportunities for people to interact and engage in activities which were dementia friendly.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the Care Quality Commission (Registration) Regulation 2009. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with five staff including the manager. Staff told us "they ensured choice and engaged with families in learning about a person's preferences if they were not able to communicate this themselves". Staff also told us "staff worked well as a team" and another told us "staff were well supported".

We found in the four care records we sampled people had a comprehensive risk assessment and care plan which was regularly reviewed with the person and/or their representative.

We found the provider protected people using services against the unsafe use and management of medicines and when errors had occurred the risks were managed as safely as possible and staff received further training and competency assessment.

We looked at the staff training record and staff allocation record and found there were sufficient skilled and experienced staff at all times to safeguard the health, safety and welfare of people.

We found there had been no complaints but the provider had in place a complaints policy which was given to people and the provider could support access to an advocate.

We were told meals were very good, portions were sufficient, and other food choices were available if they did not want the meal offered.

People told us their bedrooms and bathrooms were cleaned daily, as were the public areas. They said the in-house laundry was excellent.

People told us they were aware of the complaints procedure. They said they were confident any concerns or complaints would be dealt with to their satisfaction. Relatives told us they were happy with the care given, they felt involved, and they were kept informed of any changes to their relatives' condition or treatment. Relatives also told us the staff were helpful and respectful, and the manager was approachable and kind.