CQC report explained · a residential care home
What the CQC found at Chiltern Rest Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2019
Chiltern Rest Home was rated Requires Improvement; inspectors found kind and responsive care, but serious safety and management checks were not reliable.
The inspection was unannounced and took place on 15 August 2019. Inspectors spoke with people living in the home, a relative and staff. They observed care and checked care plans, medicine records, training records and management audits.
People were generally supported by caring and skilled staff. Inspectors found good support with meals, healthcare, personal choices, privacy, dignity, activities and contact with families. Medicines were recorded and stored appropriately, and staffing levels were considered sufficient.
However, the environment was not always safe. Fire doors had been wedged open, a corridor escape route was partly blocked, harmful products were accessible, some cupboards were unsecured and some evacuation plans were incomplete. The laundry layout also created a risk of clean linen becoming contaminated.
The overall rating fell from Good at the previous inspection to Requires Improvement. Safe and Well-led were both rated Requires Improvement because the provider's checks had not found or dealt with important risks. The report says some action was started during and after the inspection, but CQC planned to check this at a later visit.
Kind and respectful staff
Inspectors saw staff treating people with kindness and responding quickly when someone was in pain. People said staff respected their privacy and dignity.
“We observed that staff were kind and attentive to people's needs.” from the report
Enough staff and safe recruitment
People said they did not have to wait long for help. Inspectors found sufficient staffing and safety checks for recruitment.
“People told us they did not have to wait a long time for staff support.” from the report
Medicines support
Staff were assessed as competent to support people with medicines. Records and storage were appropriate, and protocols were in place for medicines used only when needed.
“People were assisted by skilled staff to take their prescribed medicines. Medicines were recorded and stored appropriately.” from the report
Personalised care and activities
Care plans included people's specific needs and equipment. People could keep in touch with important people and were supported to take part in activities.
“We looked at three care plans which provided detailed information about people's specific care and support needs and equipment required to promote their safety.” from the report
Improved responsiveness
Responsive care improved from Requires Improvement at the previous inspection to Good. Complaints were listened to, recorded and acted upon.
“Complaints were listened to, taken seriously and acted on.” from the report
Fire safety and escape routes
seriousFire doors had been propped open, reducing their ability to slow the spread of fire. Furniture and a wheelchair also compromised a first-floor escape route.
“We observed that fire doors had been propped open by furnishings which, meant in the event of a fire, these doors would be ineffective in reducing the spread of the fire.” from the report
Unsafe access to hazards
seriousCleaning chemicals and toiletries were accessible. The boiler cupboard and electricity metre were not properly secured, creating potential risks, particularly for people living with dementia.
“Cleaning chemicals and toiletries which could be harmful if ingested were not securely maintained and were accessible to people who used the service.” from the report
Incomplete evacuation information
needs fixingSome personal emergency evacuation plans were not fully completed. This could leave staff without all the information needed to evacuate people safely.
“We saw that some personal emergency evacuation plans had not been fully completed to ensure staff were aware of the support people required to evacuate the home safely.” from the report
Laundry contamination risk
seriousThe laundry layout did not properly separate clean and unclean linen. Inspectors said this created a risk of avoidable infection.
“The layout of the laundry was unsuitable to ensure that unclean linen did not contaminate clean linen which placed people at risk of avoidable infections.” from the report
Weak safety checks
seriousManagement audits had not identified the environmental and laundry problems. This led to a breach of the good governance regulation.
“The provider's governance was ineffective to ensure people were not placed at risk of harm due the environment and unsafe practices.” from the report
- 01Have all fire doors been checked so they cannot be propped open, and how are blocked escape routes now prevented?
- 02How are cleaning chemicals, toiletries, the boiler cupboard and the electricity metre kept secure?
- 03Have every person's personal emergency evacuation plans been completed and reviewed?
- 04What changes have been made to separate clean and unclean laundry?
- 05What daily and longer-term audits now check these risks, and what were the findings of the next CQC inspection?
This was an unannounced planned inspection covering all five key questions, including the premises and care provided; the registered manager was not present on the inspection day. This explanation was written from the published report of 18 September 2019 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 2017
Rated Good overall, but inspectors found care records were not always accurate or up to date, so Responsive Requires Improvement.
Inspectors made an unannounced visit on 7 March 2017. They spoke with people living in the home, relatives, staff, the manager and the provider. They observed care and reviewed care, medicine, recruitment, training and management records.
The home was rated Good for Safe, Effective, Caring and Well-led. People said they felt safe, staff were kind and patient, medicines were managed safely, and people were supported with food, health care and personal choices.
Responsive was rated Requires Improvement. Some care plans did not contain enough accurate and current information about people's needs. This could mean new or temporary staff did not have all the guidance needed to provide consistent care.
The overall rating was Good. This was the first rating inspection since the provider changed its registration in November 2016. The manager had introduced a new recording system and an improvement plan, but the new system was still being embedded.
People felt safe
People said they felt safe and staff understood how to recognise and report possible abuse. Risks such as falls and mobility needs were assessed and managed.
“People told us they felt safe when being supported by staff.” from the report
Kind and respectful care
Inspectors saw staff being patient, caring and compassionate. People were given privacy, dignity and choices about how their care was provided.
“We observed staff interaction with people and found that staff were caring and patient when they provided support.” from the report
Safe medicines practice
Staff explained medicines to people and gave reassurance. The records and checks reviewed showed medicines were administered, stored and recorded safely.
“We found that the provider had effective system in place that ensured medicines were administered, stored, recorded and managed safely.” from the report
Good support for health and nutrition
People were supported to eat and drink enough, including through monitoring where needed. Health professionals were involved when people's health required attention.
“This meant that people were supported to access health professionals to maintain their health and wellbeing.” from the report
Approachable management
People, relatives and staff said the manager was approachable. The home had monitoring systems and an improvement plan.
“The atmosphere within the home was friendly between staff and people, relatives and the senior management team” from the report
Care records were incomplete or out of date
needs fixingSome records did not give enough information about people's specialist care or how to respond to behaviour that challenged. Permanent staff knew people well, but new or temporary staff might not have had the same guidance.
“However, this information was not always accurate or up to date.” from the report
- 01What changes have been made to care records since the inspection, and how do you check that they remain accurate and up to date?
- 02How are new or temporary staff told about a person's specialist footwear, skin care needs and risks?
- 03What written guidance is now available for supporting people whose behaviour can be challenging?
- 04How do you check that staff follow each person's preferred care, communication and activity choices?
- 05What were the results of the new recording system and improvement plan after this inspection?
This was an unannounced first rating inspection covering all five CQC questions; inspectors spoke with five people, two relatives and three staff, observed care, and reviewed five care records and five medicine records. This explanation was written from the published report of 5 April 2017 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 Chiltern Rest Home
2 rated inspections over 2 years: the service has slipped, from Good to Requires improvement.
- September 2019Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- November 2016
Registered with the Care Quality Commission on 1 November 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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