Chesham House

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to medicines management. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 75 (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 registered manager and provider described how learning was taken from incidents, medicines-related issues and internal quality monitoring. This was supported by staff feedback, as staff were able to describe how they would escalate concerns, seek advice and share information with senior staff and external professionals where required.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services. Evidence reviewed showed the service considered people’s needs before admission and planned support around individual risks, including mental health needs, community access, health needs and personal care. Daily records demonstrated planned support was consistently delivered in practice.

Staff understood how to escalate concerns to appropriate professionals. Staff described seeking support from the registered manager, team leaders, pharmacy or GP where they needed advice. This helped ensure people received coordinated support and that risks were shared and acted on appropriately.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff were able to describe how they would raise safeguarding concerns, including escalating concerns to the registered manager, senior staff, the safeguarding team and other professionals where required.

For example, 1 staff member told us they would “raise it with manager” and, if the manager was not available, would raise concerns with a senior colleague before submitting information to the safeguarding team. Another staff member said safeguarding concerns needed to be “reported immediately” and described the aim as being to safeguard the person and their life. This demonstrated staff understood their safeguarding responsibilities and the need to act promptly to protect people from harm.

Decision-specific Mental Capacity Assessments and best interest decisions were completed in relation to specific restrictions in place for individual people. These records demonstrated that restrictions were considered through appropriate legal processes, were linked to identified risks and included consideration of less restrictive options.

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. Support plans identified a range of risks, including mental health deterioration, self-neglect, health conditions, community access, food and drink risks, allegations, mobility and independence-related risks. Daily care records confirmed that risk management guidance was followed consistently in practice.

Staff described supporting people to make informed choices while respecting their rights. One staff member explained that, where a person made an unwise decision about food and diabetes, staff would explain the possible consequences, offer advice and support the person to make their own choice. Another staff member described using information from the NHS app and creating a food plan with a person to support them to reduce sugar intake while still making their own decisions. This showed staff promoted people’s independence while supporting them to understand and manage risks.

The provider detected and controlled risks in the care environment. Environmental safety records reviewed included fire safety checks, gas safety certification, Portable Appliance Testing (PAT), emergency lighting, electrical installation testing, water safety and maintenance records. Where issues had been identified, the provider supplied evidence of action taken. This included evidence that failed PAT items had been removed or replaced, emergency lighting defects had been repaired, and electrical remedial works had been completed following an unsatisfactory electrical installation condition report.

The provider acknowledged there had been weaknesses in oversight to ensure actions were completed in a timely way following some environmental audits. They confirmed that changes had been made to ensure remedial actions were promptly undertaken in the future. This demonstrated the provider had taken action to reduce environmental risks and improve future monitoring.

The environment was suitable for the people living there and provided individual ensuite bedrooms, communal living areas and access to a safe enclosed rear garden, enabling people to spend time outdoors and access fresh air independently where appropriate.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff described receiving appropriate support, supervision and training to undertake their roles. Recruitment records reviewed demonstrated appropriate pre-employment checks had been completed before staff commenced employment, and training information showed staff had completed relevant mandatory and specialist training.

Staff told us there were generally enough staff to meet people’s needs. One staff member said there were “enough staff” and described regular monthly team meetings. Another said there were “lots of opportunity to discuss and raise things,” and team leaders also had separate meetings. Some staff described occasional staffing pressures due to sickness and annual leave, but there was no evidence at the time of the assessment that this had impacted on people’s care.

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. The environment was clean and well maintained, and cleaning tasks were monitored through the provider’s electronic system.

Staff were able to describe how they would recognise possible signs of infection or deterioration in people’s health. Staff told us they would look for changes in behaviour, presentation, communication, temperature and whether people were “not themselves.” Staff also described escalating concerns to the manager, team and GP. This provided assurance that staff understood the importance of identifying infection risks and seeking support where people’s health changed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. There were safe systems in place for the management of medicines, including medicines audits, stock checks, PRN protocols, medicines room oversight, and staff medicines training and competency assessments. During the assessment, low minimum medicine fridge temperatures were identified and the registered manager agreed to review this and ensure appropriate action was taken when temperatures fell below the recommended range.

Staff understood how to seek advice in relation to medicines. One staff member described contacting the pharmacy or 111 for advice if there had been a medication error, and other staff described seeking advice from the manager, pharmacy or GP where they had concerns. Daily records also showed medicines were administered and recorded, including support with PRN medicines and social leave medicines where required.