Chilton Court

Chilton Court is a residential care home that does not provide nursing. Chilton Court accommodates up to 47 people who require support with their personal care needs, some of whom are living with dementia. There were various forms of accommodation provided such as houses, flats and bedrooms. At the time of this inspection there were 36 people using the service.

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.

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

Not everyone had a sufficient and detailed care and risk management plan in place. This meant staff had not been provided with formal guidance as to the care support needed and how to identify specific risks to people's health, welfare and safety.

Whilst people were supported by kind and caring staff, there were insufficient numbers of staff to meet people’s needs in a timely manner overnight. The provider took immediate action to address this.

People were protected from the risk of abuse because the provider had effective safeguarding systems in place. Overall, effective systems were in place to prevent and control the spread of infection with the exception of some dirty equipment and light pulls.

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.

Whilst audits in place had identified some of the shortfalls we found at this inspection, progress on rectifying these concerns was slow. The provider had not ensured there was adequate oversight of the service. Quality assurance systems and processes did not identify or address all of the issues found during this inspection.

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 16 July 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 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 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 Chilton Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of risk, recruitment of staff as well as the provider’s governance at this inspection.

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

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.

We carried out an unannounced comprehensive inspection of Chilton Court on 9 May 2018. This was in response to our previous comprehensive inspection on 16 March 2017, where we rated this service as overall ‘requires improvement’.

During our inspection on 16 March 2017 we found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe care and treatment and meeting nutritional and hydration needs. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection.

At this inspection on 9 May 2018 we found no breaches in regulations, as the necessary improvements had been made and sustained. We were encouraged by the progress made by the management team to address the previous concerns and have rated this service overall ‘good’.

Chilton Court is a residential care home that does not provide nursing. 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. Chilton Court accommodates up to 47 people who require support with their personal care needs, some of whom are living with dementia. There were various forms of accommodation provided such as houses, flats and bedrooms. At the time of this inspection there were 28 people using the service.

A registered manager was 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.

Systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. The registered manager worked closely with the provider’s nominated individual and this had led to the overall quality and safety of the service improving. A nominated individual has the responsibility for supervising the management of the regulated activity, represents the provider and is a point of contact with CQC.

People and their relatives were positive about the approach of the registered manager; saying they were accessible to them and that communication in the service had improved.

People and relatives were complimentary about the care and support provided. Staff consistently respected people’s privacy and dignity and interacted with them in a kind and compassionate manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said.

Staff understood what constituted abuse and what procedure they would follow to report any concerns. Staff also received training in safeguarding.

There were sufficient numbers of staff effectively deployed to meet people’s needs who had been recruited safely. Staff were trained and supported to meet people’s needs. They knew how to minimise risks and provide people with safe care.

Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

Improvements had been made to ensure people’s care records reflected personalised care which were regularly reviewed and amended to meet changing needs.

People received care that was responsive to their needs. They participated in meaningful activities and were supported to pursue their interests. The service listened to people’s experiences, concerns and complaints and took action where needed.

People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. Appropriate referrals were made and acted on where concerns had been identified and people were encouraged to attend appointments with health care professionals to maintain their health and well-being. Where required people were safely supported with their dietary needs.

Staff understood the need to obtain consent when providing care. 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.

Improvements had been made to the security of the service. The environment met the needs of the people who lived there. All areas of the service were clean and in good state of repair with equipment maintained.

There were 35 people living in the service when we inspected on 16 March 2017. This was an unannounced inspection.

There was a registered manager in place. 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.

Improvements were needed in the management of medicines, particularly in medicines prescribed for external application and medicines to be administered ‘as required.’ The service’s own auditing system had identified the shortfalls in the records for the application of creams but this was not yet fully addressed.

Improvements were needed in the security of the service. This was in the process of being addressed by the service but not yet actioned.

The quality of information in people’s care records to guide staff in how people’s needs were met varied. Further consideration of how to provide additional and consistent guidance to staff would ensure that people were provided with safe and good quality care at all times.

There were systems in place for staff to receive training, achieve qualifications in their role and to be supported in their work practice. However, improvements were needed in the training of specific needs and subjects relevant to the people using the service.

People’s nutritional needs were assessed. However, improvements were needed in how staff recorded the amounts that each person had to drink and eat each day, where required and how this is monitored to ensure people receive enough to eat and drink. Improvements were needed in the provision of training and knowledge to staff regarding people’s specific dietary needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. However, improvements were needed in how people’s capacity and support to make decisions is included in care records to provide guidance for staff. Improvements were needed to provide training to staff in the Mental Capacity Act 2015.

There were systems in place to monitor the service provided. However, this had failed to identify and address all of the issues we had picked up during our inspection.

There was a system in place to manage complaints and these were used to improve the service.

Systems were in place to provide staff to meet the needs of people using the service. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People were provided with the opportunity to participate in activities. People were treated with respect and compassion by the staff working in the service.

Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

People were supported to see, when needed, health and social care professionals when required.

We spoke with two people's relatives who told us that they were happy with the service their relatives were provided with.

We saw that the staff were attentive to people's needs and responded to requests for assistance promptly. They interacted with people in a caring, respectful and friendly manner.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We saw that before people received any care and treatment they were asked for their consent.

Staff personnel records that were seen showed that the provider checked that staff were able to work with vulnerable people before they started work. Staff were trained to meet the needs of the people who used the service.

We looked around the service and saw records which showed that people were cared for in a clean and hygienic environment.

We saw that there was an effective complaints system in place and people's comments and complaints were listened to and acted on.