Archived: Brendoncare Chiltern View

Brendoncare Chiltern View is a residential care home providing personal and nursing care for older people living with dementia and or mental health concerns. It is registered to provide support for 30 people. At the time of the inspection 27 people were living at the home.

The home is a single storey adapted building. People had individual bedrooms. The home was split into two wings, each had a lounge area, which housed different seating options to meet people’s needs. The front door was locked, and access was supervised by staff, however, people had free access to the back garden, we routinely saw people accessing outside areas. The garden area had been fully equipped with seating and plants which provided colour.

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

People were supported by a service that did not routinely notify the Commission of events it was required to inform us about. We found mixed understanding about the Mental Capacity Act 2005. However, we found 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 demonstrated kindness, compassion and knew how to promote their dignity. Staff understood how to minimise the likelihood of harm to people. People were supported with their prescribed medicines by staff who were deemed competent and received regularly training to keep their skills and knowledge up to date.

People’s likes, dislikes and interests were well known by staff. People were offered opportunities to engage in meaningful activities.

People were supported to maintain their health and well-being. Meals were healthy and balanced, and people were supported to maintain good hydration.

People’s relatives felt their family members were well cared for and they felt welcome when they visited the home. The registered manager was praised by staff and relatives and described as “Lovely, very approachable and fair”, “Very approachable” and “Very supportive.”

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 10 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern.

Enforcement

We have identified breaches in relation to the application and use of the Mental Capacity Act 2005 and compliance with the legal requirement to notify the Commission of certain events.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

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.

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.

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.