Chiltern Support and Housing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment and safeguarding.

This service scored 59 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The provider completed incident reports which included details of the investigation and understanding why the incident occurred.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Care records included information such as emergency information and hospital passports. This meant professionals had the information required to ensure continuity of care in line with people’s preferences and needs. Staff told us how people were supported before they moved into their homes to ensure continuity of care. This included actioning a detailed transition plan to ensure the person was supported to alleviate any possible distress.

Systems and processes were not always effective in safeguarding people from abuse and improper treatment. The provider submitted statutory notifications to CQC. Staff completed safeguarding training. However, we identified when Non-Abusive Psychological and Physical Intervention (NAPPI) had been used, the records did not record the type of intervention used nor the duration. The registered managers told us, “We need to improve, we will add the type of [intervention].” Professionals told us they “have had concerns regarding staff’s training in the use of restraints or the level of restraints being used…there were no body maps from the provider to indicate if any bruising had occurred during the restraint. No body maps even prior to restraints were available for comparison.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff understood there were times when people became distressed and took steps to understand why a person was distressed and what support they needed to express their emotions. The provider completed risk assessments. Relatives told us, “I feel [Person] is safe because they are known by the staff” and “staff manage risks appropriately.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We identified risk assessments were not completed for emollient creams which pose a significant fire risk. This did not support the safe care and treatment of people and placed them at potential risk of harm in the event of a fire.

Recruitment practices were not consistently safe. The provider carried out pre-employment checks including obtaining a Disclosure and Barring Service certificate. Disclosure and Barring Service checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, we identified gaps in the recruitment records and interview records along with induction records were not always fully completed. Professionals told us when training had been arranged to support staff in meeting the individual needs of people, during the sessions, “staff engagement was limited, some staff did not participate…Due to the lack of engagement from staff, further training was stopped.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Our visits to some of the supported living properties identified the homes to be clean and well presented. Relatives told us the homes were clean and, “the home is very clean and tidy, but it is still a home that can be lived in.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. We identified concerns in relation to medicines. For example, we identified medicines had been administered but not signed for. For another person, there were no records of when to start the morning dose of their medicine and another medicine had been stopped but there was no reason recorded for this. The daily notes did not always show why “when required”, “pro re nata” (PRN), was administered. Care records contained contradictory information relating to continence care needs. Care records did not contain guidance for staff information on how to support with catheter care. For a person, we identified their prescribed food supplement was not recorded on the Medicine Administration Record (MARs). Care notes did not always state where emollient creams were applied. We identified from the care records staff were required to encourage a person to be as upright as possible when their medicine was administered. However, the care notes did not document this. We identified care records contained inconsistent information when supporting people with medicines.