Inspection on 18/02/09 for Chimera

This inspection was carried out on 18th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chimera 15/03/10

Chimera 06/01/10

Chimera 26/08/08

Chimera 27/11/07

Chimera 20/07/06

Chimera 20/03/06

Chimera 27/06/05

Chimera 09/03/05

Chimera 06/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Chimera 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT Lead Inspector Martin Bayne Unannounced Inspection 18th February 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chimera Address 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT 01202 767144 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Marise Anne Lena Holden Manager post vacant Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 7. 26th August 2008 Date of last inspection Brief Description of the Service: Chimera is a small care home catering for seven older people. Five bedrooms are on the ground floor of the home and two on the first floor. Chimera is located in a residential area of Westbourne close to the local amenities, which includes, shops, cafes, restaurants and post office; all are within walking distance of the home. The home is a large semi detached building with three floors. All residents rooms are single, three of which have en-suite facilities. The communal areas comprise a lounge/dining room and large rear garden. There is a paved area at the front of the home overlooking the street and a small sun lounge at the front of the home. Chimera is within walking distance of public transport links to the town centres of Poole and Bournemouth. The current fees for the home range from £452 - £550 per week. Additional charges are detailed within the Terms and Conditions of Residence. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission, carried out a key inspection of Chimera residential home between 10:15am and 4.45pm on the 18th February 2009. The inspection was carried out by two inspectors, but throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons. Chimera was rated as providing poor outcomes for residents at the last key inspection with three Statutory Enforcement Notices being served together with eight requirements and six recommendations. A random inspection was carried out in September 2008 to follow-up on how the home had complied with the Statutory Enforcement Notices. At that inspection we found there had been compliance in full for two Notices and partial compliance for the third notice. Details are provided with in the main text of the report. At the time of the inspection there were six residents living at the home. We were assisted throughout the inspection by Mrs Holden, the Registered Provider, who showed us records that the home is required to keep under the Care Homes Regulations 2001. We conducted a tour of the premises and had the opportunity to speak with two of the residents. We also spoke with members of staff who were on duty that day. Additional information that helped form to the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document completed by the home and the improvement plan that had been submitted by Mrs Holden. What the service does well: Prospective residents have their needs assessed and recorded before being offered a place at the home, to ensure that these needs can be met. Generally we found that health care needs of residents were being met at the home and medication administration was now being better managed. The home provides some communal and individual activities with residents, commensurate with their degree of frailty. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 6 The home provides a good standard of food. Chimera provides a ‘homely’ environment for residents. The home is staffed with sufficient numbers of staff to meet the needs of the residents accommodated. What has improved since the last inspection? What they could do better: Recommendations were made that could further improve the care planning. There are still some issues concerning maintaining residents privacy and dignity that must be addressed and are detailed in the main text of the report. The home must provide storage facilities for controlled medications that meet new Regulations. Best practice guidance was given concerning medication administration. The home must abide by the Smoke-Free (Exemptions And Vehicles) Regulations 2007. Action must be taken to ensure that the patio and areas of the garden accessible to residents are kept free of dog faeces. Staff recruitment remains a significant concern as not all the required recruitment checks had been undertaken for new members of staff and risk assessments have not been completed as required to ensure that staff are appropriately recruited, deployed and supervised. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 7 Mrs Holden has yet to complete the NVQ level 4 management qualification or an appropriate alternative. Substances harmful to health must be stored away safely. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit by having their needs assessed before being offered a place at the home, thus ensuring that the home can meet needs of people admitted to the home. EVIDENCE: Since the last key inspection one person has been admitted to Chimera. This person had attended the home for day care but owing to problems in managing daily living within their own home, they had been admitted for short-term care into the Chimera. We saw that a preadmission assessment of this persons needs had been carried out by Mrs Holden and recorded on a Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 10 template that covered all of the topics detailed within the National Minimum Standards for older people. We saw that a copy of the homes Statement of Purpose was on display in the front reception area so that people who live at the home are informed of the services that the home sets out to provide. The home does not provide an intermediate care service. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from improved care planning and medication administration in meeting health care needs of people who live at home. The home must regularly review practice to ensure that this maintains the privacy and dignity of all the people living at the home. EVIDENCE: We looked at the care plans for a sample of three people whom we tracked through the inspection. At the last key inspection in August 2008, a requirement was made, as at that time care plans were not being reviewed each month. The care plans that we saw had been developed from various assessments and clearly set out how staff were expected to meet the identified Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 12 needs of the people living at the home. We saw that care plans were now being reviewed each month thus meeting the outstanding requirement. Care planning was much improved since the last key inspection. During the inspection we spoke with one resident who was able to give a good account of what it was like to live at Chimera. They told us that all of their care and health needs were met and that they enjoyed living at the home. We found some areas where care planning could be improved and recommendations were made concerning the following: • We saw that photographs were in place at the front of each persons medication administration records and recommend that photographs are also put in place at the front of each persons care plan so that newly appointed staff can easily identify the person concerned. We found in the case of one person that they had experienced several falls and these were recorded within their daily recording notes, however these had not been recorded in the accident book. We recommend that all falls are also recorded within the accident book so that an analysis can take place that could help identify trends leading to a reduction in the risk of people experiencing falls. We found that body maps to record any injuries sustained by residents were not always completed. We recommend that any injury sustained by a resident be recorded on a body map. We saw that residents weights were being regularly recorded. In the case of one person they had experienced a loss of weight and had been prescribed build up drinks to increase their calorie intake. These supplements were not being recorded when given to the resident and we recommend that this practice be adopted to assist in identifying whether the person receives sufficient nutritional intake. We advised that this person is referred to a dietician. • • • Generally we found that health care needs of residents were being met at the home. Each resident is registered with a GP and we saw that appropriate referrals were made for doctors visits to see residents. We also saw evidence that district nursing services were being accessed appropriately. Other health care needs relating to chiropody, dentistry and care of residents eyes were being met as required. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 13 At the last key inspection in August 2008 a Statutory Enforcement Notice was issued concerning privacy and dignity of residents. At this inspection we found that some of the concerns had been addressed, namely. • The CCTV equipment that had been used to monitor residents within the home has been disconnected and the practice of monitoring a resident with the use of a baby monitor has ceased. Curtains have been put up within the residents bedroom that overlooks the conservatory thus providing more privacy. The residents bedroom where we found there were no curtains in place, these were now evident. Items belonging to the home and other residents that were being stored within one residents wardrobe had been removed. • • • One area where there has not been compliance with the Statutory Enforcement Notice regarding maintaining dignity of residents concerns management of continence within the home. At the last key inspection in August 2008 we found that black bin liners were being used to protect the cushions on some residents chairs in relation to managing one persons continence needs. The home was told within a Statutory Enforcement Notice to find other more dignified means of managing this persons continence needs. At the random inspection in November 2008 the same practice using the plastic bin liners was observed and again Mrs Holden was told that this was not a satisfactory means of meeting this persons continent needs with dignity. Following the random inspection Mrs Holden wrote to the Commission justifying her management of this residents continence needs within the home but with no action plan of how she was going to meet the Statutory Enforcement Notice. At this inspection we found this resident sitting in the lounge area with a black bin liner still being used to protect the cushions, with a paper incontinence sheet placed on top of a black bin liner. We also found another resident within their bedroom, whose chair was also being protected by this means. Mrs Holden told us that she had liaised with both social workers and district nurses who supported the management of continence by these means. Mrs Holden provided us with a record of a conversation with a social worker but this did not support Mrs Holden’s assertion. Following the inspection we spoke with the district nursing service who told us that they had discussed managing continence with the home and did not condone the use of the black bin liners to protect furniture. They told us that Mrs Holden had been made aware of their view. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 14 Following the inspection we met with Mrs Holden to discuss this inspection report. Mrs Holden advised that fabric covers have been purchased and that these will be used on all chairs within communal areas. This will improve the previous practice where the use of black bin liners and paper ‘kylies’ clearly identified where people had continence needs. Mrs Holden advised that black bin liners would continue to be used to cover the chairs of some people, but that she was liaising with District Nursing staff regarding the provision of more appropriate continence products for individuals. It is expected that the use of these products will remove the need for seats to have plastic covers. Mrs Holden must continue to review the continence management programme for these individuals to ensure that this both meets their needs and promotes dignity. This area will be re-assessed at the next inspection. Concerning management and administration of medicines within the care home, at the last key inspection requirements were made that; insulin must not be administered by persons unauthorised to do so, that medication must be stored securely and that stock levels of medication must be appropriately maintained. We found at this inspection that the home had complied with these requirements. Since the last key inspection, Regulations have changed and care homes now must provide more secure facilities for storing controlled drugs and a requirement was made that the home must meet these new Regulations. We looked at the medication administration records for all of the residents and generally found that these were being completed in full, with no gaps within the records. At the last key inspection recommendations concerning medication administration were also made, namely that where hand transcribed entries to administer medicines are recorded by hand on medication administration records, a second person checks and signs that the record has been entered correctly, that any known allergies are recorded at the front of a persons medication administration records and that there is a record of staff signatures of those staff trained to administer medication. We found some evidence of checking hand transcribed entries on medication administration records but not in all cases. This recommendation is repeated. We saw that there had been compliance with both other issues. We further recommend that there is a better audit trail of medicines entering the home and advice was given. We also recommend that where the variable doses of as required medications are administered, the variable dose given is recorded. We also recommend that the fridge used from storing medications that require refrigeration, a record is maintained of the maximum minimum temperature of the fridge to ensure that medicines are stored safely as per the manufacturer’s instructions. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living within a family environment and being provided with activities and stimulation commensurate with their degree of frailty. They also benefit from a good standard of food being provided within the home. EVIDENCE: The majority of the residents who live in the home are now very frail due to their age and infirmities. Two of the residents who are more able prefer to spend much of their time with them their rooms. One of these residents as already reported, said that she was very happy living at the home, the other person chose not to speak to us. The home provides a family orientated environment with the majority of staffing at the home being provided by relatives of Mrs Holdens. It was evident that one of the residents very much enjoys the company of the homes dogs. On the day of our visit there were no Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 16 formal activities taking place, although we saw that staff regularly conversed with residents ensuring that their needs were being met that day. We also saw that staff were recording each day activities of both communal and individual activities that were taking place with residents. We saw that peoples spiritual needs are assessed at the point of admission. No relatives visited the home on the day of our inspection, however, at previous inspections we have spoken with relatives who told us that they are made welcome to visit at any time and were kept informed by Mrs Holden of the progress of their relatives. We saw that a wholesome and nutritious meal was provided at midday to residents and the resident we spoke with told us that the food was of a good standard with the home knowing their likes and dislikes. Records of food were not inspected on this occasion as at the last key inspection it was found that there were now better records of the food provided to residents. At lunchtime we observed staff assisting some residents with eating and this was done sensitively and appropriately. As reported earlier we recommend that a record is maintained of build-up drinks administered to residents. Mrs Holden told us of how she gives residents with a low weight high calorific food supplements to ensure that their dietary needs are met. We saw that there was a bowl of fresh fruit available to residents in the lounge. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-publicised complaints procedure and by the staff being trained in adult protection. EVIDENCE: The home maintains a log for the recording of complaints. Since the last inspection and there have been no formal complaints made to the management and none have been brought to the attention of the Commission. As reported earlier, the Statement of Purpose for the home and Service User Guide are available to residents. A complaints procedure is detailed in both these documents and therefore residents are well informed of how to make a complaint. The home has policies and procedures relevant to the protection of vulnerable adults and all of the staff have been trained by an external provider in the reporting and prevention of adult abuse. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Chimera provides a ‘homely’ environment for residents but there are still areas where the physical environment can be improved. EVIDENCE: At the last key inspection a number of requirements were made concerning the physical environment. We found at this inspection that action had been taken to address the majority of these issues. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 19 • Batteries for electric mobility scooters are no longer charged in the front porch. • Storing of wheelchairs within one resident’s bedroom that were blocking access to the fire exit have been removed. • Fire extinguishers were now found to be wall mounted and not used to prop open the front door. • Window restrictors have been fitted to the first-floor window of one resident’s bedroom. • The resident’s bedroom door that was found difficult to open at the last inspection has been fixed. • Action has been taken to clear communal spaces of unused furniture. • The extractor fan in the downstairs bathroom has been repaired and the ceiling repainted and there was now no evidence of mould. The waste bin that had been blocking access to the hand washing sink had been removed as required. Action is still required in respect of two outstanding requirements. • A requirement was made at the last key inspection that wardrobes be secured to the wall to prevent the risk of these being pulled over. We found the majority of wardrobes had been fixed to the wall as required however there was one wardrobe that has still to be fixed to the wall and the deadline for the requirement is extended. This places people living at the home at risk should the wardrobe fall. DS0000004012.V374364.R01.S.doc Version 5.2 Page 20 Chimera • As found of the last key inspection, there was dog excrement on the patio. On the day of our visit the home was found to be warm with the exception of the conservatory which is used in the warmer weather. Generally the home was found to be clean and there was evidence of refurbishment of the outside of the building. At this inspection some additional issues requiring attention were noted. • In room 7 the radiator is unguarded and also we found a hole in the wall leading to the ensuite WC that needs repairing. Handles were also missing from the chest of drawers. • The bathroom on the first floor has an unsuitable locking mechanism as staff are not able to gain entry in an emergency should a resident get locked in this bathroom. • We found a strong smell of cigarette smoke on the first floor of the home. This impacts on the living environment for residents accommodated on this floor. Two staff members live on this floor and the home must abide by The Smoke-Free (Exemptions And Vehicles) Regulations 2007. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from staffing levels that meet their assessed needs and through improvements to the training provided to the staff. However, poor recruitment compliance does not ensure that residents are in ‘safe hands’ at all times. EVIDENCE: On the day of this inspection Mrs Holden was on duty at the home together with two care staff members. We were told that the staffing levels remained the same as at the last key inspection with two members of staff being on duty throughout the day with one awake member of staff on duty at night together with a sleep-in member of staff available if required. We saw a copy of the duty staff roster that reflected this level of staff and also the names for the staff on duty that day. The requirement made at the last key inspection that an accurate duty roster be maintained had therefore been complied with. We were told by the residents with whom we spoke that the staffing levels met the needs of the current resident group. At the last key inspection a requirement Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 22 was made concerning the provision of sleep-in accommodation as at that time the sleep-in member of staff was found sleeping on a sofa in the communal lounge. Mrs Holden had informed us through the submitted improvement plan that sleep-in accommodation was now provided and this was validated at the random inspection in November 2008. Since the random inspection of November 2008 one new member of staff has been recruited to the staff team as a cleaner. We looked at their recruitment records and we found that all recruitment checks had been undertaken in line with Schedule 2 of the Care Homes Regulations 2001. We also looked at the recruitment records for the two people who were listed on the roster as sleepin workers. These two people had been the subject of concern at previous inspections and their status at the home formed part of the supporting evidence for the Statutory Enforcement Notice of September 2008 concerning preserving privacy and dignity of residents. At the key inspection in August 2008, one of these people was accommodated as a lodger on the first floor of the home whilst the other was being accommodated in the summerhouse in the garden. They were not then employed to work at the home. At the random inspection in November 2008 we were told that both these people were now accommodated in the home and were now employed as staff. One person was being accommodated on the first floor of the home and the other within Mrs Holden’s accommodation. At the random inspection we looked at the recruitment records for both these staff members, which were found to be incomplete and a requirement was made for all the required recruitment checks to be undertaken. We found at this inspection that the recruitment records for these sleep-in workers were still incomplete, as there was no signed health declaration or photographic ID pertaining to them. Within the records for some staff members, there were recorded convictions on the CRB disclosures. There were no risk assessments in place to consider risks posed to residents by the appointment of staff with previous criminal convictions. Systems must be in place to ensure that residents are in safe hands. We discussed these concerns with Mrs Holden as it appeared that staff had been recruited not on the basis of needs of the home, as the home already has sufficient sleep-in members of staff, but rather as a means to providing accommodation for people whom Mrs Holden has known and supported for many years. Mrs Holden had advised that the two sleep-in staff would not provide assistance with personal care tasks. It is our expectation that sleep-in staff would provide support if someone was unwell or had a fall. They also have unsupervised access to the residents living at the home. We would ask Mrs Holden to consider that appropriateness of these appointments. Concerning staff training, at the key inspection in August 2008 a requirement was made for staff to be trained in medication administration, challenging behaviour and updated moving and handling. We found this inspection at Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 23 improvements to staff training had been made. Staff were now being trained in care of people with dementia, moving and handling training had been updated and staff have been trained in medication administration. Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Provider must take some further actions to ensure that people living at the home are not placed at risk of harm. EVIDENCE: Failure to comply with Regulations concerning the recruitment of new staff as reported in the staffing section is also reflected in the scoring for this section of the report as this is a specific and necessary management function to protect people living at the home. The Registered Provider had been advised of the required actions at the random inspection in November 2008 and repeated Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 25 these failings for a further staff member employed following that inspection. During our meeting Mrs Holden provided a verbal account of the areas of risk and control measures considered in employment of these staff members. This risk assessment process must be appropriately documented and copies provided to the Commission. Mrs Holden has owned and managed Chimera residential home since 1993 and trained as a nurse. Mrs Holden does not hold an NVQ level 4 management qualification and is currently undertaking this training. At this inspection she informed us that her daughter, who also works at the home has started her NVQ management training, as in time she would like to put her forward as the registered manager of the home. Mrs Holden no longer works as part time manager of another registered service. At the last key inspection a requirement was made concerning the safekeeping of residents’ finances, as Mrs Holden at the time was having the personal allowances for two residents paid directly into her account. Since that time Mrs Holden has liaised with Social Services who now are appointees for these residents and they manage these residents’ monies. Mrs Holden no longer holds money for any residents. We looked at the fire log book and found that all tests and inspections of the fire safety system were taking place to the required timescales with the exception of recording a visual check of the fire fighting equipment. The requirement made at the last key inspection for the testing of the fire safety system remains in place. At the meeting following the inspection, Mrs Holden provided documentary evidence that these checks were now being completed. The health and safety issues required at the last key inspection have been addressed, save the fixing of all wardrobes to the wall, as mentioned earlier in the report. One further issue was identified at this inspection. We found that a denture cleaning product for one resident who suffers with dementia was being kept within the person’s ensuite toilet area. This product must be stored away safely as this poses a hazard to that person. . Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 x 3 X X 2 Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement You are required to provide storage facilities for controlled drugs that conform to the new regulatory standards. You must continue to review the continence management programme for these individuals to ensure that this both meets their needs and promotes dignity. This requirement was not fully met at the random inspection of 20/11/08 with a timescale of 25/10/08imposed by a Statutory Enforcement Notice following the key inspection of 22/08/08. 3. OP29 19 When recruiting new members of 08/05/09 staff, all the requirements of Schedule 2 of the Care Homes Regulations 2001 must be complied with. In addition, Any concerns about these staff are properly investigated and risk assessed. This requirement is repeated from the key inspection of Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 28 Timescale for action 30/03/09 2. OP10 12 (4) (a) (b) 08/05/09 24/08/09 Copies of the written risk assessments must be forwarded to the Commission. 4. OP38 23(4)(c )(v) You are required to ensure that: • Substances harmful to health are stored securely so that the risk to residents is minimised. • You are required to ensure that the patio and garden accessible to residents is kept free of dog excrement. 01/05/09 15/03/09 13 (4) 5. OP31 10(3) You are required to complete NVQ level 4 training or equivalent. This requirement is repeated from the key inspection of 24/08/08 The registered provider must complete an improvement plan to provide information regarding the actions being taken to address requirements made as a result of this inspection. 6. OP33 24 (1) 18/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations We recommend that: • Photographs of residents are attached to their care plan, so that new staff can identify easily to which resident the plan refers. DS0000004012.V374364.R01.S.doc Version 5.2 Page 29 Chimera 2. OP9 4. OP29 Records of any falls sustained by residents are recorded in the accident book as well as the daily recording notes. • ‘Body maps’ are used to record any injuries sustained by a resident. We recommend that: • A better audit trail for medications that enter the home is developed. • The record of temperatures for the fridge used for storing of medications requiring refrigeration records the maximum and minimum temperature range. • ‘Build-up’ drinks prescribed to residents should be recorded when given to residents. We recommend that the staff application form be changed to seek information in line with the regulations, such as: Requesting that a full employment history be detailed. Requests that gaps in the employment record be explained. A request that one reference be provided from a person’s last place of work of not less than three months duration where the person had worked with children or vulnerable adults. • Chimera DS0000004012.V374364.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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