CQC report explained · a nursing home
What the CQC found at The Chilterns
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found continued breaches involving safeguarding, risk assessments and medicines. Staffing and infection control had improved.
- Effective?
- Requires improvement
- Inspectors looked at specific concerns about mental capacity, restrictions and consent. They found best interest meetings and capacity assessments were now in place, but they did not review the whole question.
- Caring?
- Requires improvement
- Are people treated with kindness and dignity?
- Responsive?
- Requires improvement
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Requires improvement
- Management and record keeping had improved but were still inconsistent. Audits had not always identified problems, and care records were split between paper and electronic systems.
What inspectors found, September 2021
Rated Requires Improvement; safety and management problems remained, although the home improved from Inadequate and left Special Measures.
This was an unannounced, focused follow-up inspection on 21 July 2021. Inspectors spoke with four people and eight staff, and reviewed care records, medicines records, staff files and management records.
The home had improved since the previous inspection. Staffing levels were enough, recruitment checks had improved, the home was cleaner and people had more choice about going out and taking part in activities.
Important problems remained. Care plans and risk assessments were not always updated after incidents. Medicines records and guidance were incomplete. Checks and audits had not always found these issues. The home remained in breach of three regulations.
The overall rating was Requires Improvement. Safe and Well-led were rated Requires Improvement. Effective was inspected but not rated. The home was no longer rated Inadequate or placed in Special Measures.
Enough staff
Inspectors saw enough staff to meet people's needs. Staffing levels had been reviewed and a dependency tool was in place.
“We observed there were enough staff to meet people's needs.” from the report
Improved infection control
The home was cleaner than at the previous inspection, and staff were using personal protective equipment.
“At this inspection the service was cleaner and staff were wearing PPE.” from the report
More choice and freedom
Restrictions had been reviewed. People were able to go out when they chose, and people helped shape activities at the home.
“At this inspection, people told us they were able to go out when they chose to.” from the report
Better recruitment checks
The home had improved its recruitment process. Employment gaps were explained, references were obtained and criminal record checks were completed before staff started.
“Disclosure and Barring Service (DBS) criminal records checks had been completed for all staff before they began working at the service.” from the report
Safeguarding and risk records
seriousAfter abuse incidents, care plans and risk assessments were not always updated. Claims of financial abuse were not clearly recorded in people's files.
“The provider had failed to protect people from abuse and improper treatment.” from the report
Medicine safety
seriousRecords did not always show where pain relief patches should be placed. Guidance for some as-needed medicines and medicated creams could not always be found.
“Some people were prescribed medicated creams. We found there was no guidance or instructions in place for staff to indicate where and how to apply the cream.” from the report
Incomplete care records
needs fixingCare plans and risk assessments did not always contain enough detail or get updated after incidents. Paper and electronic records were being used at the same time, which could confuse staff.
“Care plans and risk assessments were not always reviewed and updated following incidents.” from the report
Audits did not find problems
needs fixingManagement checks had not identified the medicines and record-keeping problems found by inspectors. The home still needed to improve how it monitored quality and safety.
“Medicines audits had failed to identify the issues we found on this inspection.” from the report
- 01Have all care plans and risk assessments now been updated after incidents, including incidents involving abuse or self-harm?
- 02How do you record the position of pain relief patches and give staff instructions for applying medicated creams?
- 03Where can staff find protocols for people's as-needed medicines?
- 04Has the move from paper to electronic care plans been completed, and how do you make sure agency and new staff see important risk information?
- 05How are your audits now checking that safeguarding, medicines and care records are accurate and complete?
This was a focused inspection covering Safe, specific parts of Effective and Well-led; the other key question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 9 September 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.
What inspectors found, May 2021
Rated Inadequate and placed in special measures; inspectors found people at risk of harm, unlawful restrictions and serious failures in leadership.
This was an unannounced focused inspection on 25 March 2021. Inspectors looked mainly at Safe and Well-led because of concerns about incidents between people, possible abuse and staff skills. They spoke with people and staff and checked care records, medicines records, staff files and management records.
The inspectors found that people were at risk from themselves and each other. Risk assessments and care plans were often missing or out of date. Staff did not always know how to manage complex needs, incidents, injuries or behaviours that could be challenging. There were also unlawful restraints and restrictions, including limits on belongings, money and leaving the home.
The home was not clean or well maintained, and staffing levels and training were not always enough. The provider had not learned from earlier incidents or acted on previous inspection findings. Safeguarding concerns and some incidents were not reported as required, and the home was not following the Mental Capacity Act.
The overall rating fell from Requires Improvement to Inadequate. Safe and Well-led were rated Inadequate. Effective was inspected but not rated, so its previous Requires Improvement rating was not changed. The home was placed in special measures and CQC said it would ask for an action plan and return to check progress.
Medicines
People received their medicines as prescribed. Records for medicine administration were complete, and guidance was available for medicines given when needed.
“People received their medicines when required and as prescribed.” from the report
Medicine guidance
Protocols for medicines given when needed explained why they were used and the maximum dose.
“PRN protocols were in place and detailed why they needed the medicine and what the maximum dosages were.” from the report
Fire checks
The home carried out fire drills and weekly checks of fire equipment.
“Environmental checks had been completed, for example a recent fire drill had taken place, and there were weekly fire checks completed to ensure equipment was working correctly.” from the report
Dining room repair
The dining room ceiling, which had been a problem at the previous inspection, had been repaired by this inspection.
“At this inspection, we found the dining room ceiling had been fixed.” from the report
People were not protected from harm
seriousIncidents between people were not dealt with effectively, and similar incidents happened again. One person said they were frightened to live there, but no action had been taken to protect them.
“People were at risk from themselves and each other.” from the report
Unlawful restraint and restrictions
seriousPeople were restrained unlawfully and were subject to restrictions without proper legal authority. Staff also threatened to remove belongings or impose a fine for not following rules.
“People had been unlawfully restrained by staff. Staff placed unlawful restrictions on people.” from the report
Insufficient staffing and training
seriousThe home often had fewer staff working than its rota indicated were needed. Staff lacked training in mental health, positive behaviour support and safe restraint, and guidance was not always shared with agency staff.
“There were not always sufficient numbers of staff to meet people's needs and keep them safe.” from the report
Health risks were not managed
seriousRisk assessments and care plans were missing or out of date. Staff did not respond promptly when people hit their heads, and there was no proper guidance for constipation, falls or weight loss.
“Risks to people had not been managed and as a result people had suffered harm.” from the report
Poor cleanliness and maintenance
needs fixingThe home was not clean or well maintained. Holes in walls and doors, dirty surfaces and a lack of effective cleaning increased risks, including during the Covid-19 pandemic.
“The service was not clean, for example the toilet walls on the ground floor were visibly dirty.” from the report
Weak leadership and oversight
seriousAudits and governance systems failed to identify serious problems. Safeguarding incidents and statutory notifications were not always reported, and records were incomplete or out of date.
“There was a lack of effective governance and oversight.” from the report
- 01What has changed since the inspection to prevent incidents between people and protect anyone who feels unsafe?
- 02How do you ensure every person has current risk assessments and care plans for falls, injuries, constipation, weight loss and self-injurious behaviour?
- 03What training and competency checks have staff completed in mental health, positive behaviour support, safeguarding and restraint?
- 04How do you now ensure restrictions on leaving the home, personal belongings, money and community access are lawful and based on individual best-interest decisions?
- 05What action has been taken to improve staffing levels, cleanliness, maintenance, incident reporting and management audits?
This was an unannounced focused inspection of Safe and Well-led, with specific concerns about mental capacity, liberty and premises also examined; Effective was inspected but not rated, while Caring and Responsive were not reviewed. This explanation was written from the published report of 21 May 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 The Chilterns
6 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- September 2021Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2021Inadequatedown from Requires improvementSafe: InadequateEffective: Inspected but not ratedWell-led: Inadequate
- September 2018Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2014
Registered with the Care Quality Commission on 28 March 2014.
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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39 live-in carers within about an hour of Kent
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Most charge £980 to £1,260 a week. 33 can care for a couple. 12 years' experience on average.
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