Chiltern Support and Housing

Updated 15 March 2023

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.

Inspection team

The inspection was carried out by 1 Inspector, 1 Inspection Manager and 1 Expert by Experience. 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

This service provides care and support to people living in 8 ‘supported living’ settings, so that they can live as independently as possible. At the time of our inspection not all of the settings supported people who required assistance with personal care. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were two registered managers in post.

Notice of inspection

We gave a short notice period of the inspection. This was because the service is small and some people go out and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 30 January 2023 and ended on 13 February 2023. An Expert by Experience gathered telephone feedback from people and families on 30 January 2023. We visited some of the service’s supported living sites on 31 January 2023 and 3 February 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from local authorities in which the service operated. 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 all of this information to plan our inspection.

During the inspection

During the inspection we spoke with 10 people using the service, some of whom did not require help with personal care, however we gathered their general feedback to support our wider understanding of how staff supported people within the supported living settings.

We also spoke with 5 relatives and 15 members of staff including 7 support workers, 1 senior support worker, 2 team leaders, 1 deputy manager, 1 trustee, the operations manager and 2 registered managers, one of whom was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also received email or online feedback from 1 additional family member and 3 additional members of staff. We received feedback from 6 professionals who worked with or commissioned care from the service.

We reviewed a range of records. This included 7 people's care records, either in full or in part, and 6 people's medicines records. We looked at 6 staff files in relation to recruitment, induction and supervision. A variety of records relating to the management of the service were reviewed, including information relating to compliments and complaints, accidents and incidents, safeguarding, staff training, minutes of staff meetings, quality assurance audits, staff handover records, staffing rotas for 3 supported living settings, and policies and pro

Updated 15 March 2023

About the service

Chiltern Support and Housing provides care for people who live in supported living settings. The

provider supports people in 8 properties in the Buckinghamshire, Barnet and Bexley local authority areas. The numbers of people supported in each property ranged from 1 to 9. The service supports people living with a range of needs, including learning disabilities and autism, acquired brain injury, mental health, sensory needs, and physical disabilities such as needs arising from progressive neurological conditions.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People did not always live free from the risk of avoidable harm. This was because the service did not assess, monitor or manage people's safety well, including risks of abuse and risks posed by the behaviours of people using the service. We also identified concerns in relation to the safe management of medicines and the safety of people’s living environments, including measures for fire safety and controlling the risks of infection. Staff recruitment practices were not always fully followed in line with the provider’s policy and procedure to ensure the safe recruitment of staff.

Some people and relatives told us they believed care was safe. One relative commented, “I do think my daughter is receiving safe care…they always make sure she walks safely.” Another relative commented, “Yes they are absolutely safe.” Some relatives were not fully assured regarding safety, with concerns raised about past unexplained injuries and a relative highlighted they did not always feel their family member was safe due to the management of people’s distressed behaviours.

Governance processes had not been operated effectively to keep people safe, provide good quality care and protect people's rights. People were supported by a service which lacked effective oversight by the registered managers and provider. Audits had been inconsistently completed and did not effectively drive improvements to the quality and safety of the service. We found some incidents had not been reported to CQC in line with requirements, and the service had failed to provide an appropriate written response under their duty of candour.

We received variable feedback from people’s representatives regarding communication and management of the service. One family member provided positive feedback regarding the responsiveness of management in meeting their relative’s need for a bespoke support package, commenting, “I think the manager does a good job.” Other relative feedback was more variable, with comments including, “I am to an extent involved in [relative’s] care…only to an extent…I wouldn’t say [relative] is involved in the running of the [setting]” and “We had a meeting last year but nothing really changed…I would go to [registered manager name] and she would try…when I told her about a lack of communication last year things changed in the short term.”

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to evidence how they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support:

People were not consistently supported by staff to pursue varied meaningful interests and care records did not always reflect that people had been offered choices on a day-to-day basis to promote their independence. Practice was inconsistent across the different settings operated by the service.

Right Care:

We observed people were treated with kindness and compassion. The service did not always promote people’s privacy and human rights because the service failed to consider the need for consent for the use of CCTV and did not always ensure people’s mental capacity to consent to aspects of their care and support was appropriately assessed.

Right Culture:

People were not consistently supported to lead inclusive and empowered lives. The service had failed to consistently evaluate the quality of support provided to people. Staff received training to enable them to support people however there was ineffective oversight by the registered managers and provider to ensure practice across all settings was consistent in supporting people to achieve good outcomes.

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 11 October 2019).

At our last inspection we recommended the service seek support on the management of medicine records and guidance in relation to mental capacity assessment records. At this inspection we found the provider had not made sufficient improvements and the service was now in breach of regulation in both areas.

Why we inspected

We received concerns in relation to safeguarding adults from abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chiltern Support and Housing on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding adults from abuse, consent, good governance, safe recruitment, duty of candour and in informing the Commission of information they are required to.

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

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 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.