The Chimes Residential Home

The Chimes Residential Home is a residential care home providing personal and nursing care to up to 44 people aged 65 and over. The home supports people living with dementia, mental health conditions, physical disability and sensory impairment.

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

We have identified areas where the provider needs to make improvements to ensure people are in receipt of good quality care.

People had not always been supported by staff who had been safely recruited. Staff recruitment checks were not always completed in a timely way and gaps in employment history were not always explored and documented. We have made a recommendation about recruitment processes.

The provider was not following current government guidance relating to infection, prevention and control for COVID-19. Staff and managers did not always follow current best practice to ensure cross infection was minimised at all times.

Improvement was needed in the provider’s governance systems to ensure they kept up to date with national government guidance. Records relating to the home’s environment needed to be organised so they were easily available and audit trails made clearer.

Visits had commenced following the changes in government guidelines and relatives were screened for symptoms of COVID-19 before visiting their family members. People and staff had access to COVID-19 testing.

The provider had made improvements since our previous inspection to ensure the monitoring of when people were repositioned was recorded. Risks to people were identified and plans were in place to help staff manage and help reduce the risks. Staff knew how to support people safely and were attentive to their needs. People received their medicine when they needed them. People were supported by sufficient numbers of staff and staff knew how to raise concerns in relation to people’s safety or abuse.

People and staff told us the registered manager was approachable and they were supported in their roles. The registered manager was aware of their duty of candour and worked in partnership with other organisations for the benefit of the people who lived at The Chimes Residential Home.

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 requires improvement (published 13 January 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

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 had received concerns in relation to the management of medicines, the cleanliness of the home and how the home was being managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, we have found evidence the provider needs to make improvement in other areas. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Chimes Residential 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 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 two breaches in relation to the provider’s governance of the home and infection control practices.

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.

The Chimes Residential Home provides accommodation with personal care for up to 44 people. People who

use the service had physical health and / or mental health needs, such as dementia. At the time of the inspection, 43 people used the service.

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

People’s risks were not always managed safely. People’s risk assessments were not reviewed or completed to ensure they were kept up to date and reflected any changing needs. People’s care plans and risk assessments were reviewed monthly. However, not all actions relating to people’s care had been documented when there was a change in circumstances.

Medicines were administered safely, and records demonstrated that people had received their medicines as prescribed. Staff medication training and competency checks were up to date.

The service was clean and free of malodour. There were a number of personal protective equipment (PPE) stations positioned throughout the home and staff wore appropriate PPE.

The registered manager’s care file audit system had not always been effective in finding the issues and information that had not been updated.

People told us they felt safe in the home.

Relatives were positive regarding the communication they’d received from the service during the pandemic.

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 07 December 2019). The service remains rated requires improvement. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Chimes Residential Home on our website at www.cqc.org.uk.

Why we inspected

We received concerns in relation to people's care and how the service was promoting people's

safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The ratings from the previous comprehensive inspection for those key questions not looked at on this

occasion were used in calculating the overall rating at this inspection. The overall rating for the service has

not changed. We did not inspect effective, caring and responsive due to us wanting to limit ourselves and spend the least amount of time in the home as possible.

Follow up

We will aim to re-inspect this service within the published time scale for services rated requires improvement. We will continue to monitor the service through the information we receive.

The Chimes Residential Home provides accommodation with personal care for up to 44 people. People who

use the service had physical health and / or mental health needs, such as dementia. At the time of the inspection, 42 people used the service. The service had three separate dining rooms where people could eat.

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

People’s risks were not always managed safely. People’s risk assessments were not reviewed or completed to ensure they were kept up to date and reflected any changing needs. People’s care plans and risk assessments were reviewed monthly. However, not all actions relating to people’s care had been documented when there was a change in circumstances.

Where people were prescribed 'as required' (PRN) medication, the service did not always have protocols or guidance in place.

Personal protective equipment (PPE) was available for staff, such as disposable gloves to use to help prevent the spread of infection. However, we found during both days of inspection that staff were not always using the equipment provided when working with people.

We made a recommendation about staff use of PPE to help prevent the spread of infection.

We used the Short Observational Framework for Inspection (SOFI) during meal times that looked at people’s dining experience. We observed that there was limited interaction between staff and people.

The registered manager’s audit system had not been effective in finding the issues and risks that were found during our inspection.

There were effective systems in place to safeguard people from harm and abuse. The registered manager took the necessary action to implement the required learning identified from accidents and near misses.

People and their families, where appropriate, were involved in the planning of care and support needs. The registered manager had an effective system to ensure that staff received appropriate training.

People were involved in decisions about the décor of their rooms, which met their personal and cultural needs and preferences. People brought furnishings of their choosing that allowed personalisation of their rooms.

We observed staff supported people in a caring and compassionate manner. People’s care plans clearly evidenced the support they required and their personal preferences.

The service facilitated several theme days throughout the year to celebrate different events, which involved people, relatives and staff members.

People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance

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.

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 19 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches. Regulation 12 the registered person failed to ensure risks relating to the safety, health and welfare of people using the service were assessed and managed safely and the registered person failed to ensure the proper and safe management of medicines. Regulation 17 The registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

You can see what action we have asked the provider to take at the end of this full 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.

The Chimes Residential Home provides accommodation with personal care for up to 44 people. People who use the service had physical health and / or mental health needs, such as dementia. At the time of the inspection, 33 people used the service.

There was a registered manager in place. 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 had individual risk assessments in place to keep them safe, which included assessments for mobility, nutrition and medicines. Measures taken to minimise risk of harm included the provision of mobility aids and sensor mats to alert staff.

Staff knew what action they would take if they had any concerns and showed a good understanding of the different types of abuse. We found that there were systems in place to protect people who lived at the home by ensuring appropriate referrals were made and action taken to keep people safe.

We found home had appropriate recruitment procedures in place, which ensured staff were suitable to support people who used the service.

There were sufficient numbers of staff on duty to support people.

People had the support they needed to take their medicines safely. Competency checks to ensure the staff had the relevant skills and knowledge for safe administration were in place

Staff had the necessary skills and knowledge to meet people’s needs.

The provider protected people’s right under the Mental Capacity Act 2005. Staff were able to demonstrate that they had knowledge of the principles of the MCA and confirmed they had received training in the MCA.

Staff promoted peoples independence, dignity and respect.

People were involved in making decisions about their care and were listened to by staff and management about their needs.

People's health needs were monitored and changes were made to people's care in response to any changes in their needs.

People were stimulated in both group and individual activities. The provider routinely and actively listened to people to address any concerns or complaints.

The registered manager and the provider were approachable and supportive. There was an open and inclusive culture within the home.

There were systems in place to gain people’s experiences and to continually monitor the quality of the service provided.