The Chilterns

Medicines management was not always safe. The relevant supporting documents were not always used to inform staff of where and how to apply medicated patches. Body maps were not in place to inform staff of where to apply medicated creams.

Checks and audits were being completed but had not always identified and resolved issues identified during this inspection. The culture within the service had improved, but there were still areas needing further improvement. The manager acknowledged there were still improvements to be made.

Staffing levels had been reviewed and a dependency tool was now in place to support how many staff were needed on each shift. We observed there to be enough levels of staff to meet people's needs.

There had been some improvements to the environment of the service. The service was clean and there was a maintenance schedule to make improvements that were still needed, such as decorating parts of the service.

People had been involved in the service, with their opinions sought and acted on. For example, sporting events were made into activities for people, with projectors and themed meals. Restrictions placed on people had been reviewed, and there were no longer restrictions placed on everyone. For example, one person had a key fob enabling them to leave and return to the service as they chose to.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make

assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Right support: • Model of care and setting mostly maximises people's choice, control and independence Right care: • Care was mostly person-centred and promotes people's dignity, privacy and human rights Right culture: • Ethos, values, attitudes and behaviours of leaders and care staff mostly ensured people using services lead confident, inclusive and empowered lives