This inspection took place on 23 and 24 August 2018 and was unannounced.

The Chilterns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Chilterns accommodates up to 26 people in three adapted adjoining buildings. At the time of the inspection there were 20 people living at the service.

There was no registered manager in post. The previous registered had left the service in July 2018. There was a manager in post who had started at the service on 1 August 2018 and would be registering with the Care Quality Commission. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected The Chilterns in August 2017 when a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice in relation to staffing numbers. At this inspection, there was a continued breach of Regulation and three new breaches of Regulation.

At our last inspection, the service was rated ‘Requires Improvement’ overall with effective, caring and responsive being rated as Good. At this inspection, improvements had not been made and there continued to be breaches of regulation. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

At our last inspection, there were not always sufficient staff to meet people’s needs and enable them to always attend activities when they wanted. At this inspection, there continued to be times when there were not enough staff and people were not able to go out when they wanted.

Potential risks to people who had recently moved to the service, had not been consistently assessed and detailed guidance was not available for staff to follow to mitigate the risks. Some people displayed behaviour that may challenge the service or could become very anxious. Staff told us that they felt that they did not always know how to support these people. People were at risk of not receiving consistent support when they needed it. People who had lived at the service for a long time had detailed risk assessments and plans for staff to follow and support them so they remained safe and these had been effective.

Staff had met with people before they moved into the service, a comprehensive assessment was completed. The assessment covered all aspects of people’s lives including their social, cultural and sexual orientation. This was used to develop a detailed support plan, however, recently this had not happened and people who had moved to the service did not have person centred care plans that gave details of their choices and preferences. People who had lived at the service for a long time, had person centred plans that they had agreed to. The service had not supported anyone at the end of their lives, the service did not include end of life wishes in people’s support plan.

Medicines were not always managed safely. Systems that were in place to identify when errors had been made had not been completed correctly and had not been effective in identifying shortfalls found at this inspection. Checks and audits had been completed on all aspects of the service including care plans. Shortfalls had been identified and an action plan put in place, but these had not been followed up and the shortfalls continued at the inspection.

The buildings had been adapted to meet people’s needs, however, the dining room had been out of use since February 2018, as the ceiling had fallen down. People told us that they were unable to eat their meals together. People and sta

This inspection took place on 30 and 31 August 2017 and was unannounced on the first day and announced on the second day.

The Chilterns is formed of three separate buildings on the seafront with gender specific accommodation of various types, including single rooms and single occupancy self-contained flats. The service is registered for a maximum of 26 people who live with mental health conditions and or a learning disability. Some people are in transition from a secure environment, some people are there on an informal basis and some people are restricted under the Mental Health Act. At the time of the inspection there were 19 people living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We last inspected this service in July 2016. We found shortfalls in the service. The provider had failed to ensure that timely care planning and risk assessing took place, staff had not received appropriate training and supervision necessary for them to carry out their role and the provider had failed to make sure people received person centred care that reflected their personal preferences.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made. There was, however, a new breach of regulation.

There were not sufficient staff consistently on duty, to keep people safe. People told us they were treated with dignity and respect.

Staff received training appropriate to their role. Staff had received supervision, however, some staff had not received supervision as often as the registered manager would like, there was a plan in place to address this. Staff were recruited safely and received an induction when they started working at the service.

Each person had a detailed support plan. Potential risks to people’s health and welfare had been assessed including behaviours that may challenge. There was guidance in place for staff to follow to be able to manage the risk, however, some wording required clarity. Support plans were reviewed regularly, people were involved in the review of their support. The support plan gave details of people’s preferences and choices about how they liked to be supported.

Communication between the registered manager and staff was not always effective. Staff did not have an understanding of how decisions about people’s support had been made. Changes to people’s support was decided by the multi-disciplinary team. When changes to people’s support had not been successful, staff had felt the registered manager had been responsible.

Staff had mixed views about whether they were supported by the registered manager. Some felt they could not approach the registered manager while others felt that there were able to talk to the registered manager at any time. The registered manager told us that without a deputy manager in post it was difficult to give staff the support they needed.

People received their medicines safely. Staff were trained to administer medicines and their competencies were assessed. Some people were prescribed ‘as and when’ medicines, there was guidance in place for when these medicines should be given. Some medicines had not been available due to problems with ordering them, staff were managing the situation.

Staff understood how to protect people from abuse and the action they needed to take to keep people safe. People told us that they felt safe living at the service. Staff were confident that the registered manager would take appropriate action when concerns were raised. Staff knew they could go to agencies outside the service if th

This was an unannounced inspection carried out on 27 and 28 July 2016.

The Chilterns is formed of three separate buildings on the seafront with gender-specific accommodation of various types, from shared to single occupancy in self-contained flats. The service is registered for a maximum of 26 people who live with mental health conditions and /or a learning disability. Some people are in transition from a secure environment, some people are there on an informal basis and some people are under Mental Health Act sections or Community Treatment Orders. At the time of the inspection there were 19 people living at the service.

The service is run by a registered manager who was present on the day of the inspection. 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 and associated Regulations about how the service is run. The registered manager was supported by a registered mental health nurse and team leaders. The service had been in the day to day control of an acting manager for the previous six months while the registered manager took on an area manager role; however, they were not present at the time of the inspection.

There had been a plan in place to ensure staff were up to date with their training, however, the acting manager had not followed this and staff had not completed refresher training when it was due.

People’s records were reviewed every six months and some had been updated as changes had happened, however this had not been consistently done. People’s confidentiality was respected; conversations about people’s support were held privately and care records were stored securely. The provider told us people’s personal information may not have been safeguarded and this was being investigated.

When people were transitioning into the service this was done in a structured way. However, there were no transitional support plans or risk management plans in place for people who were at the service for a short stay.

Staff understood how to protect people from the risk of abuse and the action they needed to take to keep people safe. Risk assessments gave staff guidance, which was followed in practice, to reduce the risks to people.

People told us they felt safe living at The Chilterns. Staff were confident to whistle blow to the registered manager and were confident that the appropriate action would be taken. Staff said they would not hesitate to contact other organisations outside the service if they needed to.

The provider had a recruitment and selection policy which was followed to make sure staff were of good character and safe to work with people.

People received their medicines safely and told us they received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Improvements were needed relating to the storage and administration of some medicines.

People were supported by sufficient numbers of staff who knew them very well. All qualified professionals were receiving clinical supervision by a clinical supervisor independent to the service. Staff completed an induction when they started working at the service. Staff were encouraged and supported to complete adult social care vocational qualification for their personal development.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agre

The Chilterns was inspected on 15 and 16 July 2015. The inspection was unannounced. The service provides accommodation for persons who require nursing or personal care for up to 26 people with learning disabilities and mental health needs. The service is split into three houses. There are communal spaces which include lounges, a dining room and kitchen. People have access to the garden.

There was 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.

People told us that they were safe and that they were protected from bullying and avoidable harm. Some staff had not had safeguarding training and were unsure as to how to report abuse to organisations outside of the service.

People’s needs and personal risks were identified when people moved into the service and these assessments were on going. However, these risks were not always documented and shared with all staff, so risks were not always identified or managed. Some people did not have comprehensive risk management plans that are a requirement of the Mental Health Act 1983. Care plans were not always fully completed and did not always include the guidance staff needed to make sure people received care in ways that suited them best.

There were sufficient numbers of suitable staff deployed at the service. Staff did not all have the necessary skills, knowledge and experience to make sure people received their care and support safely. Staff did not always receive the training and support they needed to carry out their roles and responsibilities effectively and safely. Staff did not always have access to specialist training in order to meet individual people’s needs in ways that suited them best.

Systems were in place to monitor the quality of service. However, action had not always been taken to address all the shortfalls which had been highlighted. Support and care records were not included in the quality assurance process and people could not be sure that their care records were up to date, accurate and included all the information staff needed to give them the care and support they needed.

Safe recruitment practices were followed and there was a clear disciplinary process.

People’s medicines were managed safely. People told us that they were given their medicines when they needed them. People were supported to have regular access to the doctor, dentist and optician. All appointments with, or visits by, health care professionals were recorded in individual health action plans and advice and recommendations were followed. Some people were using the service due to the requirements of the Mental Health Act 1983 and had their mental health needs monitored and reviewed every six weeks.

People were asked for their consent in ways they could understand before care and support was given and staff understood the requirements of the Mental Capacity Act 2005 (MCA).

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The manager understood when a DoLS application should be made and how to submit one. The service was meeting the requirements of the DoLS.

People were encouraged to follow a healthy diet. People were asked about their dietary requirements and were regularly consulted about their food preferences. People could prepare their own snacks and meals if they wanted to.

Staff felt valued and supported by the manager. Communication between staff took place through regular meetings and handovers between each shift. The manager and staff were aware of their accountability and responsibility in meeting the requirements of legislation.

People were treated with respect and dignity. Staff spoke with and supported people in a caring, respectful and professional manner. People’s diversity was recognised and supported. Staff supported people to be as independent as they could be, and their privacy was respected. There were no restrictions on people having visitors.

Staff were aware of the values and behaviours expected of them and the manager regularly reviewed the culture of the service to make sure staff were positive, inclusive and empowering towards the people they supported. People had the opportunity to be as involved as they wanted to be in their assessments and in the planning of their care and support.

People said they knew how to make a complaint and there was an easy read version of the complaints process available for people who needed it.

The manager made sure they submitted notifications to CQC in line with CQC guidelines.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.