Chiltern Grange Care Home

Updated 21 January 2021

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.

This inspection took place on 18 December 2020 and was announced by phone on arrival, before the inspector entered the home.

Updated 21 January 2021

This unannounced inspection took place on the 15 and 16 January 2018. Chiltern Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there were 44 people living in the home. Chiltern Grange Care Home can accommodate 75 people across three separate floors, each of which have separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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.

When we completed our previous inspection on 23 and 24 April 2017 we found concerns relating to end of life care documentation. At this time this topic area was included under the key question of “Is the service caring?” We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of “Is the service responsive? Therefore, for this inspection, we have inspected this key question and also the previous key question of “Is the service caring?” to make sure all areas are inspected to validate the ratings.

During our previous inspection on 23 and 24 April 2017 we found a number of breaches of regulations. These included Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 and Regulation 19 of the Care Quality Commission (Registration) Regulations 2009. Following the last inspection, we spoke with the provider and asked them to complete an action plan to show what they would do and by when to improve all the key questions to at least good.

During this inspection we found improvements had been made to all the areas that we previously reported as required improvement. During this inspection we found records were up to date, accurate and appropriate. Records related to risks had clearly identified the risk and the methods used to minimise risk. Standards of infection control were high with clear policies and procedures in place to minimise the spread of infection. The management of risks in relation to fire, health and safety and risks related to the provision of care were clearly recorded.

We observed and records demonstrated that improvements had been made to the administration of medicines. During this inspection we found medicines were administered in line with the prescribed times. Records were kept up to date and audits had proved effective in ensuring people received their medicines correctly.

Improvements had been made in the way staff were deployed. Through our observations and records of staff rotas we could see there were sufficient numbers of staff to ensure people’s needs were met.

Systems were in place to ensure the risk of employing unsuitable staff was minimised.

During our previous inspection in April 2017 we found the provider had failed to comply with the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). During this inspection we found this had improved and the provider was now compliant with the requirements of the Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice.

We observed food was presented in an attractive way to encourage people to eat and maintain good health. People’s dietary needs were identified and understood by staff who were involved in the preparation and delivery of food. People told us they enjoyed the food on offer in the home.

Staff support had also improved, with staff receiving regular supervision and training. Staff appeared to enjoy their work, and there was a strong team emphasis throughout the home.

Consideration had been given to the environment that people living with dementia resided in. The décor and equipment purchased showed an improved level of interaction for people along with enjoyment and stimulation.

During our previous inspection we found confidential information related to people living in the home and their families was not stored securely. During this inspection we found this had been rectified.

People and their relatives spoke positively about the staff, the care they provided and the senior staff. We observed positive and meaningful interaction between staff and people living in the home. Staff were kind and gentle in their dealings with people. People responded well to attention from staff.

The home was complying with the Accessible Information Standard. The service had or could obtain information in different mediums, fonts and languages if required.

Consideration had been given to people with protected characteristics. Support was available from staff for people to enjoy their chosen lifestyle and gender. People’s cultural and religious needs were also acknowledged.

At our previous inspection we found a breach of Regulation 9 of the Health and Social Care Act 2008. This was due to the lack of evidence that people’s end of life wishes had been considered and documented. This area had improved and information was now available to guide staff to provide person centred care at the end of their life.

During our previous inspection we made a recommendation that the service increased the opportunity for people to participate in activities that were relevant to their individual interests. We found this had improved during this inspection. People participated in activities they appeared to enjoy, were in line with their choices and protected them from the risk of social isolation.

People, relatives and staff were able to feed back to the registered manager about how they felt the care being provided could be improved. This was listened to and evidence was available that showed action had been taken.

During our previous inspection we found a breach of Regulation 18 of the Registration Regulations 2009 because the provider had failed to notify us of safeguarding concerns in the home. During this inspection we found this was no longer the case and the Commission had been sent all relevant notifications.

The dedication, hard work and commitment shown by the registered manager was evidenced throughout the inspection. The improvements made to the running of the home and the provision of care was apparent. Staff appeared happy with their work. Audits were carried out to ensure improvements were continuous. Care standards were maintained due to close monitoring.

People, their relatives and staff spoke positively about the ability of the registered manager and staff to provide good quality care. There was a shared ethos of putting the needs of people first which we observed throughout the inspection.