Archived: Chiltern Court Care Home

Updated 13 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Following the last inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions, is the service, safe, effective, responsive, caring and well-led to at least a good standard. We found there had been little or no improvement in any of the areas.

This inspection took place on 13, 14 and 16 November 2017and was unannounced. The inspection was carried out by an inspector, a specialist nurse advisor and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was as a family carer of older people, people with dementia and those who use regulated services.

Before the inspection we reviewed all the information we held about the service. We looked at notifications the provider was legally required to send us. Notifications are information about certain incidents, events and changes that affect a service or the people using it. We contacted and received information from the local authority safeguarding, contracts and commissioning teams. For this inspection we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with 11 people, two visitors, and a health care professional. We spoke with 10 staff including the acting manager and regional manager, permanent and agency nurses and care staff. We also spoke with housekeeping and catering staff.

We looked at care records for 10 people; four staff recruitment records; eight people’s medicines and topical medicine administration records and records relating to the management of the service.

Updated 13 January 2018

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This unannounced inspection took place on the 13, 14 and 16 November 2017. During our last inspection in February 2017 we found breaches of Regulations 9, 10,12, 13,14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ( HSCA RA Regulations 2014) and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 ( Registration Regulations 2009)

As a result we imposed conditions on the provider’s registration. This meant we asked the provider to supply us with information on a monthly basis to evidence improvements in these areas. They were legally required to do so and complied with these conditions. During this inspection we found improvements in regulations 13 and 14 HSCA RA Regulations 2014 and Regulation 18(Registration Regulations 2009).

However we found continued breaches in regulation 9, 10, 12 and 17 of the HSCA RA Regulations 2014 with additional breaches in regulation 19, 15 and 18 HSCA RA Regulations 2014.

The home had not had a registered manager in post since April 2017. Since the last registered manager left their post there have been three further managers covering the position, none of whom have remained in employment or applied to be registered with us.

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.

Chiltern Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Chiltern Court Care Home is a nursing and residential home for older people. The home is registered to accommodate up to 53 people, at the time of our inspection 23 people were living in the home. The accommodation is spread over three floors. The bottom two floors have lounges and dining areas. Only one person was living on the third floor.

We found improvements had been made in some areas of the safe handling of medicines. However, records were not always up to date or used appropriately to prevent people from being harmed by medicines or lack of medicines. For example patches. This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our last inspection we found the provider had failed to notify us or the local authority of safeguarding concerns that had taken place in the home. During this inspection we found this had improved and there was only one outstanding safeguarding notification we had not received. Staff had understood the indicators of abuse and systems were in place to report concerns and to take appropriate action to keep people safe.

During our previous inspection in February 2017 we found failings in the recruitment practices of the service. During this inspection we found the same failings as gaps in employee’s previous employment histories had not been investigated and recorded. This placed people at risk of harm. This was a continued breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the standards of hygiene and infection control were of concern in some parts of the home. Some areas were not clean, and catering and domestic staff had not all received training in infection control. This was a breach of 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Health and safety checks had not been carried out continuously in the months since our last inspection. We found some areas of the building required attention to ensure the security and safety of the staff and people living in the home. This is a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Maintenance contracts and service checks on gas and electricity had been maintained and were up to date.

During our previous inspection in February 2017 we recommended to the provider they gave consideration to the deployment of staff. This was because staff were not always available when people needed them due to taking breaks at the same time. During this inspection we found improvements had been made and staff were more accessible and able to respond quickly when people needed assistance.

During our last inspection we made a recommendation for the provider to improve support to staff through appropriate training, supervision and appraisals. We found this area had improved and the rate of training had increased. However, we found staff that required specific training to carry out their roles had not all received training. Supervision and appraisals were not being provided in line with the provider’s policy. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found during this inspection a continued breach in regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because records were not always available, up to date or accurate. The provider had failed to monitor the management of the home and address issues that affected the safe provision of care and support for staff.

Records showed people’s mental capacity had been taken into consideration when making decisions for themselves. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. However, people were not always supported to have maximum choice and control of their lives. People’s dignity and privacy were not always protected by staff. This was a continued breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also observed good care practices from staff including how they communicated with people and their general caring attitude towards the people living in the home.

We found a continued breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans did not always consider how people could be supported with their mental health. They did not always reflect the involvement of people and did not always consider how to support people to be as independent as possible. People still remained at risk of social isolation as the provider had failed to improve the provision of person centred meaningful activities to people living in the home.

During our last inspection and this inspection we found people did not always know how to make complaints.

We have made a recommendation in relation to end of life care planning for people within the home, as this was not a consistent practice throughout.

Due to the lack of consistent management in the home, we found staff had been put under pressure to repeatedly change the way they were working, this had affected morale, and their understanding of what was required. The provider had failed to monitor the quality of the management in the home and this had resulted in a lack of progress with regards to the expected improvements. A new regional manager and acting manager are now in post and improvements have been reported from the local authority contracts team since our inspection.

We found a number of 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 the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.