Chiltern Support and Housing

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The registered managers told us they involved people when creating care plans and also the next of kin where the person had agreed for them to be involved. Care records included assessments with guidance for staff to follow to support people. Care records included information relating to health, care, wellness and communication to enable care and support to be delivered.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Care records included guidance for staff to follow, such as following the positive behaviour support plan and for the staff to use their Non-Abusive Psychological and Physical Intervention (NAPPI) training at the right level. One person had a prescribed eating and drinking plan to support staff in supporting the person with their nutrition and hydration needs.

The provider told us they worked with teams and services to support people.The registered managers told us they held multi-disciplinary meetings, worked with professionals and the safeguarding team. We received feedback from professionals who told us there were some concerns with staffing levels in relation to one person. Professionals also told us, there were situations where the provider was not escalating concerns in a timely manner, concerns that the provider was not open to reviewing their actions when safeguarding concerns were raised and when concerns were raised, they were not always open to working together. In addition, professionals told us when information was requested from the service, this could take some time, and they regularly had to chase this up and there were concerns with care staff’s reluctance to follow one person’s action plan. However, professionals also told us, one of the registered managers was noted for being responsive, always available and helpful in promoting effective partnership working, communication was generally open, and the team engaged with when there were changes, concerns, or updates relating to individuals.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Care records included information regarding daily routines, communication, responding to distress, personal care and sleeping patterns. A relative told us their loved one was, “Very settled in the home, [Person] has known the home for years.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Daily notes were recorded of the support provided to people. Care records were written in a detailed manner to support staff in monitoring and improving outcomes and to support people in achieving their goals. Annual reports were completed by key workers. Relatives told us, “[Person] has a health annual check. I am asked, as family, to attend appointments” and “The staff are monitoring [Person] and inform us as family.”

Systems and processes were not always established and operated effectively to ensure consent was obtained and recorded and the principles of the Mental Capacity Act 2005 were followed.The provider worked with professionals in relation to Deprivation of liberty safeguards (DoLS) applications. The registered managers told us, “Staff ask for consent and this is recorded in the daily notes.” However, the daily care notes were unclear and did not always show staff obtained consent. The Mental Capacity Act 2005 says “A person must be assumed to have capacity unless it is established that he lacks capacity” and, “For the purposes of this Act, a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.” One person’s care records guided staff to act in the best interest of the person by prompting them to take medicines and the person did not understand what the medicine was for. Whilst we recognised the provider completed some best interests decisions, we identified other best interests decisions and mental capacity assessments were not always completed. We acknowledge the provider worked with families and professionals. However, we were not assured the provider understood their responsibility in relation to obtaining consent and conducting mental capacity assessments.