CQC report explained · a residential care home
What the CQC found at Chesham House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, January 2023
Chesham House rated Requires Improvement; inspectors found important weaknesses in medicines management, although people experienced kind and supportive care.
This was an unannounced, focused inspection after CQC received information about possible risks with medicines. Inspectors visited on 13 October 2022 and reviewed medicines, care plans, risk assessments, records, audits and recruitment files. They also spoke with people, staff, managers and health and social care professionals.
The home had systems for medicines, but they did not always work effectively. Risks for people who managed their own medicines were not always clearly recorded. One person at risk could access a month's supply. Plans for people with conditions such as diabetes did not always explain what staff should look for or do.
Inspectors found that staff understood safeguarding, staffing and recruitment checks were in place, and risks in the environment were managed. People described staff as approachable and respectful. The home had a positive culture and worked with health and social care professionals.
The overall rating changed from Good at the previous inspection, published in 2017, to Requires Improvement. This report only inspected Safe and Well-led. The other ratings were carried over from the previous inspection.
Positive relationships
People and professionals described staff and managers as approachable, respectful and supportive. Inspectors found a positive culture in the home.
“The registered manager promoted a positive culture within the home.” from the report
Staffing and recruitment
The provider completed pre-employment checks before staff started. Staffing levels were based on people's assessed needs.
“The provider followed a recruitment procedure which ensured pre-employment checks were in place before new staff started work at the home.” from the report
Risk management
Risk assessments were in place for activities and other risks. The home also had safety checks, fire procedures and emergency evacuation plans.
“Risk assessments were in place and action taken to reduce risks.” from the report
Infection control
Inspectors were assured that the home used protective equipment safely, kept cleaning records and had an up-to-date infection prevention policy.
“We were assured that the provider was using personal protective equipment effectively and safely.” from the report
Working with professionals
The home maintained links with GPs, care coordinators, mental health teams, nurses and occupational therapists.
“The registered manager and staff maintained links with health and social professionals, for example the GP and the care co-ordinator, who they spoke with weekly.” from the report
Medicines could not always be managed safely
seriousA person at risk was able to access a month's supply of medicines. The report says this was a breach because the system for safe medicines management was not effective.
“However, this process was not followed for one person who was at risk and was able to access a month's supply of medicines.” from the report
Incomplete care plans
needs fixingCare plans did not always explain the risks and controls for self-administered medicines. Plans for conditions such as diabetes did not always give staff clear instructions.
“Person-centred care plans were not always in place to support staff in caring for people with long term conditions, such as diabetes.” from the report
Audits missed problems
needs fixingThe home's checks and audits did not identify the concerns found with medicines administration and management.
“However, these audits had not identified issues with the safe administration and management of medicines.” from the report
PRN records were not always complete
needs fixingRecords did not always explain why medicines prescribed when needed were given or whether they had helped.
“The provider did not always clearly record the reason for administering PRN medicines or if it had been beneficial” from the report
- 01What changes have you made to control and record the risks for people who self-administer medicines?
- 02How do you now check the amount of medicine held by people who self-administer?
- 03How do care plans explain what staff should do if someone with diabetes has high or low blood sugar?
- 04How do you record why a medicine prescribed when needed was given and whether it helped?
- 05What actions from the CQC improvement plan have been completed, and how are they checked?
This was a focused inspection of Safe and Well-led after concerns about medicines; Effective, Caring and Responsive were not inspected and their ratings carried over from the 2017 inspection. This explanation was written from the published report of 13 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2021
Chesham House was inspected but not rated; inspectors were assured that infection prevention and control arrangements were in place.
This was an announced, targeted inspection on 10 March 2021. It was carried out because of the COVID-19 pandemic and looked only at infection prevention and control.
The home supported 10 people with mental health needs. Inspectors found extra cleaning, records showing cleaning was completed, and arrangements to reduce contact between staff during breaks.
Inspectors were assured about visitor safety, social distancing, admissions, personal protective equipment, testing, premises hygiene, outbreak planning and the infection control policy. The service was inspected but not rated, so this report does not give an overall quality rating.
Support with COVID-19 understanding
Staff used advice from relevant professionals to help people understand COVID-19, changes to their normal routines and the use of protective equipment.
“Staff accessed the advice of relevant professionals to support people to understand COVID-19 and the impact on their usual ways of living at the home and going out.” from the report
Practical staff arrangements
Staff took breaks at different times so that only one person used the staff room at a time.
“Staff took different breaktimes so only one staff member used the staff room at any one time.” from the report
Extra cleaning
Extra cleaning was carried out and records were kept to show that cleaning was completed regularly.
“Extra cleaning was in place and records were kept to ensure everything was cleaned regularly.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you now check that visitors cannot bring infections into the home?
- 02How often are communal areas and other frequently used surfaces cleaned, and can families see the cleaning records?
- 03How do you test people living here and staff when infection risks arise?
- 04What is your current plan for managing an infection outbreak?
- 05How is the infection prevention and control policy kept up to date?
This was a targeted inspection of infection prevention and control during the COVID-19 pandemic; it was not a full inspection and the service was not rated. This explanation was written from the published report of 10 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Chesham House
2 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- November 2017GoodSafe: GoodWell-led: Good
- October 2016
Registered with the Care Quality Commission on 10 October 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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