Chesham House

Chesham House is a residential home for up to ten people. The service offers accommodation, care and support to people with mental health needs. The accommodation is over two floors and includes a communal sitting and dining area and a communal kitchen. There are eight bedrooms in the main house and a further two flats in the garden. The flats are self-contained as they each have their own kitchen and bathroom. At the time of our inspection there were nine people living at the home.

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

The service had systems and processes in place for the safe administration and management of medicines, but these were not always effective. Potential risks were not always clearly documented within medicines assessments. Person-centred care plans were not always in place to support staff in caring for people with long term conditions, such as diabetes. There was not a policy in place for monitoring people who self-administered their medicines. The provider had a system of auditing in place which covered various aspects of the governance of the service provided. However, these audits had not identified issues with the safe administration and management of medicines.

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.

People were supported by staff who had completed training in safeguarding and understood different types of abuse. Risk assessments were in place and action taken to reduce risks for people. Risk assessments identified what support people needed, for example, with activities.

People were supported by staff who had been recruited following a robust procedure which ensured pre-employment checks were in place before new staff started work at the home. We were assured that the provider was using personal protective equipment effectively and safely. The provider was open to learning lessons if things went wrong or could go wrong. They recorded accidents and incidents and analysed the information for any trends or issues arising.

People living in the home experienced a positive culture. People were involved and engaged in how the home was managed. There were systems in place to ensure continuous learning to improve care. The registered manager and staff maintained links with health and social professionals.

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 3 November 2017).

Why we inspected

The inspection was prompted in part by notification of an incident. This inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of medicines administration. This inspection examined those risks.

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.

This report only covers our findings in relation to the key questions safe and well-led. 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 full 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 Chesham House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the lack of an effective system to ensure the safe administration of medicines. We found that the two areas reviewed were now rated as requires improvement.

Follow up

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

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 found the following examples of good practice.

Staff accessed the advice of relevant professionals to support people to understand COVID-19 and the impact on their usual ways of living at the home and going out. This had also helped people to understand the use of personal protective equipment.

Staff took different breaktimes so only one staff member used the staff room at any one time.

Extra cleaning was in place and records were kept to ensure everything was cleaned regularly.

The inspection took place on 6 September 2017 and was unannounced. The inspection team consisted of one inspector and a mental health specialist advisor with experience of working with people with mental health needs.

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 and associated Regulations about how the service is run.

People and staff said they felt safe at the home. The provider had policies and procedures in place designed to protect people from abuse and staff had completed training in safeguarding people. The registered manager knew how and when to use safeguarding procedures appropriately. Risk assessments identified when people were at risk from every day activities and comprehensive plans were in place to minimise those risks and to deliver care and support which met people’s needs. People’s needs were met by suitable numbers of staff. Appropriate recruitment procedures were in place.

People were supported to take their medicines as prescribed and systems were in place to manage peoples’ medicines safely. Two staff administered the medicines which ensured the process and recording were accurate.

People were supported by staff who were trained appropriately for their role. New staff completed an in-house induction and the Care Certificate where they did not have previous experience in support work. The provider had an ongoing training programme in place and staff spoke highly of the training available and additional bespoke training was provided when needed. Staff had training about the Mental Capacity Act 2005 (MCA).

People were supported to shop and make their own meals as well as to access healthcare services when necessary.

Staff formed positive caring relationships with people. Staff presented as genuinely caring and interested in people’s welfare. We observed positive interactions between people and staff on duty. The service supported people to express their views and be actively involved in making decisions about their care and support. Staff respected people’s privacy and dignity when supporting them.

People were supported to undertake a range of activities, both individually and as a group. People who were moving in to the home were involved in choosing the décor of their bedroom. People received personalised care that was responsive to their needs. People’s care and support needs were assessed and care plans were written, reviewed and developed regularly. The registered manager kept a log of complaints raised and we saw that complaints were investigated and responded to and included an apology where this was needed.

The provider and registered manager promoted a positive culture and staff spoke highly of the organisation, the project, and its management. There was a clear management structure in place which demonstrated good management and leadership. The registered manager had a system of audit in place to monitor the quality of service provided. “Service user meetings” were held regularly and were used to discuss the views of people living there and to give people information.