Chiltern Health Division

Chiltern Health Division is a domiciliary care agency providing personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 170 adults and 3 children/young people who received packages of support which included personal care.

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

Some areas of people's care records required strengthening to ensure risk assessments were in place and personalised for known risks, and care plans reviewed regularly and updated after any changes occurred.

Some notifications had not been submitted to CQC as required by law, and this was rectified during the inspection.

Quality assurance audits took place in most key areas of the service, and the provider introduced additional checks during the inspection to strengthen oversight further.

Staff understood safeguarding procedures. Safe recruitment practices were followed to ensure staff were suitable for their roles.

People normally received care from a consistent group of staff who arrived within a window of time and stayed for the duration of the call. Calls were monitored on a live system and regularly audited to identify and rectify any arising issues. People and their relatives were usually informed if carers were running late.

People were supported safely with their medicines and good infection control practices were in place.

Staff reported and followed up on accidents and incidents promptly. Lessons were learned when things went wrong, and learning was shared with the staff team to reduce the risk of the same thing happening again.

The provider and management team were proactive in their approach to ensuring people received high quality care. They were supportive of the inspection process and keen to drive continuous improvements to the service. A high majority of people were confident any arising problems or issues would be resolved in a timely manner.

Very positive feedback was received from professionals who worked with the service. The staff team felt supported and gave positive feedback about teamwork and working for Chiltern Health Division.

Staff understood and followed the principles of the Mental Capacity Act and sought consent, offered choice and supported people make decisions about their care.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 7 August 2021.) We made a recommendation for the provider to ensure an accurate information system was developed to provide up to the minute information to ensure a good outcome for people and staff. At this inspection we found improvements had been made in this area.

Why we inspected

The inspection was prompted in part due to concerns received about call times and some aspects of care. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

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 remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chiltern Health Division on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Chiltern Health Division, is a domiciliary care agency. It provides personal care to people living in their own houses or flats. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of our inspection 110 people were receiving personal care.

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

Medicines were administered safely and where errors had occurred we saw staff had been re-trained in line with Chiltern Health Division policies and procedures.

Some of the people and relatives we spoke with were not happy with the timing of staff calls and if staff completed their full calls before leaving for the next call. We looked at the electronic monitoring system which is not fully effective in recording all staff interactions in ‘real time’. This placed people and staff at increased risk.

People were safeguarded from abuse; staff were trained and were aware of how to escalate safeguarding issues if not dealt with in a timely fashion. Risks were assessed and care plans were regularly reviewed to ensure people were cared for safely.

Staff followed infection prevention and control (IPC) best practice, in relation to reducing the risks of transfer of infections, wearing personal protective equipment (PPE) and following good hand hygiene. Staff were aware of the latest information about changing face masks after completing a person’s personal care. Staff had access to enough supplies of PPE equipment.

People and their relatives knew how to raise a complaint and said they would feel confident to do so if needed. Staff were happy with the support provided by the management team at Chiltern Health Division. Some people; their relatives and staff were sent questionnaires periodically to judge their satisfaction of the service. Negative comments from relatives were followed up. Suggestions from both people and staff were being looked at as development opportunities.

The provider understood their role and responsibilities under the duty of candour and informed CQC of incidents they were legally obliged to do so.

Rating at last inspection

The last rating for this service was Good (published 10 November 2018).

Why we inspected

The inspection was prompted due to concerns received from people’s relatives. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating of Good has not changed based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chiltern Health Division on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the first inspection of this service since it was registered with the Care Quality Commission in April 2016.

Chiltern Health Division is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection, the service was providing care to 11 people across Milton Keynes.

The service had a registered manager. 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.’

Staff supported people with the administration of medicines, and were trained to do so. The people we spoke with were happy with the support they received. Medicine administration was not always recorded appropriately. Some prescribed topical creams were being administered but not recorded on a medication administration record.

People told us they felt safe, and staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by their manager.

Staffing levels were adequate to meet people's current needs. People told us that staff always arrived on time, and calls were not missed.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Staff attended induction training where they completed mandatory training courses and were able to shadow more experienced staff giving care. All new staff were taking part in the Care Certificate which teaches the fundamental standards within care. Ongoing training was offered to staff and mandatory areas of training were kept up to date.

Staff were trained in infection control, and told us they had the appropriate personal protective equipment to perform their roles safely. We saw that staff had reported any concerns they had around infection control within people’s homes to management, who had then acted appropriately.

Staff were well supported by the manager and senior team, and had one to one meet ups, spot checks and observations.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Consent forms were signed and within people’s files.

People were able to choose the food and drink they wanted and staff supported people with this, and people could be supported to access health appointments when necessary.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and provided their care in a respectful and dignified manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. Care planning was personalised and mentioned people’s likes and dislikes, so that staff understood their needs fully. People told us they felt in control of their care and were listened to by staff.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and improvements were highlighted and worked upon as required.