Chesham House

Updated 13 January 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.

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

The service was inspected by an adult social care inspector and a medicines inspector.

Service and service type

Chesham House 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. Chesham House 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.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 13 October 2022 and ended on 17 November 2022. We visited the service on 13 October.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We reviewed information we had received about the service.

We used all this information to plan our inspection.

During the inspection

We spoke with one person, two staff, the registered manager and a member of the senior management team. We observed interactions between people and staff in communal areas. We reviewed recruitment files for three staff, risk assessments, safety records and audits. We received feedback from four health and social care professionals. We inspected the storage of medicines, medicines administration records (MAR), care plans, observational notes and risk assessments. We reviewed the governance arrangements for the safe handling of medicines, including the providers medicines policy, audits and staff training records.

Updated 13 January 2023

About the service

Chesham House is a residential home for up to ten people. The service offers accommodation, care and support to people with mental health needs. The accommodation is over two floors and includes a communal sitting and dining area and a communal kitchen. There are eight bedrooms in the main house and a further two flats in the garden. The flats are self-contained as they each have their own kitchen and bathroom. At the time of our inspection there were nine people living at the home.

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

The service had systems and processes in place for the safe administration and management of medicines, but these were not always effective. Potential risks were not always clearly documented within medicines assessments. Person-centred care plans were not always in place to support staff in caring for people with long term conditions, such as diabetes. There was not a policy in place for monitoring people who self-administered their medicines. The provider had a system of auditing in place which covered various aspects of the governance of the service provided. However, these audits had not identified issues with the safe administration and management of medicines.

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

People were supported by staff who had completed training in safeguarding and understood different types of abuse. Risk assessments were in place and action taken to reduce risks for people. Risk assessments identified what support people needed, for example, with activities.

People were supported by staff who had been recruited following a robust procedure which ensured pre-employment checks were in place before new staff started work at the home. We were assured that the provider was using personal protective equipment effectively and safely. The provider was open to learning lessons if things went wrong or could go wrong. They recorded accidents and incidents and analysed the information for any trends or issues arising.

People living in the home experienced a positive culture. People were involved and engaged in how the home was managed. There were systems in place to ensure continuous learning to improve care. The registered manager and staff maintained links with health and social professionals.

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

Rating at last inspection

The last rating for this service was good (published 3 November 2017).

Why we inspected

The inspection was prompted in part by notification of an incident. This inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of medicines administration. This inspection examined those risks.

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.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chesham House on our website at www.cqc.org.uk.

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 a breach in relation to the lack of an effective system to ensure the safe administration of medicines. We found that the two areas reviewed were now rated as requires improvement.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.