About the service:

Chiltern View is a residential care home in north Buckinghamshire. It is registered to support up to eight people living with a learning and physical disabilities. At the time of the inspection eight people with a learning disability and or physical disabilities were living at the home.

People’s experience of using this service:

¿People were cared for by staff who had developed kind, caring and compassionate relationships with them.

¿People were supported to maintain their nutrition and hydration. However, we found improvements could be made to ensure people were provided with fruit and vegetables at every meal. Records relating to one person’s hydration regime was not routinely completed by staff. We have made a recommendation about this in the report.

¿People were supported by staff who had been recruited safely and who demonstrated the right skills and attributes.

¿People were encouraged to maintain important family and friend relationships.

¿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 in the service supported this.

¿People were protected from abuse, as staff were aware of how to recognise potential signs and were confident to report concerns.

¿People told us they were happy living at the home, one person told us, “I like it here I do.”

¿People were treated with dignity and respect. Staff ensured people were protected from discrimination.

¿The provider and registered manager ensured they learnt from mistakes and always cascaded learning to all staff.

¿People were supported to engage in meaningful activities both within the home and the local community. Where possible people were supported to go out for a meal or to a weekly social club. However, this was limited due to the location of the home and the availability of staff who could drive.

¿The provider and registered manager had systems in place to monitor the quality of the service provided and were keen to improve the service provided.

¿The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Rating at last inspection:

The previous inspection was carried out 13 and 14 February 2018 (Published on 23 March 2018). The service was rated Requires Improvement at the time.

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care. At this inspection we found improvements had been made to the management of risks posed to people and the cleanliness of the environment.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This inspection took place on 13 and 14 February 2018. It was an unannounced visit to the service.

We previously inspected the service on the 14 and 15 January 2016.The service was meeting the requirements of the regulations at that time.

Chiltern View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide support for up to eight people with learning and or physical disabilities, at the time of our inspection eight people were living at the home.

Chiltern view is a single story building made up of people’s bedrooms and communal areas, including a lounge and dining room. The building is accessible to all.

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.

People were supported by staff who demonstrated kindness and compassion. Staff had developed good working relationships with people. Staff told us they liked working at the home. One staff member told us “I thoroughly enjoy work and I enjoy working with the residents and they can make your day a lot better.”

Staff were employed through a robust recruitment process and were supported in their role once appointed. Staff had access to a wide range of initial and ongoing training to maintain and develop their skills.

People were protected from abuse and staff had awareness of how to recognise abuse.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

Risks posed to people were not always acknowledged and potential harm to people was not always minimised. One person was put at risk as staff failed to ensure they measured the correct amount of thickener required in liquid to prevent choking. Risks posed to people as a result of unsafe premises were not always reported. For instance we found one person with a diagnosis of epilepsy was at risk of strangulation due to hanging electrical wires near their bed.

We observed there was poor infection prevention in place. The home required immediate cleaning and staff did not always observe good hand hygiene.

We found record management required improvement. Records did not always reflect current level of care required or activities which people had been involved in. We have made a recommendation about this in the report.

We found the providers quality assurance processes did not always pick up areas of improvement required. However the provider did have systems in place to share learning and discuss what they could improve on.

We found 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.

This inspection took place on 14 and 15 January 2016. It was an unannounced visit to the service.

Chiltern View is a care home for adults who have learning disabilities and or physical disabilities. Chiltern View is accessible to people of all abilities with all ground floor accommodation.

Chiltern View is registered to provide accommodation for nine people. At the time of our inspection eight people lived at Chiltern View.

We previously inspected the service on 11 June 2015. 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 through maintaining an accurate and complete record of the care and treatment provided. As a result we issued a warning notice for non-compliance with Regulation 17 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan to tell us what action they were taking to ensure compliance. At this inspection we found that the provider had reviewed care plans and improvements have been made in respect of recording risks and actions taken to minimise them. Staff knew about actions required and we observed this in action.

The service did not have 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. The previous manager was deregistered with The Commission on 30 October 2015. Since then the service had support from another service manager within the same organisation. The provider had successfully recruited into the manager role and the new manager commenced in post on 04 January 2016.

People were protected from avoidable harm and or abuse. Staff had received training and were aware of what to do if concerns were raised. Contact numbers for the local safeguarding team were visible in the home.

Care and support plans included an assessment of risks to people. Appropriate plans to manage those risks were in place. Staff had read and understood the assessments and demonstrated in practice they followed the guidance.

Robust recruitment processes were in place, staff were supported to understand their role through an initial induction and on-going training.

The service sought regular feedback to check their performance. Action plans were devised to ensure any identified shortcomings were resolved.

People were supported to maintain a healthy lifestyle; changes in health were quickly reported and acted upon.

People who lived at Chiltern View had a mixture of communication styles. Staff knew and understood these. We used observations to form a judgement about their experience. This was crossed referenced with care plans which detailed how people expressed joy or sadness.

We carried out an unannounced comprehensive inspection of this service on 20 and 27 January 2015. Breaches of legal requirements were found in relation to maintaining accurate records in respect of each service user and failing to operate an effective recruitment procedure. We also made recommendations around developing a system for checking in medicines in a robust manner and developing a system to ensure staff receive supervisions and annual appraisals in line with the organisations policy and procedure. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches and submitted an action plan informing us they would be compliant by 31 May 2015. We undertook this focused inspection to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Chiltern View provides accommodation for eight people with a learning disability. At the time of our inspection eight people were using the service.

Chiltern View has 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.’

At this focused inspection on the 11 June 2015, we found that the provider had made some improvements and had followed most of their plan which they had told us would be completed by May 2015. However there were still some areas of record keeping where improvements could be made. These were in relation to completing monitoring records, specific plans of care for health related conditions and maintaining accurate records to ensure people’s health care needs were met appropriately

We saw improvements had been made in relation to the recruitment of staff. The provider had implemented a system for checking agency staffs identification and ensuring a one page profile for each agency worker had been gained from the agency before they began working at the home. This detailed all relevant recruitment checks had been undertaken, checked their eligibility to work, proof of identity any qualifications they held and relevant training they had undertaken. Similarly photographs of staff were now held in their personnel files. This meant a robust recruitment procedure was in place to ensure staff were of good character and had the qualifications and experience to perform tasks in relation to the work they were employed to do.

Further improvements had been made in relation to supporting staff. We found staff were now provided with regular supervision and an appraisal of their work. This meant staff were provided with opportunities to discuss their work and any areas of personal development. We saw these had been documented appropriately within their personnel file.

Systems were now in place to ensure people’s routine health appointments were undertaken in a timely manner. Improvements had been made to the recording and monitoring of these to ensure people’s health care needs were met appropriately.

Through discussion and observation of staff it was evident they knew the people who lived in the home well. They had built up good relationships with them and were knowledgeable about their individual needs. They were able to communicate with them effectively and were knowledgeable on what particular individual gestures and signs meant. They were able to tell us what they would do in instances in which a person may have a seizure and knew when to escalate such situations to the emergency services.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to the regulations 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.

When we visited Chiltern View in September 2013, we found concerns with record keeping. We found examples where people's health care needs were not always completed or accurate. Care plans had not been updated to show changes in people's care and support needs. Appointments with health care professionals, such as regular dental appointments and medication reviews had not been documented. There were no records in people's files or the diary to substantiate they had taken place. People's health passports which detailed important information about their support needs had not been completed in full and contained many gaps. These gaps indicated poor record keeping which did not provide an accurate record to show people's health care needs were being met appropriately. Similarly they did not provide hospital staff, if admitted, with a succinct record of the person's needs. These practices had not ensured that people were protected against the risk of unsafe or inappropriate care through maintaining an accurate record in respect of people who lived in the home.

During this visit we reviewed three people's care and support files. We found improvements had been made in the standard of record keeping and maintaining them accurately. Systems were used to monitor and audit them to ensure they were accurate, kept up to date, reflective of people's needs and detailed the care and support provided. This meant people were protected against the risk of unsafe or inappropriate care.

During this visit we looked at a sample of two people's care plans. They were individualised and provided a good account of people's health, personal and social care needs and the level of support they required. The care and support plans included information on the person's likes and dislikes, activities they enjoyed doing and whether they were able to communicate their needs. Where people could not communicate verbally a communication plan was in place.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well. However, there were some inconsistencies in maintaining an accurate record of people's appointments they had attended.

There were enough qualified, skilled and experienced staff to meet the needs of people who lived at Chiltern View.

Staff received appropriate professional development. We spoke with two members of staff who provided care to people. Each said they had received an induction and further training. This ensured they had the knowledge and skills to undertake their roles safely.

Staff we spoke with felt well supported. They told us there was an open door policy, that they could approach the manager at any time if they had any concerns.

We spoke to staff, viewed policies and processes, reviewed four sets of notes and three staff records, spoke to three people using the service and observed the daily routine to gain further insight of the care provided.

We observed people using the service throughout the day. Some people had gone to visits before we arrived and returned whilst we were there. Two people went to an arts and music activity. Everyone we saw was involved in some activity.

There were processes in place to recruit staff and support their training. The staff showed a good knowledge of people living at Chiltern View and there was good rapport between them. Staff told us they liked working there very much and care was given in a gentle and caring manner.

People we spoke to were very happy at the home, and appeared satisfied with the care they received. We saw that they were able to personalise their own rooms and that the home was clean and comfortable. Many had lived there for some time and were seen to have a positive regard for the carers. One person told us they really loved living there. Another said they liked going to the activity centre. A third was excited to watch the football match that evening.

We saw evidence of processes to audit the quality of care and seek people’s views on the care they receive. Meetings were used to discuss new information and matters important to people using the service, their families and staff.

Chiltern View provides accommodation for ten people with a learning disability. At the time of our inspection eight people were using the service.

Chiltern View has 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.

The inspection was unannounced and undertaken by one inspector on the 20 and 27 January 2015.

People told us, or indicated through gestures that they were happy living at Chiltern View. Those who could communicate with us told us they felt safe living in Chiltern View and would let staff know if they were worried or unhappy about anything. Relatives we spoke with confirmed they they were always kept informed of any changes in their relative’s health.

Staff understood the needs of the people living in the home and were knowledgeable about how to keep them safe. Staff knew how to identify any suspected abuse and how to escalate it further to the correct people.

The care provided was personalised to meet people’s individual needs. Staff understood the needs of the people living in the home and provided care and support with kindness and compassion.

Risks to people using the service were identified and incorporated into their care plans to enable staff to manage any such risks appropriately and keep people safe. Information within people’s care files were not always up to date and fully completed. However the registered manager had identified this through their own auditing procedures and had begun to take appropriate action to address the issue. Similarly accurate records were not maintained of routine appointments with dentists, opticians and chiropodists to ensure peoples health care needs were being met appropriately.

Robust systems were not in place for checking in medicines when they were received from the pharmacy. Whilst checks were made against people’s medicine administration records, no reference was made to people’s prescriptions to ensure they matched up with their prescribed medicines.

The service had robust recruitment procedures in place but these were not always followed in practice. Staff files did not always contain an up to date photograph as a means of identity. The organisation had recently changed agencies and had a service level agreement with them. We noted they had generally gained a profile for each member of agency staff which detailed all relevant recruitment checks had been undertaken, checked their eligibility to work proof of identity any qualifications they held and relevant training they had undertaken. However whilst they had profiles for eight agency staff, they had not gained these for two of the agency staff to ensure they were suitable to work with people who lived in the home.

There were shortfalls in staff supervision and annual appraisals of their work where they could meet with their line manager formally and discuss any issues about their role or personal development needs.

We noted that whilst two people attended meaningful activities within their local community in which they could build friendships and relationships with people outside of their home this did not appear to be the case for everyone who lived in the home. Concerns about the lack of meaningful activities were also raised by some healthcare professionals and two relatives we spoke with. The organisation were aware of this and were and we saw they had had begun to take appropriate action to address the issue.

There was a policy and procedure in place in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The MCA is a law about making decisions on what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom.

Staff had received training in the Deprivation of Liberty Safeguards (DoLS). At the time of our inspection there were no DoLS authorisations in place, however the registered manager had identified the need and was in the process of making applications to people’s funding local authorities (the supervisory body) for people who they felt were or may become deprived of their liberty for their own safety.

Where people were assessed as not having capacity to make a decision a best interest decision was made involving family members, representatives or people who knew the person well and other healthcare professionals.

The provider had systems in place to monitor the home and gain feedback from people who used the service, staff, relatives and health and social care professionals involved in the home. Management undertook audits to ensure the quality of the service and to identify where improvement was required. Where accidents and incidents had occurred, these had been thoroughly investigated to assess any trends or patterns.

We have made a recommendation that the provider develops a system for checking in medicines in a robust manner to ensure the medicines match those prescribed by people’s GP’s and correlate with those detailed on people’s medicine administration records.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.