About the service
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
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.
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.
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.