Archived: Chilterns Manor

Updated 9 August 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.

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

The inspection was carried out by 1 inspector 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

Chilterns Manor is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Chilterns Manor is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We contacted staff by email but did not receive any replies.

We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 8 relatives. The Expert by Experience contacted relatives by telephone to seek feedback on the quality of people’s care.

We spoke with a range of staff including the registered manager, deputy manager a senior care worker and housekeeping staff.

We checked some of the required records. These included care plans, medicines records, staff recruitment files and staff training and development files. Other records included those which related to monitoring and auditing of the service, minutes of staff meetings, accident and incident reports.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We requested and received additional evidence from the provider to support our judgements. We continued to review this information until 16 March 2023.

Updated 9 August 2023

About the service

Chilterns Manor is a residential care home providing accommodation and personal care to up to 22 people. The service provides support to older people and people with dementia. At the time of our inspection there were 14 people using the service. Chilterns Manor accommodates people in one adapted building.

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

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People were not protected from the risk of avoidable harm. For example, portable heaters were in use in bedrooms. In one room, the radiator was extremely hot to touch and could have caused serious injury. Risk assessments had not always been put in place where risk was evident, for example use of anti-coagulant medicine to thin blood, use of bed rails and choking risks.

People could not be confident they would be repositioned safely by staff. Moving and handling competency assessments had been done under training scenarios where staff practiced on each other, rather than in real life situations where people’s movements and behaviour are likely to be unpredictable. One person had been injured in an accident when staff had failed to provide their walking frame. We observed another person was poorly assisted getting off the stairlift.

People were not sufficiently protected against the risk of fire. The provider could not assure us recommendations in the fire risk assessment had been fully addressed or were in action. Fire drill records showed demonstration of what staff might do but did not indicate simulated rehearsal and obstacles they may encounter, so that these could be addressed before an emergency arose.

Medicines were not consistently managed in line with good practice. Two end of life medicines had not been logged in to the home. This meant there was no record of quantities received and would prevent accurate auditing of their use. Some entries on medicines records indicated they had not been given. When this was queried with the provider, they told us the medicines were not required. One of the medicines was an antipsychotic medicine, another a vitamin; both were prescribed for regular use therefore they should have been given.

There were sufficient numbers of staff on duty and recruitment checks had been undertaken. However, it was not clear how some new staff had been assessed as suitable where they had no background in adult social care and references and application forms did not provide information about suitability. We observed staff with poor English skills and speaking in their first language in front of people. Staff did not always engage well with people. For example, we saw some staff standing up to assist people with drinks and meals, sitting on the arm of chairs and sometimes not talking to people whilst sitting next to them.

People could not be confident they would be protected from the risk of abuse. Incident reports did not always provide information about the extent of injuries referred to and who other people were who were injured or affected. The provider was unable to send us information to assure us people were adequately safeguarded when we asked for these details. We also found some of these incidents should have been referred to the local authority. We had not always been informed about all events the provider was obliged to report to us.

There was little evidence of engaging with people to consult with them and seek their views. Relatives reported communication from the home was still an area that needed attention.

Management oversight and governance processes were not robust enough to examine the quality of people’s care and identify areas for improvement. Concerns we found as a result of the inspection had not been picked up as part of monitoring. There was a lack of understanding around risks to people and looking at care from people’s perspective.

There was some evidence of contacting people when things went wrong. However, the provider did not fully act in an open and transparent manner (duty of candour) by offering an apology and saying what actions they would take to prevent recurrence.

Relatives expressed a mix of experiences of the home. Comments included “Always clean and well-fed and well-cared for,” “No complaints, seem to be very kind” and “Staff seem very nice.” Others told us there was no rapport with some staff and that staff did not engage well with people. Some themes where they felt there could be improvement included the poor condition of the garden and activity provision.

Improvements had been made to infection prevention and control measures.

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.

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 (report published 14 October 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 the provider remained in breach of regulations.

At our last inspection we recommended the provider follow good practice where people lacked mental capacity. Improvements had been made in this area. A further recommendation was made to improve people’s mealtime experiences. Actions taken were not sufficient.

Why we inspected

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service remains Inadequate.

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

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

Enforcement and Recommendations

We have identified continued breaches in relation to safeguarding people from abuse, safe care and treatment, recruitment practice, being open and transparent (duty of candour), governance of the service and notifying us of significant events.

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.

The overall rating for this service is ‘Inadequate’ and the service remains 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 of 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.