Chiltern Support and Housing

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.

Chiltern Support and Housing provides care for people who live in supported living accommodation. The provider supports people in seven properties in the High Wycombe, Aylesbury and Barnet areas. The numbers of people supported in each property ranged from one to eight. All people supported had an individual bedroom, shared main bathroom and kitchen facilities.

Not everyone who used the service received personal care. The Care Quality Commission (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.

At the time of the inspection 20 people with a range of needs including learning disabilities, autistic spectrum disorder, brain injury and neurological conditions were supported with the regulated activity of personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Where required people were supported with prescribed medicines. However, records did not always reflect best practice. We have made a recommendation about this in the report.

People were supported to have maximum 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. However, we found some improvements could be made to ensuring everyone was supported in line with the Mental Capacity Act 2005. We have made a recommendation about this in the report.

We observed people were supported to live a life of their choosing. People were supported to be independent with their life skills and chosen activities.

People were supported by staff who had been recruited safely and had received training to ensure they had the right skills and attributes.

People were supported by staff who demonstrated they were kind and considerate. Staff were able to provide dignity to people.

People received a personalised care service. Care plans were written to reflect their likes and dislikes and staff were knowledgeable about people and their personal circumstances.

The service had a clear management structure. Relatives told us communication was good and felt the service was well-led.

The service consistently applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the provider at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. Some minor restrictive intervention practice was used as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (report published 15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected the service in January 2014. The service was meeting the requirements of the regulations at that time.

Chiltern Support and Housing Limited provides support to people in their own homes and supported living properties. Nine people were receiving a service at the time of our visit. These were younger adults with a range of needs including learning disabilities, autistic spectrum disorder, brain injury and neurological conditions in the High Wycombe and surrounding areas.

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.

We received positive feedback about the service. A social care professional told us “I have a client in supported living and have been very pleased with the care and support provided.” They said their client “Has thrived with the care in place. He is happy at the house and his ability has increased…and able to manage personal care.” They said the person’s “Cognition improved with good nutrition, social interaction, prompting as required. Staff have been friendly and caring.” Another social care professional said “We are generally satisfied with the support received.” They added “They are local and so it’s easy to talk to the management, to get timely assessments and negotiate cost of packages. We have not had concerns with this provider that we have not been able to resolve. I find them responsive and always improving.” They said the service had “Good staffing levels and adequate social stimulation for residents.” Comments from relatives included “I have always been happy with them; they do quite a difficult job” and “They try very, very hard. I’m very contented for my relative to be there and looked after.”

We found people were safeguarded from the risk of abuse. Staff understood about safeguarding and did not have any concerns about care practices. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

People were supported to be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care.

There were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction, supervision and training. We saw staff interacted well with people and had developed positive relationships, often involving humour.

People’s needs were recorded in care plans. These had been kept up to date to reflect changes in people’s needs. Staff supported people to attend healthcare appointments to keep healthy and well. People’s medicines were handled safely and given to them in accordance with their prescriptions.

The service was managed well. The provider regularly checked quality of care at the service through visits. Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We saw people's needs had been assessed and their care and support was planned and delivered in line with their care plan. We saw potential areas of risk had been identified in each person's care plan. Any risks in delivering the care and support had been discussed with people and measures had been put in place to minimise such risks. People's care plans and risk assessment were regularly reviewed and updated to make sure the information was still accurate for their situations.

Newly appointed staff were provided with an induction programme and shadowed experienced care workers until they felt comfortable and were competent in undertaking their role alone.

Staff had the appropriate training and support to give them the knowledge and skills to undertake their roles competently and in a safe manner.

People said they felt safe and knew who to speak to if they had any concerns.

The care and support that people received was tailored to ensure it met their individual needs and preferences. Guidelines were in place which documented how any assessed risk was to be managed. These helped staff manage risk and promote people's safety and comfort.

There was a recruitment procedure in place, to ensure suitable staff were employed to work with people receiving care and support.

People spoke of staff as "very supportive", "they are brilliant the most patient, caring people I can't speak higher of them...all I can say is anyone that gets care from them are very lucky." "The staff are very good, we had been struggling for the last three years, he responds well to them."