Archived: Chiltern House - Care Home Physical Disabilities

We found the following examples of good practice.

Robust infection prevention and control measures were in place. There were supplies of PPE by the front door and posters and signage to alert people to the restrictions and measures in place. A sanitising station had been set up inside the front door so that hands and wheelchairs could be cleaned before people entered the building.

The premises were kept in a clean and hygienic condition throughout. Areas of potential high risk of cross-infection, such as handrails and light switches, were regularly disinfected. Supplies of PPE were available to staff throughout the premises. Staff were encouraged to bring a spare set of clothes to change into when they finished their shift. There were showering facilities for staff to use. There was a room staff could move into if they wished to self-isolate at work, to protect family members.

Staff had received training on infection prevention and control. This included use of PPE and how to put it on and take it off. The risks of potential exposure to the virus had been assessed for all staff, taking into account health conditions and high risks associated with people from black, Asian and other ethnic minority backgrounds. There was a designated Covid-19 champion who promoted good practice at the home.

Staff and people who used the service were tested for Covid-19. People were tested prior to admission to the home, such as if they needed to return from hospital.

The home was effectively managing an outbreak of Covid-19 and preventing further spread. A root cause analysis was carried out to see how the outbreak happened, to help prevent further occurrence. Visitors to the home were restricted due to the outbreak. Contact tracing and health declaration forms were completed on arrival at the home and staff checked people’s temperature. The home facilitated contact between people who use the service and their families, using computer technology, and had purchased additional IT equipment for people to use.

The home liaised with appropriate external bodies for advice and guidance, such as Public Health England, the local authority’s infection prevention trainer and the primary care clinical lead for the service. Any advice or equipment provided by these agencies was incorporated into how staff cared for people. A business contingency plan was in place, to reduce the effects of potential disruption to people’s care. There were policies and procedures to provide guidance for staff on safe working practices during the pandemic. Auditing and observation of care practice took place to ensure these were adhered to.

Chiltern House Care Home is a residential care home for up to 22 people with physical disabilities catered for. The service is split into three wings over one floor.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good.

Why the service is rated Good.

There were safe systems in place to monitor people’s medicines. We observed a member of staff administering medicines to people and the correct procedure was followed. People received their medicines as the prescriber intended. Risk assessments were assessed and managed. These included procedures to follow in the event of an emergency.

Staff completed induction training and shadowed experienced staff before working alone. Staff received supervision to monitor their work. We observed the supervision matrix which confirmed this. People were offered a choice of menu which included a vegetarian option. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect. We saw staff knocking on people’s doors and waiting for a response before entering. People told us they could come and go as they wished. Care plans were individualised and detailed people’s preferences on how they wanted to be supported.

People received care that was responsive and effective and tailored to their needs. People had detailed care plans in place which included a health plan and risk assessment. A complaints procedure was available for people and their relatives. People told us they would speak to the manager or staff in the first instance. People were able to join in activities and plan trips for the month ahead. We saw people engaged in activities and were preparing for Christmas events.

The service followed their infection control policy and procedure. We saw the premises were visibly clean and free from odours. The service used an outside cleaning company to ensure the environment was clean and a cleaning scheduled was in place.

People were provided with a well led service. The organisations values and philosophy were explained to staff and there was a positive culture where people were included.

Audits completed ensured the services policies and procedures were followed. The service had processes in place to ensure there was a clear audit trail of any actions required following completion of audits. The service worked closely with other healthcare professionals who offered advice support and training. Regular meetings were held which gave clear instructions on any areas of concern. The service notified us of any reportable occurrences which were followed with actions to be taken. The service met all relevant fundamental standards.

Further information is in the detailed findings below

Chiltern House is situated in the village of Gerrard’s Cross in South Buckinghamshire. The location is registered to provide care and support for up to 22 people who have physical disabilities. The home is set out in three separate areas on the ground floor accommodating seven people in two of the areas and eight in the third. Each living area had its own kitchen and dining facilities.

This inspection took place on 13 14 July 2016 and was unannounced.

There was a registered manager in place at the time of our inspection.

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.

People’s feedback regarding Chiltern House was mostly positive. One person told us, “I think it is good and the volunteers are a great asset.” Other comments were, “To my mind it’s excellent, and I feel safe here.” A visiting relative told us, “It’s first class.”

Care plans recorded people’s likes and dislikes and provided staff with information to enable them to provide care effectively.

Staff were well trained and motivated and had received training in safeguarding. Staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated.

Staff were trained in the administration of medicines and medicines were administered safely in accordance with best practice.

We saw people were cared for with compassion and respect. The registered manager provided effective leadership to the service and held regular meetings with people to ensure they were involved in the running of the home. The service was well-led and people’s care was regularly reviewed.

Staff told us they felt happy and supported working for the service. Supervisions took place on a regular basis.

The service had a physiotherapist who worked throughout the week. Activities and social events were planned to give people choice and social contact.

A general risk assessment was in place to identify hazards within the home. We looked at this and saw measures put in place to protect people from cross contamination from biological and chemical waste. The risk assessment identified what staff members should do when using mops to clean any spillages and procedures to ensure all mops used were kept cleaned to prevent cross contamination. We found people could be confident there was an effective system to assess the risk of and to prevent, detect and control the spread of health care associated infection.

We viewed the monthly cleaning chart which showed a list of equipment to be cleaned. For example, bed frames, bed rails, bed controls, mattresses. We saw notes left for staff member’s supervisors to address areas where equipment required further attention. One person we spoke with said: “When residents query why we have to do anything, staff always says it’s because of infection control.” People could be confident there were systems to ensure the maintenance of equipment were to appropriate standards of cleanliness and hygiene.

We found people who used the service were happy with the service being provided. One person told us the “home is different from a lot of care homes; this is the only one I would want to live in.” Another person told us they found the home “brilliant” and “your life is your own.”

We found the provider was changing the way they recorded people’s care needs. The new format was more centred on the person rather than the service. It enabled people to communicate how they wanted the service to meet their needs. It clearly demonstrated a willingness by the provider to listen to people’ views and understand what was important to them.

We had difficulty in obtaining information regarding the staff training matrix, due to the change in computer systems.

Whilst the provider had in place a designated worker for Infection control within the service, it did not appear the staff were applying the training to their practice. It also appeared information regarding prevention of infection and good hygiene practices were not being shared with the staff. We saw evidence staff were not carrying out the required practices of infection prevention in some areas.