Brendoncare Chiltern View provides nursing care for older adults who are living with dementia. It is registered to provide accommodation for 30 people. At the time of our inspection 28 people lived at Brendoncare Chiltern View.

This inspection took place on 11 and 12 July 2017. It was an announced visit to the service.

The service had a registered manager in post. 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.

We previously undertook a comprehensive inspection on 23 and 27 May 2016. We found continued breaches of the Health and Social Care Act 2008. We found people who used the service were not protected against the risk of unsafe or inappropriate care in regards to management of medicines. We took enforcement action to ensure people’s safety. We served a warning notice to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be compliant by was 31 July 2016. We asked the provider to send us an action plan detailing how they intended to improve. We followed up on the warning notice at a focused inspection carried out on 3 November 2016. We found ongoing breaches of Regulation 12 of the Health and Social Care Act. We imposed conditions on the provider’s and registered manager’s registration to supply the Care Quality Commission (CQC) with regular information on how they monitored the service to drive improvements.

At this inspection we found significant improvements had been made in the management and administration of medicines. We acknowledge the improvements and the provider and manager had met the condition imposed upon them.

At the last comprehensive inspection we found a breach of the Care Quality Commission (Registration) Regulations 2009, as the provider did not inform us when they made changes to their statement of purpose. At this inspection we found the service had informed us when needed. We were satisfied the provider was no longer in breach of the regulation.

People were supported by staff who were well equipped to provide person centred care. Staff had been recruited, trained and supported to ensure they had the right skills and experience to provide safe care.

People were supported to make decisions in line with the Mental Capacity Act 2005 (MCA). Where required decisions were made in people’s best interests and with people who had legal authority to act on their behalf.

People were protected from avoidable harm and were safeguarded from abuse.

People were supported to engage in meaningful activities and had access to individual and group sessions.

There was appropriate monitoring of the service by the registered manager and provider to drive improvements.

The home provided support to people who displayed challenging behaviours and staff had the right skills to ensure people were protected from harm.

Brendoncare Chiltern View is a nursing home for adults who have dementia. Brendoncare Chiltern View is registered to provide accommodation for 30 people.

This focused inspection took place on 3 November 2016. It was conducted to follow up on previous enforcement action taken.

We previously inspected the service on 23 and 27 May 2016. We found continued breaches of the Health and Social Care Act 2008. We found people who used the service were not protected against the risk of unsafe or inappropriate care in regards to medicines. We took enforcement action to ensure people’s safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be compliant was 31 July 2016. We asked the provider to send us an action plan detailing how they intended to improve. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Brendoncare Chiltern View’ on our website at www.cqc.org.uk.

The service had a registered manager in post. 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.

We have not provided a rating for this inspection as we only looked at the management of medicines.

We found on-going issues around the storage, recording and administration of medicines. There were ineffective systems in place to ensure risks were minimised around medicines.

We found the service did not have an accurate record of what medicine had been delivered or administered to people.

Since the last inspection the registered manager had increased the monitoring they conducted on the management of medicines. We found the storage and recording of control medicines were correct.

We found continued breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Brendoncare Chiltern View provides nursing care for older adults who are living with dementia. It is registered to provide accommodation for 30 people. At the time of our inspection 28 people lived at Brendoncare Chiltern View.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This inspection took place on 23 and 27 May 2016. It was unannounced visit to the service.

We previously inspected the service on 18 June 2015. We found people did not consistently receive safe care and treatment, in relation to medicines practice and record keeping. The provider sent us an action plan, to tell us what action they were taking to ensure people received safe care. At this inspection we found the provider had improved in the area of record keeping in the form of care plans. However we found continued issues in relation to safe storage, administration and record keeping of medicines. We found there was an overstock of medicine, newly dispensed medicine was being used before older. This meant there was a potential for medicine to go out of date. No dates were recorded on some eye drops, which meant the service could not be sure they were still able to be used, as they are only useful for 28 days after opening.

Providers should inform CQC when a decision has been made about an application to deprive someone of their liberty. We checked our records and found we had not received all the required notifications. We have made a recommendation about this in the report.

Providers should inform CQC when they make changes to their statement of purpose. A change had been made following the registration of a new manager. We checked our records and we had not been notified of the changes made.

Providers have a legal responsibility to be open and transparent. We call this duty of candour. Providers have to offer an apology and written explanation to people or their legal representative when certain events occur. There had been a number of events which occurred at Brendoncare Chiltern View which met the duty of candour threshold. We asked the registered manager for the evidence they had met this requirement. They told us they did not have any evidence. We have made a recommendation about this in the report.

Some staff working at the home had done so for some considerable time. Staff were passionate about their work. Comments included “I do enjoy working here” and “I love it I really do.”

Relatives described the care staff as kind and caring. Comments included “It is perfect here”, “It is remarkable, very good”, “The care is brilliant.”

People were protected from abuse, as staff knew how to recognise it and there were procedures in place to deal with events if they happened.

People were supported to be involved in decision making and where people lacked capacity to make certain decisions, the principles of the Mental Capacity Act 2005 were implemented.

People had access to healthcare when needed, and we saw any changes in healthcare needs were responded to quickly.

There was a clear vision for the service to provide a ‘home for life’. People had access to a wide range of activities, and the home was part of the community.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Brendoncare Chiltern View provides nursing care for up to 30 older people living with dementia. At the time of this inspection 23 people were living at the home.

Brendoncare Chiltern View did not have 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 2008 and associated Regulations about how the service is run.

Management support was being provided by The Brendoncare Foundation senior management team, in addition to the day to day management input of the Senior Nurse Manager for Brendoncare Chiltern View. We were informed recruitment to the registered manager vacancy was being actively pursued.

In September 2012 we found that medicines practice at Brendoncare Chiltern View was not meeting the necessary standard. In October 2012 The Brendoncare Foundation submitted an action plan which set out how they would make the necessary improvements to medicines practice. In November 2012 we carried out a responsive review and found those improvements had been made and sustained. In July 2013 we carried out a review of other areas of the service’s operation, not including medicines, and found those areas assessed met the required standard.

At the review of 18 June 2015 we found people were not being adequately protected by robust and consistently safe medicines practice and record keeping.

We found identified risks to people had not always been effectively managed or eliminated. Care plans were not always being kept up to date or used to inform the way people’s care was received.

The communal activities observed during our visit were imaginative and engaged those people who took part in them. People were not consistently being engaged or involved other than when specific care tasks were being carried out or during activities sessions, which only some of the people were able to access and take part in.

The provider had undertaken a number of recent audits of the service, covering care practice and records amongst other things. These had identified areas which required significant improvement, although these improvements had not yet been fully put into practice or become embedded in the service’s routine.

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 this report.

We spoke with two visitors. Both were pleased with the standards of care at the home. One commented staff had a good understanding of the needs of people with dementia. They also felt the environment was appropriate for their relative.

We found people were protected from the risks of inadequate nutrition and dehydration. Care plans contained information about supporting people with their nutrition and hydration needs. People were screened for the likelihood of developing malnutrition and weighed regularly. Weight loss was reported to people’s GPs. Staff acted on the advice of dieticians and speech and language therapists to meet people’s needs. Staff told us the standards of food were good and people had a varied diet. We saw people who needed assistance with meals were given appropriate support.

There were effective systems in place to reduce the risk and spread of infection. Staff were provided with guidance on infection control measures. They were provided with and used protective items, such as disposable gloves and aprons. Training records showed staff undertook courses on infection control and food hygiene. This provided them with the skills and knowledge to prevent the spread of infection.

We looked at the recruitment files of four members of staff. We saw appropriate checks were undertaken before staff began work. Each file contained evidence of required checks. For example, a check for criminal convictions and obtaining written references. This showed there were effective recruitment and selection processes in place.

We found there were improvements to how people's medicines were managed. Staff were keeping better records of medicines given to people. The reasons why people had not been given medicines were also recorded.

Some medicines had been prescribed ''as required'' to sedate people. We saw these had been used appropriately. In one example, use of sedation had decreased significantly as staff were using other interventions to support the person.

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.

We spoke with people using the service but they were not always able to tell us their views about their care. We relied upon our observations of care, speaking with staff and looking at records to help us understand people's experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

A visitor told us they were pleased with their relative's care and felt their needs were being met.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw that people were able to have their meals where their wished to if they did not want to go into the dining room. This gave them the freedom to choose where they were most comfortable to eat. Clothes protectors were used to prevent clothes becoming soiled. Tables were attractively laid with table cloths and napkins to create a pleasant environment. We saw that different options were available to people at meal times so that they could choose foods they liked. Pureed meals were served well to retain the colours, textures and tastes of individual components and make the meals appetising. Those who needed assistance were helped gently.

We observed that one person was sitting in their pyjamas in one of the lounges just after 4.00 p.m. When we spoke with staff about this, they told us they had needed to change the person. They said that because of the time of day, and to prevent more clothes becoming soiled, they put them in their night clothes. We did not feel that this promoted the person's dignity in a communal setting and with visitors present.

We spoke with three visitors to the service as part of our inspection. All said that they were pleased with their relative's care and could visit them when they wanted to. One told us that they were able to be involved in their relative's care; they said staff were approachable and they had no complaints. The visitors said they were greeted by staff and made to feel welcome when they came to the home. One of the visitors we spoke with told us they had been able to personalise their relative's room to their taste.

The people using the service at Chiltern View have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We saw that people were given their breakfast in the lounges, sitting in armchairs with side tables to eat from. People were not invited to use the dining room. Clothes protectors were used when people were eating, to prevent clothing becoming soiled. We observed staff giving people choices of drinks mid morning. Drinks were given either in melamine mugs or plastic beakers with a spout; care plans did not indentify reasons for using these.

All personal care was carried out in private. People cared for in bed were kept comfortable. We saw gentle assistance was given to someone who needed support in managing his lunch and staff chatted to him whilst helping.

During the morning we saw staff in one of the lounges looking through books with people, initiating discussion and talking about people's backgrounds and experiences. A look through a jewellery box prompted discussion among two people and a staff member. We observed the activity organiser offering people different things to try, such as dominoes. Gentle music was put on to provide some pleasant background noise. One person was enjoying this and humming to the tunes.

In the afternoon we spent some time in the other lounge. People were initially sitting in silence, finishing off afternoon tea. Some music was put on which prompted brief discussion between a member of staff and one of the people using the service. We observed limited verbal interaction after that.

We noticed that people were not restricted to spending time in one lounge only; people were free to walk around the building and out into the garden.

We also spoke with visitors to the service to gain their feedback. A relative said "I'm very happy with my husband's care. Food is very good and staff are very friendly and welcoming." Another relative said "I'm very pleased with mum's care…no complaints…I'm glad they've got an activity co-ordinator on board now".

Staff that we spoke with said there were good support and training opportunities at the service. One said the approach of the service was to treat each person as an individual.