Archived: Chiltern View

Updated 23 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check on concerns we had about medicines management and management oversight.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors

Service and service type

Chiltern View is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Chiltern View is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post, but they were not working in the service. The provider’s operations director was acting as manager in their absence. Following the inspection, the provider confirmed to us that the registered manager is no longer in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 12 December 2022 and ended on 10 January 2023. We visited the service on 12 December 2022.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We considered feedback received from the local authority and professionals who work with the service. We wrote to the provider for an update about improvements to the service but did not receive a response. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with two people who used the service, and three staff including the acting manager and the deputy manager. We reviewed a range of records. This included care records for four people and medicine and supplementary records for multiple people, such as repositioning charts. We reviewed various records relating to the management of the service including records relating to the oversight of the service and how accidents and incidents were identified, monitored and reported.

Updated 23 December 2023

Chiltern View is a residential care home providing personal care to up to 36 people. The service provides support to older people and people who have dementia. At the time of our inspection there were 29 people using the service.

The premises is on three levels with bedrooms on the first and second floors. On the ground floor there are further bedrooms and communal areas including a lounge, dining area and conservatory. There is also shared garden space. Administrative and management offices are also on the ground floor.

People’s experience of using this service and what we found

The service was not well-led. The provider and registered manager did not use quality monitoring systems effectively to identify and address shortfalls in the service.

People were not protected from harm and lessons were not learnt when things went wrong. Risks to people's safety were not adequately assessed and staff did not act to reduce the risk of harm. People at risk of pressure damage to their skin did not receive appropriate support to reduce the risk of new or worsening injury.

People were not protected from the risk of malnourishment or dehydration. People at very high risk of weight loss did not receive support in line with their care plan to ensure they maintained adequate food intake. Medicines were not managed safely, and staff did not follow good practice when administering medicines. The service was not clean and appropriate measures to protect people from the spread of infection were not followed. The premises had not been designed or maintained to meet the needs of people living there.

There were not enough staff to meet people's care and support needs. There were a high number of agency staff used to cover shifts, some of whom lacked the required skills and experience and were unfamiliar with the needs of the people living at the service. Although permanent staff provided better care, they were extremely busy and did not have time to provide good quality outcomes for people. People did not receive timely care and were left for long periods with no interaction or support from staff. People, particularly those cared for in their bedrooms, were left isolated with no stimulation. Many staff did not engage with people or initiate conversation. There were no opportunities for meaningful occupation offered to people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always treated with dignity and respect. Staff did not always treat people with kindness and compassion and the language used to describe people was not always respectful. People, or their relatives where appropriate, did not always feel supported to be involved in making decisions about their care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 July 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. It was also prompted in part due to information received from the Environmental Health Officer and the Fire Safety Officer about risks found at the service. This information indicated a risk of shortfalls in the management oversight of the service. A decision was made for us to inspect and examine that risk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Although initially slow to respond to concerns we raised with them, the provider has since increased staffing levels and developed a plan to support improvements to the service. The newly appointed operations director is working closely with the registered manager to make improvements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to leadership, staffing numbers and skills, safe care, protecting people from harm, infection control, medicines management, nutrition and hydration, dignity and respect, person centred care and a lack of meaningful engagement for people.

In response to the areas of very high risk we found at the inspection we took urgent action to keep people safe. This included placing conditions on the provider’s registration to restrict them from admitting new people to the service and requiring them to take specific actions to reduce risks to people.

Following this inspection we took enforcement action to cancel the registered manager 's registration and to remove Chiltern View from the provider's registration so they are unable to continue to provide accommodation and personal care from this location.

The overall rating for this service was ‘Inadequate’ and the service was therefore in ‘special measures’. This meant we kept the service under review and, if we did not propose to cancel the provider’s registration, we would re-inspect within 6 months to check for significant improvements.

The provider had not made enough improvement within this timeframe and there was still a rating of inadequate for a key question or overall rating, We took action in line with our enforcement procedures. This meant we began the process of preventing the provider from operating this service. This led to varying the conditions of their registration. to prevent them from operating the service.

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.