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Archived: Chesham House Requires improvement

The provider of this service changed - see new profile


Inspection carried out on 19 January 2016

During a routine inspection

This inspection took place on 19 January 2016. The home was given one days’ notice of our intention to inspect to ensure staff we needed to speak with would be available. The home provides accommodation and personal care for up to 10 younger adults with mental health needs. There were eight people living at the home and two people on day transition as part of moving into the home when we visited.

The home 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.

Care plans and risk assessments did not all provide comprehensive information about how people should be cared for. Information was not always available about the outcome of health appointments or if these had occurred. Not all people received the support they required to ensure they had a varied and nutritious diet.

Information about how legislation designed to protect people’s legal rights should be applied for individual people was not always present. Staff were offering people choices and respecting their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied for appropriately but staff had not ensured they were aware of any specific requirements of one which had been approved. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Medicines were stored securely and administered safely. Individual ‘as required’ guidance were in use meaning there would be consistency in administration by different staff.

The recruitment process records showed all necessary pre-employment checks had been completed. There were enough staff to meet people’s needs and contingency arrangements were in place to ensure staffing levels remained safe. Staff received appropriate training and were supported through the use of one to one supervision and appraisal.

People felt safe and staff knew how to identify, prevent and report abuse. Plans were in place to deal with foreseeable emergencies. The home was well maintained with procedures in place to ensure this continued.

People were positive about the service they received. They praised the staff. A range of varied individual and small group mental and physical activities were offered with people able to choose to participate or not.

People were able to complain or raise issues on an informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager was aware of key strengths and areas for development of the service. Quality assurance systems were in place with regular contact by the provider’s senior management team and the registered manager with people and staff.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 8 January 2014

During a routine inspection

We spoke with five people. Three told us they had received the help they needed. They had regular opportunities to discuss and make changes to the care and support they received. We heard comments such as “Nothing is too much trouble. I might have to wait if they are busy but that is not a problem”. Another comment was “I get support when I need it”. One person said they would like more feedback and we found how they were being supported was under review by the manager. Another person said they got help but raised a concern which the manager addressed. Systems were in place to assess people's needs and associated risks. People told us there were enough staff in place to support them when they wanted it. People had regular opportunities to discuss and make changes to the care and support they received.

We spoke with four established staff and one new member of staff. Induction was in place for new staff. Established staff were organised to be available to assist people as needed. They showed knowledge of individual people's needs and wishes. We spoke with three about support, supervision and training and found this was provided.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Local safeguarding procedures were understood and followed to the benefit of the people who used the service.

Systems were in place to effectively manage people's prescribed medicines. Effective records were held securely in the home. These were in relation to people who used the service, staff and the management of the home. They were kept under review to ensure adjustments were made so they were fit for purpose.

Inspection carried out on 12 February 2013

During a routine inspection

We found that people were involved in decisions about their individual care and support provided at the home. They were positive about the care provided and had regular opportunities to discuss the help and support they received. There also forums for people and staff for discussion and feedback about the service which the manager addressed. We received comments such as “staff look after your interests” and they were “supportive, friendly and helpful”. We found examples to show that the service worked well with other care and health professionals involved in monitoring Mental Health Act arrangements.

Staff were aware of the safeguarding concerns that could arise in residential setting and had received training. Safeguarding procedures were in place and known by staff. Staff had also been trained in dealing with challenging situations. Interventions used were monitored by the manager to check that staff followed guidance to ensure their responses were proportionate. Arrangements were in place to ensure that staff were vetted and suitable to work with people living in the home. The provider had an effective system to regularly assess and monitor the quality of service that people received.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.