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The Chilterns Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 September 2018

This inspection took place on 23 and 24 August 2018 and was unannounced.

The Chilterns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Chilterns accommodates up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 20 people living at the service.

There was no registered manager in post. The previous registered had left the service in July 2018. There was a manager in post who had started at the service on 1 August 2018 and would be registering with the Care Quality Commission. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected The Chilterns in August 2017 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice in relation to staffing numbers. At this inspection, there was a continued breach of Regulation and three new breaches of Regulation.

At our last inspection, the service was rated ‘Requires Improvement’ overall with effective, caring and responsive being rated as Good. At this inspection, improvements had not been made and there continued to be breaches of regulation. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

At our last inspection, there were not always sufficient staff to meet people’s needs and enable them to always attend activities when they wanted. At this inspection, there continued to be times when there were not enough staff and people were not able to go out when they wanted.

Potential risks to people who had recently moved to the service, had not been consistently assessed and detailed guidance was not available for staff to follow to mitigate the risks. Some people displayed behaviour that may challenge the service or could become very anxious. Staff told us that they felt that they did not always know how to support these people. People were at risk of not receiving consistent support when they needed it. People who had lived at the service for a long time had detailed risk assessments and plans for staff to follow and support them so they remained safe and these had been effective.

Staff had met with people before they moved into the service, a comprehensive assessment was completed. The assessment covered all aspects of people’s lives including their social, cultural and sexual orientation. This was used to develop a detailed support plan, however, recently this had not happened and people who had moved to the service did not have person centred care plans that gave details of their choices and preferences. People who had lived at the service for a long time, had person centred plans that they had agreed to. The service had not supported anyone at the end of their lives, the service did not include end of life wishes in people’s support plan.

Medicines were not always managed safely. Systems that were in place to identify when errors had been made had not been completed correctly and had not been effective in identifying shortfalls found at this inspection. Checks and audits had been completed on all aspects of the service including care plans. Shortfalls had been identified and an action plan put in place, but these had not been followed up and the shortfalls continued at the inspection.

The buildings had been adapted to meet people’s needs, however, the dining room had been out of use since February 2018, as the ceiling had fallen down. People told us that they were unable to eat their meals together. People and sta

Inspection areas

Safe

Requires improvement

Updated 28 September 2018

The service was not always safe.

There were not sufficient staff on duty to meet people�s needs. Staff were recruited safely.

Potential risks had not been consistently assessed when new people came to live at the service, there was not always detailed guidance to mitigate the risk.

Medicines were not always managed safely.

People were protected from the risk of infection.

Environmental checks were completed to ensure people were safe.

Incidents were analysed and action taken to reduce the risk of them happening again.

Safeguarding concerns were reported and appropriate action taken to protect people from abuse.

Effective

Requires improvement

Updated 28 September 2018

The service was not always effective.

The building was adapted to meet people�s needs, however, not all areas of the service were able to be used.

People were supported to make their own decisions. Staff worked within the principles of the Mental Capacity Act 2005.

There was a training programme in place but not all staff had received all the training available.

People were supported to eat and drink enough and lead a healthier lifestyle.

People had access to healthcare professionals.

People�s needs were assessed using recognised tools and covered all areas of people�s lives.

Caring

Requires improvement

Updated 28 September 2018

The service was not always caring.

The provider still needed to make improvements to staffing levels to consistently meet people�s social needs.

People were treated with dignity and respect.

People were supported to be as independent as possible.

People were involved in planning their support.

Responsive

Requires improvement

Updated 28 September 2018

The service was not always responsive.

New people living at the service did not always have personalised support plan that gave information about their choices and preferences.

People�s end of life wishes had not been recorded.

People took part in activities that developed their skills for the future.

People knew how to complain and any complaints were investigated following the provider�s policy.

Well-led

Requires improvement

Updated 28 September 2018

The service was not always well led.

There was no registered manager in post.

Audits and checks had identified shortfalls; however, the shortfalls had not been rectified and were identified at this inspection.

People and staff were involved in the development of the service.

The service worked well with other agencies.

The manager understood their responsibility to continue to learn and improve the service.

There was an open and transparent culture within the service and there was a clear vision to improve people�s lives.