Chiswick House

Updated 21 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 30 October 2018 and was unannounced. The inspection team comprised two CQC inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection, we reviewed information we held about the service. This included statutory notifications that the provider had sent in the last twelve months. A statutory notification contains information about significant events that affect people’s safety, which the provider is required to send to us by law. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service. We also contacted the local authority safeguarding team and the local authority quality assurance team for their views on the service.

During our inspection, we spoke with ten people who used the service and thirteen visiting relatives. Two additional relatives provided written feedback. We also spoke with one healthcare professional and a visiting activity provider. Furthermore, we spoke with the managing director, the regional manager, the registered manager, two care staff members, one of whom was the deputy manager, the cook and the person responsible for maintenance. We observed the care and support being provided to the people who used the service, which included the support provided over lunch time and activity sessions.

We viewed the care records and medicines records for three people who used the service. We also looked at records in relation to the management of the home. These included the recruitment files for three staff members, training records, health and safety documents, quality monitoring audits and minutes from meetings held.

Updated 21 December 2018

The inspection took place on 30 October 2018 and was unannounced.

Chiswick House provides residential care for up to 26 people, some of whom may be living with dementia. People in care homes receive accommodation and 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. At the time of the inspection there were 22 people living in the home. Chiswick House is a large Victorian property with a modern extension and people benefit from communal areas and a garden.

There was 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 the service is run.

At the last inspection, in February 2016, the service was rated as Good. At this inspection we found the service was Outstanding. The reasons for this are:

There were effective systems in place to assess and manage any potential risks identified. Staff understood fully the significance of health and safety management.

Medication was stored, administered and recorded safely and people received their medicines as prescribed.

Staff were recruited appropriately and there were always sufficient members of staff available to ensure people were kept safe.

The service delivered very effective care. The service worked in partnership with other health professionals to ensure a person-centred and preventative approach. Very good outcomes were achieved.

Staff were encouraged to undertake comprehensive and advanced training to cater for the needs of people in the home.

People’s nutritional and hydration needs were met particularly well.

People’s needs were assessed holistically.

The service had a solid understanding of its responsibilities regarding the Mental Capacity Act (MCA) 2005 and had followed best practice in respect of assessing capacity and arriving at decisions where capacity was lacking.

Staff showed exceptionally kind, compassionate and caring qualities. They were consistently attentive and went the extra mile to meet people’s needs.

Staff demonstrated a genuine desire to ensure people were comfortable, stimulated and content. They treated people with the utmost respect and ensured their dignity was maintained.

Staff made every effort to ensure communication was facilitated and that people’s choices were recognised. Staff maximised people’s independence.

The service’s approach to person-centred planning ensured that people’s needs were met and the support they received was personalised to suit their views and beliefs.

The service provided a wide array of activities and events that people could engage with. The service strove to ensure people’s individual wishes were met and created the circumstances for people to live a fulfilling and enriched life.

The service provided personalised care to people and their relatives when people reached the end of their life.

The service demonstrated outstanding management and leadership which created a caring, inclusive and respectful culture. Staff were fully aware of their responsibilities. They felt valued, supported and empowered to deliver high quality care.

The service was exceptionally inclusive and responsive to feedback and suggestions. It was always keen to listen, learn and improve. The quality management framework was of a very high standard.

The service actively embraced opportunities to work with external agencies to enhance its provision of care.