The Chilterns

Updated 9 September 2021

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 Care Act 2014.

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

This inspection was carried out by three inspectors.

Service and service type

The Chilterns is a residential care home for people who need support with their mental health, or who are living with a learning disability, or both. This inspection focused on care for those experiencing mental ill health. We inspected for the regulated activity of 'treatment for a disease, disorder or injury (TDDI)' during this inspection. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service does not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

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 sought feedback from the local authority and professionals who work with the service. We did not request a provider information request, this is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experience of the care provided. We spoke with eight members of staff, this included the manager, operations manager, team leader and care staff.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 9 September 2021

About the service

The Chilterns is a residential care home, that can accommodate up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 13 people living at the service, who needed support with their mental health, or living with a learning disability.

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

People told us they were not always happy with the staff supporting them. When safeguarding incidents occurred, care plans and risk assessments had not been updated to reflect any changes in risks to the person. Care plans and risk assessments did not always contain the information necessary to inform new or agency staff on how best to support people. Incidents between people had reduced as a result of people moving on from the service, and a review of staffing. Accident and incident analysis were being carried out by the manager but needed improvements to ensure learning was documented on people’s care plans.

Medicines management was not always safe. The relevant supporting documents were not always used to inform staff of where and how to apply medicated patches. Body maps were not in place to inform staff of where to apply medicated creams.

Checks and audits were being completed but had not always identified and resolved issues identified during this inspection. The culture within the service had improved, but there were still areas needing further improvement. The manager acknowledged there were still improvements to be made.

Staffing levels had been reviewed and a dependency tool was now in place to support how many staff were needed on each shift. We observed there to be enough levels of staff to meet people’s needs.

There had been some improvements to the environment of the service. The service was clean and there was a maintenance schedule to make improvements that were still needed, such as decorating parts of the service.

People had been involved in the service, with their opinions sought and acted on. For example, sporting events were made into activities for people, with projectors and themed meals. Restrictions placed on people had been reviewed, and there were no longer restrictions placed on everyone. For example, one person had a key fob enabling them to leave and return to the service as they chose to.

People were supported to have 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting mostly maximises people’s choice, control and independence

Right care:

• Care was mostly person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff mostly ensured people using services lead confident, inclusive and empowered lives

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 24 May 2021) and there were multiple breaches of regulation. 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 some improvements had been made however the provider remained in breach of regulations. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

This service has been in Special Measures since 24 May 2021. During this inspection the provider demonstrated that improvements have been made. 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

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last 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 carried out an unannounced inspection of this service on 25 March 2021. Breaches of legal requirements was/ 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, staffing, fit and proper persons employed, safeguarding service users from abuse, premises and equipment, need for consent, good governance and notification of incidents.

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 contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to well-led. 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 The Chilterns 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users from abuse and improper treatment, safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.