Chimnies Residential Care Home

Chimnies Residential Care Home (Chimnies) is a care home providing accommodation and personal care for up to 29 people, some of whom may be living with dementia. People live in an adapted house over two floors, with a lift connecting the floors. The service sits in a small village with views across open fields. At the time of our inspection 19 people were living at Chimnies.

People’s experience of using this service and what we found

Since our last inspection, management had worked hard to improve the service and as such the care people received. We found big improvements during this visit and work was continuing to embed the positive changes into daily working practice. Staff were positive about the effect the changes had had on the service.

The registered manager acted promptly to address a couple of areas that we identified needing further work. This included following the requirements of safe recruitment and identifying and recording all risks to people. We have made a recommendation to the registered manager in these areas.

People were happy living at Chimnies. They told us staff were kind and caring and they did not have to wait long to receive staff input if they rang their bell.

People felt safe and staff were aware of how to recognise abuse and report it correctly. Where people had accidents and incidents these were recorded and action taken to address them.

Risks to people had been identified and staff followed guidance to help keep people free from harm. People were supported with their medicines and provided with sufficient food and drink. Staff involved health care professionals where needed to help people maintain a good level of health.

People were supported to have maximum 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.

People lived in an environment which was clean and safe and people said they could choose how and where they spent their time. People were cared for by a staff team who were trained in their role, worked well together and enjoying working at Chimnies. Friendships had formed between people and staff and people got on well together.

The registered manager gave people the opportunity to be involved in the service and retain their independence where they could. The registered manager supported staff and worked with external agencies and professionals to support people’s care needs. The registered manager had plans on how to further improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 18 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 November 2021. Breaches of legal requirements were found that related to safe care and treatment, staffing, good governance, and safeguarding service users from abuse and improper treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chimnies Residential Care Home on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation to the registered provider in relation to risks for people and recruitment processes.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Chimnies Residential Care Home is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. Two people were cared for in bed. The service can support up to 29 people.

People’s experience of using this service and what we found

People told us they felt safe and well cared for. Comments included, “I feel safe”; “I know most of the people here. We all mix together and have a laugh”; “They are a good bunch of people”; “The staff are quite nice”; “The carers are lovely people. They are very gentle and talk to me” and “The staff are very nice.”

Relatives told us they were happy with the care at Chimnies Residential Care Home. Comments included, “They are brilliant. They’ve taken a whole lot of worry off us as we know he’s being looked after”; “Mum is very happy there. They are a caring team”; “The care is exceptional”; “The staff go above and beyond”; “We know the individual carers quite well and they’re all friendly”; “Chimnies is really good. I can’t fault it. They are all very obliging and very friendly”; “It’s like a big family. Staff are all very relaxed. You’re not made to feel an inconvenience when you’re there” and “It’s little things like that make me feel they care.”

Although people and relatives were happy with the care and support we found serious concerns about people’s safety. Risks to people’s safety had not been well managed. A range of risks to people had not been properly assessed or managed. Personal emergency evacuation plans (PEEPS) were not sufficient to enable staff to know which equipment to use and what action they should take to evacuate each person in the event of an emergency such as a fire. Fire risks were not well managed, we reported this to the fire service.

The staffing rota showed there were not enough staff on shift to safely meet people’s needs. Medicines were not well managed. Protocols were not in place to detail how people communicated pain or constipation, why they needed as and when required medicines and what the maximum dosages were. Records and stocks of medicines were not safely managed.

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Safeguarding concerns had not always been reported to the local authority. The registered manager lacked awareness of what action they should take in response to allegations of abuse.

We were not assured that the provider was admitting people safely to the service. People had moved into the service and had not been isolated in their rooms for the required period to meet government guidance in order to prevent the risk of spread of COVID-19 and to keep other people safe. PPE was not consistently used appropriately. This put people at risk. The provider was accessing testing for people using the service and staff.

Staff training and induction was not adequate to provide staff with the guidance and skills to safely carry out their roles. Some people lived with diabetes, no staff had undertaken diabetes training. People also lived with Parkinson’s and epilepsy, again no training had been provided to staff.

There was insufficient oversight of the service by the provider and registered managers to pick up and address the risks found by inspectors. Records were an area of concern across the service; records were not complete and accurate. The provider had failed to make improvements and the service had declined in quality. The provider and registered manager had not developed an open and honest culture where staff were empowered to raise any safeguarding concerns.

Assessments were not robust or complete. Assessments had not been reviewed and amended when people’s needs changed. People were not assessed to check their capacity to make particular decisions when this was in doubt. Records were not kept to show how decisions were made in people's best interest. At this inspection, some capacity assessments were in place, these were not decision specific and showed a lack of understanding about the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice.

People and relatives told us the food was good and met their needs. Mealtimes continued to be a social occasion where most people ate at dining room tables and had the opportunity to chat together. Most people’s weights were regularly monitored to make sure they remained as healthy as possible.

People were supported to access healthcare services when they needed them. Relatives told us their loved one’s health needs were met.

The environment required improvements. There was no signage to support people living with dementia (as well as new people to the service) to orientate themselves.

Staff were recruited safely. Disclosure and Barring Service (DBS) criminal record checks were completed as well as reference checks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 March 2020). Three breaches of regulations were found in relation to need for consent, person-centred care and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This inspection was also prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings.

The inspection was also prompted in part due to concerns received about people’s safety and staffing levels. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review all the key questions review the key questions of Safe, Effective and Well-led only. This enabled us to review the previous ratings.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this report. Please see the Safe, Effective and Well-led sections of this full report.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chimnies Residential Care Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, medicines management, infection control, deployment of staff, safeguarding people from abuse, capacity and consent, staff training, records and effective systems to monitor and improve the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this targeted inspection to check infection control and prevention measures in place at the service. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

About the service

Chimnies Residential Care home is a care home providing personal care for up to 29 older people. Some people at the service were living with dementia. The service was provided in one adapted building in a rural residential area. People had access to a garden and patio area with countryside views to enjoy when the weather was suitable.

People's experience of using this service and what we found

People had been given information to help them understand the changes which had occurred due to the pandemic. Changes included staff wearing personal protective equipment (PPE), such as masks and aprons and the importance of people social distancing.

Some people were living with dementia and liked to walk around the service. Staff were vigilant in ensuring social distancing was maintained. They described how they did this in an individual and gentle way, whilst maintaining people’s dignity.

We observed staff using PPE appropriately. There were PPE ‘stations’ around the service to ensure PPE was available when needed.

The registered managers were following advice and guidance from other agencies about infection control and prevention and had updated staff practice accordingly.

Further information is in the detailed findings below

Chimnies Residential Care home is a care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 29 people. The service was provided in one adapted building in a rural residential area. People had access to a garden and patio area with countryside views to enjoy when the weather was suitable.

People’s experience of using this service and what we found

Risks to people's individual health and wellbeing had not always been assessed or kept up to date with their changing needs. People’s care needs had not been assessed and their records had not been reviewed and kept updated when their needs had changed, to make sure the care provided was safe, person centred, and consistently met their needs. People were not supported to make individual plans for the end of their life to make sure staff knew their wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not evidence this practice.

Accurate records of people’s care had not been kept. The monitoring systems in place, to make sure the service was good quality and safe, were not effective in reliably identifying areas for improvement and ensuring lessons were learnt.

The provider and registered managers did not keep up to date with current and best practice to make sure people were receiving the best possible care. We have made a recommendation about this.

People were supported by staff who had been through a robust recruitment process. There were enough staff and people said they did not have to wait when they needed the attention of a staff member.

Staff understood how to keep people safe and knew how to report concerns if they had any. People received their medicines as prescribed and staff understood the importance of safe medicines management.

People were supported by staff who had received the training and one to one supervision they needed to meet people’s needs.

People were happy with the food provided and people who needed assistance with their meals were not rushed. People’s dietary needs and preferences were known by staff. People were referred to health care professionals when they needed advice and treatment.

People said they were happy with their care and support and thought staff looked after them well. Relatives were very happy with the care of their loved ones. People were involved in their own care and treatment and were regularly asked their views of the service provided.

People, relatives and staff described the registered managers as approachable, who listened and took action when changes were suggested.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 15 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to safe care and treatment and accurate record keeping and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We asked the provider to take action to meet the regulations. The provider sent us a report of the actions they were taking to comply with Regulations 17, 18 and 19 on 09 September 2016. They told us they had already taken the action specified in the plan and were meeting the regulations.

We returned to carry out a comprehensive inspection on 05 June 2017. The inspection was unannounced. At this inspection we found that the provider had implemented new ways of working to address the breaches from the previous inspection which had resulted in an improvement to the service provided.

The Chimnies Residential Care Home is registered to provide accommodation and personal care for up to 29 people over the age of 65 years. There were 21 people living at the service on the day of our inspection. Some people living at the home were quite independent, only requiring minimal help and others were frail with various care needs such as Parkinson’s disease or diabetes.

The accommodation is set over two floors in a large well maintained former vicarage with building extensions added over the years. Outside are well maintained gardens where people can enjoy sitting outside with good views in a rural setting.

There were two registered managers based at the service. 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 how the service is run. Chimnies Residential Care Home was a family run business owned by two providers, one of whom was one of the registered managers.

Safer recruitment practices were now being used. New staff went through a thorough application and vetting process to make sure they were suitable to work with the people living in the service. There were enough staff employed to meet the assessed needs of people. Many staff had worked at the service for a number of years and lived locally so were available and happy to cover short notice staff absences.

The provider had made additional training available for all staff to refresh and update their skills and knowledge as this was an area found to be of concern at the last inspection. Staff told us they found this had been of benefit and was an improvement made to the service. Staff were supported to carry out their role through regular one to one supervision meetings.

The premises were well maintained and the appropriate checks and servicing of equipment had been carried out. Fire evacuation documentation and practical drills required some improvement as these had not been carried out. We have made a recommendation about this.

Individual risks to people had been identified and assessments were carried out to make sure control measures were in place, helping to manage and control the risks. An initial assessment was undertaken with people before they moved in to the service. Care plans were developed to help staff to support people with their assessed needs in the way they wanted.

All aspects of medicines administration continued to be managed well. People received their medicines in a safe way and as prescribed. Accidents and incidents were recorded well by staff and monitored by the registered manager to check for trends or concerns.

People’s rights were protected as staff had a good understanding of the Mental Capacity Act 2005. People were given choices and supported to make their own decisions. Where necessary, mental capacity assessments were carried out to assess people’s ability to make specific decisions.

People were supported to maintain their health and staff contacted health care professionals when needed or when people asked. Those who had special nutrition and hydration needs were supported to access specialist advice and guidance. People were generally happy with the food provided and the choices available.

People said they were very happy living at Chimnies and found the staff to be kind and helpful. People were involved in their care and how they wanted things to be done. The service had a homely atmosphere with gardens and country views that people enjoyed.

There were mixed comments about the activities available for people to join in and enjoy. Most people appeared happy but some people said they would prefer to have more opportunities. We have made a recommendation about this.

Although no complaints had been made since the last inspection people told us they knew who to go if they did have a complaint.

The provider and the registered manager sought the views of people using the service through surveys and regular residents meetings. The views of other involved in the service were also requested through an annual survey.

The provider now had a range of monitoring and auditing processes to check the quality and safety of the service they were providing. These were used effectively and had improved the oversight of the service by the provider and the registered manager.

People and staff thought the service was well run. Staff felt well supported and said they were very happy in their role. They found the provider and the registered manager to be approachable and keen to listen to suggestions.

The Chimnies Residential Care Home provides residential care for up to 29 people over the age of 65. The accommodation is set over two floors in a large, well maintained detached house. There are communal lounges, kitchen, offices, private bedrooms with washing facilities and communal bathrooms. Outside there are well kept gardens for the residents to enjoy. There were 22 residents living in the home when we inspected.

There were two registered manager at the home, one of whom was also part of the registered company that was the provider. 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 how the service is run.

People told us they felt safe at the home and relatives also said they thought their relatives were safe.

The provider had a recruitment policy in place but this was not being followed. Some staff records showed that checks through the Disclosure and Barring Service (DBS) were carried after they had started working at the home. Some staff had previously worked at the home and the provider and registered manager relied on references from their past employment with the provider.

The provider had a safeguarding policy in place and staff were aware of the responsibilities to report any concerns they might have. Safeguarding training was out of date for staff. Risk assessments were in place for most people, however, some risk to people and how to reduce those risk were not in place. We have made a recommendation about this. There were environmental risk assessments in place and the building was well maintained. There were no personal evacuation plans in place for people living the in home. We have made a recommendation about this.

Accidents and incidents had been responded to appropriately and involved the relevant health care professionals.

There was no formal tool for assessing staffing levels at the home but we saw that there were enough staff on duty to meet people’s needs.

People were protected from the risks associated with the management of medicines. The provider was following their medication policy. The provider was not carrying out medication audits.

The provider did not have a training policy in place and theirs and staff training was out of date. They did not have a training matrix to ensure an overall view of what training was needed and when it needed to be update. Staff had not received training on the Mental Capacity Act 2005. The staff and provider and manager did not have a good understanding of the MCA or DoLS and how this needed to inform care given to people. We have made a recommendation about this

People were supported to access health care professionals such as opticians, dentists and GP’s. When people’s needs changed referrals were made to the appropriate professionals such as dieticians and the memory clinic. End of life care plans had been put in place and the palliative care teams and hospice were involved where needed. People told us they thought the home was responsive to their needs. The registered managers recognised when they were unable to meet people’s needs and took steps to ensure that people were supported so that their needs could be met elsewhere.

People were supported to maintain a healthy and nutritious diet. People told us they enjoyed the food and there was plenty of choice. People’s weights were monitored on a regular basis.

Staff were kind and caring to people and they knew them well. Care plans had pre admission plans which fed into person centred care plans. People’s likes and dislikes had been recorded.

Staff told us about how they protected people’s privacy and dignity and we saw staff knock on doors before entering bedrooms. Confidential documents such as care plans and staff files were only accessible to those authorised to have access to them.

People were encouraged to maintain their independence as much as possible. We saw that family and friends were involved with the home and often visited people.

There were activities taking place in the home. There were outside professionals such as singers and exercise trainers that came into the home on regular basis. Some people told us that activities were not always what they wanted to do. We have made a recommendation about this. People were able to access the wider community and there was a bus stop outside the home installed after one person campaigned with the bus company.

There was a complaints policy in place with out of date information. People and relatives were confident to complain and who to complain to. However, the service user guide contained out of date information.

There were no residents or relatives meetings being held in the home. The provider did carry out satisfaction surveys with residents and health care professionals. All the responses we saw were positive and there was no action required by the provider. However, there was no mechanism in place to seek continuous improvement to the care provided to people.

There were no systems or processes in place to assess and monitor the quality of the service. The registered managers and provider did not keep up to date with training and published best practice. Although supervisions were taking place on a regular basis this meant they would not be able to give staff appropriate guidance. The registered manager and provider were not managing staff and ensuring that they carried out their responsibilities such as completing training that the provider considered mandatory.

The staff were very positive about the provider and registered manager and said that they felt supported by them. Staff were seen to uphold the visions and values of the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found at this visit that medicines were being safely administered and appropriate arrangements were in place regarding recording and obtaining medicines.

Quality assurance systems had been implemented that included medication audits, health and safety checks and cleaning schedules to ensure people received good quality and safe care. The provider had committed to seeking support from a care quality consultant in order to improve the current quality monitoring systems in operation.

People that used the service told us that they were happy with the service provided. They said that the staff were good, and the home was nice and clean. People told us 'I am very well looked after here' and 'The staff are kind and look after us well'.

People were asked for their consent before any care or treatment was given.

Care records showed that the people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed.

Medications were not recorded or handled appropriately and safely. People who used the service may not have received their medication as prescribed.

We found that staff received training appropriate to their role and this was being refreshed in a timely way.

Quality assurance systems were not fully in place to ensure people received good quality safe care.

People told us that the staff were very supportive, one said 'nothing is ever too much trouble', another said 'we are never rushed we are encouraged to do things for our selves, but staff are there when you need the help.'