Archived: Chiltern View

The premises are on three levels with bedrooms on the first and second floors. On the ground floor there are further bedrooms and communal areas including a lounge, dining area and conservatory. There is also shared garden space. Administrative and management offices are also on the ground floor.

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

People’s medicines were not managed safely. Guidance for staff on how to support the safe administration of medicines was not always in place or where it was, it was not sufficiently detailed to ensure they understood what they needed to do.

People were not protected from the risk of infection because staff did not always follow good practice in relation to wearing Personal Protective Equipment (PPE) or the handling of clinical waste. There was a malodour on the ground floor of the building.

Systems in place to monitor the quality of the service were not used effectively to identify shortfalls in quality. Reportable incidents had not always been identified affecting external bodies’ ability to monitor the safety and quality of the service.

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 inadequate (published 10 November 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.

Why we inspected

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 undertook this targeted inspection to check on specific concerns we had about medicines management, the management of the home and the identification and reporting of incidents in the service. This included events that we became aware of through third parties that we had not received formal notifications about as required by law.

Following the last inspection, we urgently imposed conditions on the providers registration in relation to Chiltern View. One of these conditions was that the provider was to submit to us fortnightly updates on making the required improvements. We did not receive these updates after 24 October 2022.

We use targeted inspections to follow up on warning notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 medicines management, infection control and the management oversight of the home including how they identify and report incidents and accidents to protect people from potential harm.

Following this inspection we took enforcement action to cancel the registered manager's registration and to remove the location of Chiltern View from the provider's registration, which meant they could not continue to operate this service.

The premises is on three levels with bedrooms on the first and second floors. On the ground floor there are further bedrooms and communal areas including a lounge, dining area and conservatory. There is also shared garden space. Administrative and management offices are also on the ground floor.

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

The service was not well-led. The provider and registered manager did not use quality monitoring systems effectively to identify and address shortfalls in the service.

People were not protected from harm and lessons were not learnt when things went wrong. Risks to people's safety were not adequately assessed and staff did not act to reduce the risk of harm. People at risk of pressure damage to their skin did not receive appropriate support to reduce the risk of new or worsening injury.

People were not protected from the risk of malnourishment or dehydration. People at very high risk of weight loss did not receive support in line with their care plan to ensure they maintained adequate food intake. Medicines were not managed safely, and staff did not follow good practice when administering medicines. The service was not clean and appropriate measures to protect people from the spread of infection were not followed. The premises had not been designed or maintained to meet the needs of people living there.

There were not enough staff to meet people's care and support needs. There were a high number of agency staff used to cover shifts, some of whom lacked the required skills and experience and were unfamiliar with the needs of the people living at the service. Although permanent staff provided better care, they were extremely busy and did not have time to provide good quality outcomes for people. People did not receive timely care and were left for long periods with no interaction or support from staff. People, particularly those cared for in their bedrooms, were left isolated with no stimulation. Many staff did not engage with people or initiate conversation. There were no opportunities for meaningful occupation offered to people.

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.

People were not always treated with dignity and respect. Staff did not always treat people with kindness and compassion and the language used to describe people was not always respectful. People, or their relatives where appropriate, did not always feel supported to be involved in making decisions about their care.

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 requires improvement (published 09 July 2019) and there were 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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. It was also prompted in part due to information received from the Environmental Health Officer and the Fire Safety Officer about risks found at the service. This information indicated a risk of shortfalls in the management oversight of the service. A decision was made for us to inspect and examine that risk.

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, caring, responsive 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.

Although initially slow to respond to concerns we raised with them, the provider has since increased staffing levels and developed a plan to support improvements to the service. The newly appointed operations director is working closely with the registered manager to make improvements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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 breaches in relation to leadership, staffing numbers and skills, safe care, protecting people from harm, infection control, medicines management, nutrition and hydration, dignity and respect, person centred care and a lack of meaningful engagement for people.

In response to the areas of very high risk we found at the inspection we took urgent action to keep people safe. This included placing conditions on the provider’s registration to restrict them from admitting new people to the service and requiring them to take specific actions to reduce risks to people.

Following this inspection we took enforcement action to cancel the registered manager 's registration and to remove Chiltern View from the provider's registration so they are unable to continue to provide accommodation and personal care from this location.

The overall rating for this service was ‘Inadequate’ and the service was therefore in ‘special measures’. This meant we kept the service under review and, if we did not propose to cancel the provider’s registration, we would re-inspect within 6 months to check for significant improvements.

The provider had not made enough improvement within this timeframe and there was still a rating of inadequate for a key question or overall rating, We took action in line with our enforcement procedures. This meant we began the process of preventing the provider from operating this service. This led to varying the conditions of their registration. to prevent them from operating the service.

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.

Relatives told us visiting their family member was encouraged and supported by staff. Relatives were required to produce a negative rapid COVID-19 test, and have their temperature checked before entering the main building. Personal protective equipment (PPE) was supplied, and guidance for PPE usage was displayed at the care home.

External health and social care professionals, and visitors, had to evidence COVID-19 vaccination status, and produce a negative rapid COVID-19 test before entering the care home. Additionally, health declaration and temperature checks were completed. The only exception to this was for emergency workers, to ensure no delay of their review and care for people.

Staff used PPE correctly, and wore uniforms whilst at work. Hand sanitiser was available, and this was appropriately stored to promote safety. Handwashing guidance was displayed, and the registered manager ensured posters were replaced should movement occur.

The registered manager had clear knowledge of the testing and admission requirements for people. Staff used a handover diary which highlighted people’s individual requirements and ensured continuation of care to meet their health and vaccination needs.

The care home was clean and hygienic. Frequently touched areas, such as door handles and handrails, received enhanced cleaning. Staff told us they had access to the required cleaning products and equipment to maintain a safe environment.

The registered manager told us they had received good support from their community clinical lead, and the local authority. Additionally, the registered manager evidenced their commitment to challenge concerns to promote the safety and wellbeing of people and staff.

Chiltern View is a residential care home that provides personal care to 36 people aged 65 and over. At the time of the inspection on 30 May 2019, 25 people were receiving care. On 3 June 2019, 23 people were receiving care.

People’s experience of using this service:

Governance systems and provider oversight were not sufficiently robust to have identified the issues we found.

Not all areas of the service were safe for people to access when we arrived. The registered manager and deputy manager took immediate action to make these areas safe. The four communal bathrooms were in poor decorative condition and people were not able to use three of them for bathing or showering. Processes were not effective to prevent the spread of infection.

Staff were very busy, and people were left unsupervised and unoccupied. People were not offered baths or showers at the frequency suggested in their care plans. Staff were not always following people’s care plans, and they were not reviewed when people’s needs changed.

People did not always receive their meals evenly spaced throughout the day. Staff were not sufficiently supervising people at mealtimes. The provider had not encouraged a culture that supported staff and promoted a service centred on the people that used it. Staff discussed people’s care in front of other people.

Staff were aware of safeguarding processes and how to reduce risk of harm. Staff had access to disposable protective equipment, such as gloves and aprons, and cleaning materials.

The provider had a system in place to make sure they only employed staff once they were satisfied of their suitability to work with people who used the service. Staff engaged openly with outside agencies to address safeguarding concerns. People received their prescribed medicines safely and in line with the prescriber’s instructions.

Staff were competent, knowledgeable and skilled to carry out their roles. Staff used equipment appropriately to help people move. Some areas of the service had benefitted from redecoration and some refurbishment. The garden had been redesigned to stimulate the senses, but as people were only able to access it with staff or visitor assistance, it’s use was limited.

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. Staff supported people in a kind, friendly and respectful way. Staff knew people, and their preferences, well.

People and their relatives confirmed they were involved in the assessment and care planning process. Staff supported people to maintain relationships that were important to them and encouraged people’s relatives and friends to visit the them. Staff recognised and respected people’s end of life wishes.

The provider had systems in place, including a complaints procedure, to deal with any concerns or complaints. People and their relatives were given opportunities to comment on the service. The registered manager recognised and rewarded staff who provided an exceptional level of service with a staff recognition scheme. The registered manager told us that they kept themselves up to date with developments and best practice in health and social care.

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

Rating at last inspection:

The service was rated good at the last inspection (the last report was published on 21 December 2016).

Why we inspected:

This was a planned inspection based on the last rating.

Enforcement:

We have identified breaches in relation to staffing levels and the monitoring of the service at this inspection.

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

Follow up:

We will continue to monitor intelligence 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.

More information is in the detailed findings below.

Chiltern View is a residential care home that provides accommodation and personal care for up to 36 older people, some of whom live with dementia. At the time of our inspection there were 24 people living at the home.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service was not always safe because pressure care for people who needed it was not always provided in a timely way. People’s medicines were managed and stored appropriately and the provider had robust policies in place for the safe recruitment of staff. Staff were trained in safeguarding people and people had individualised risk assessments in place that gave guidance on keeping them safe.

Adaptations of the home environment had been made in order to meet people’s needs. Staff recognised people’s care needs and were trained to meet them. They understood their responsibilities to seek people’s consent before providing care in line with the requirements of the Mental Capacity Act 2005. They supported people to access healthcare services when required.

People were cared for by staff that were friendly, kind and caring. They supported people in ways that promoted their privacy, dignity and respected their views. They provided the support that was personalised to people and with support from the management team, they ensured people’s complaints and concerns were resolved. The registered manager, with support from the provider, ensured the service ran appropriately providing visible leadership and oversight at all levels.

The provider submitted an action plan, which stated that affected areas of the home, furniture and carpets were to be thoroughly cleaned or replaced and increased monitoring of the environment and that thorough spot checks would be completed. It confirmed that this work would be completed by 18 October 2013. On 3 December 2013, we carried out an inspection to check that these actions had been implemented.

We found people were supported to have adequate nutrition and hydration. A relative that we spoke with confirmed that overall they were very satisfied with the service provided in this home saying, '.is happy here, ' is safe and extremely well cared for.' One person who used the service said, "I'm happy here."

We also saw a number of responses from satisfaction surveys that had recently been completed and returned to the registered manager. Chiltern View also facilitated a "Family Association Group" a meeting held monthly to enable people who use the service and their relatives to share their views and opinions, and make suggestions for improvements.

However, we found that appropriate standards of cleanliness and hygiene in the home were not effectively maintained throughout the home.