Inspection on 20/07/06 for Chimera

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 18/02/09

Chimera 26/08/08

Chimera 27/11/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chimera 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT Lead Inspector Martin Bayne Key Unannounced Inspection 09:00 20th July 2006 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 DS0000004012.V305556.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. DS0000004012.V305556.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 Care Home 5 Category(ies) of Old age, not falling within any other category registration, with number (5) of places DS0000004012.V305556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2006 Brief Description of the Service: Chimera is a small care home catering for five older people. All five resident rooms are on the ground floor of the home. 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. Residents are accommodated on the ground floor; the first and second floors are private accommodation for the owners. 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. DS0000004012.V305556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home, the aim of which was to evaluate the home against the core standards for older people and to follow up on the one requirement and three recommendations made at the last inspection in March this year. Mrs Holden, the registered provider assisted throughout the inspection. Three of the four residents were spoken about their experience of life at the home and two members of staff. A tour of the premises were made and records required to be maintained by regulation were viewed. The fees for the home range from £436 - £500 per week. What the service does well: What has improved since the last inspection? What they could do better: 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. DS0000004012.V305556.R01.S.doc Version 5.2 Page 6 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 DS0000004012.V305556.R01.S.doc Version 5.2 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before a place is offered at the home to ensure that these needs can be met. EVIDENCE: Since the last inspection two long term residents of the home have died. One long term resident has been admitted, whilst the other vacancy has been used for people requiring respite care. At the time of inspection there were four residents accommodated at the home. The records for the newly admitted resident and the records for one other resident were used to track the records that the home must keep within the home. Mrs Holden informed that she carries out a pre-admission assessment of need for all new referrals to ensure that their needs can be met at the home. In the case of the newly admitted resident there was a record of an assessment visit to the person who was living at another home out of the area. Mrs Holden gained information from the resident and manager of the home about this person needs, which covered all of the topics detailed within the standards. DS0000004012.V305556.R01.S.doc Version 5.2 Page 8 The resident was then offered a place at the home and given a 28 day trial period. The home does not provide a service for intermediate care. DS0000004012.V305556.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home meets the health and social needs of residents in a way that respects their privacy and dignity with appropriate record keeping in place. Residents’ medication is governed by policies and procedures that provide for safe administration. EVIDENCE: The health and social care needs of all of the residents were discussed with Mrs Holden and how the home met these. The newly admitted resident had suffered health problems soon after admission and records indicated that appropriate health care was sought to support this person through this period. Three residents were spoken with who could give an account of life at the home. They informed that their health needs were met and that were all registered with a GP. Paperwork was in order for the two residents tracked through the inspection with a full assessment of their needs having been undertaken with them. From this assessment, care plans had been developed including a separate night care plan for residents’ preferences and needs during the night time. The plans were concisely written but very detailed and gave a good account of how the staff should support each resident. Risk assessments were also found to have been carried out for specific areas of DS0000004012.V305556.R01.S.doc Version 5.2 Page 10 risk. These included skin care monitoring, where residents were at risk of skin break down. The home has specialist equipment such as profile beds, pressure mattresses and fleeces. Nutritional assessments where residents were at risk of loosing weight and moving and handling assessments for all of the residents. There was also evidence in the residents’ files that other health needs such as eye care, dentistry and chiropody were being attended to. All the staff were currently undertaking training in medication administration. The home has recently had a pharmacy inspection through CSCI and has adopted the recommendations made at that inspection. The medication administration records for the residents tracked through the inspection were viewed and it was found that there were no gaps within the records. It was recommended that where the staff have to hand write a medication onto the printed record, a second person should sign that this has been entered correctly. The residents spoken with informed that they were treated with respect and that their dignity was respected. The staff were observed interacting with the residents and it was evident that there were good relationships between them. DS0000004012.V305556.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home meets the standards of matching the lifestyle preferences of residents in terms in their social and cultural needs. Residents are able to maintain contact with family and friends and are supported to maintain control over their lives. There is a good standard of food provided in the home. EVIDENCE: Since the last inspection Mrs Holden has developed the service and has entered into an arrangement through Social Services to take up to four people into the home for day care. Currently there are three people who come to the home for this service on two days a week. The work on developing the garden, the patio area and the decked area covered by the awning has been done in order to provide additional facilities for both residents and the day care clients. The home now provides more in the way of activities, such as games, craft and outings. Two of the residents prefer to spend much of their time in their rooms, however all said that it was nice to have more people around in the daytime. An outing was being arranged the next day to go to Poole Quay and a trip the following week to Mudeford. The home has a minibus to take people out on trips. DS0000004012.V305556.R01.S.doc Version 5.2 Page 12 The home tries to match the lifestyle expectations of the residents. A kitten has been bought for the home as one resident very missed having a cat. Spiritual needs of residents discussed as part of the assessment process and currently one resident is taken each week to a service in the community. Residents informed that they could have visitors see them when they choose and they are made welcome at the home. Residents also said that they could get up and go to bed when they chose and had freedom to exercise choice over their lives. Residents have a nutritional assessment should there be any concerns about their dietary intake. One resident who now has dementia was seen to be allowed to eat slowly and unrushed. The midday meal was of a good standard and there was plenty to eat. All of the residents said that the food was of a good standard and there was plenty of choice. The menu for two weeks ahead was seen and this reflected what the inspector had been told. There are three choices for the main meal each day and specialist diets are arranged. One resident had a diabetic diet and another was provided with a pureed diet. Food supplements are provided if there is a need. Residents informed that they could have their meals in their rooms if they chose. Records were available of what each resident had eaten. DS0000004012.V305556.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected through well publicised by complaints procedure and a staff team trained in adult protection. EVIDENCE: The home maintains a log of complaints made against the home. Since the time of the last inspection there have been no complaints made internally and none have been brought to the attention of CSCI. The complaints procedure is detailed within the Terms and Conditions of residence and also with the Service User Guide, a copy of which is available in the home. Residents are therefore well informed should they wish to make a complaint. The home has copies of all the policies and procedures for the protection of vulnerable adults and they are trained as part of their induction training. DS0000004012.V305556.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and well maintained environment for the residents with infection control measures in place. EVIDENCE: In order to be able to meet both the needs of the current residents and also the new day care clients, more communal space has been provided. A large decked area has been added to the rear of the building leading from the patio doors. This has been fitted with an awning that also has removable side panels. New chairs have been bought so that all the residents and day care clients can be seated at one time. The garden has also been extensively redesigned with a new patio and ramped access to the new lawn. Mrs Holden informed that a green house and gazebo would be added. New garden furniture has been bought including a patio heater. The garden is enclosed and new lighting fitted to provide a safe environment. DS0000004012.V305556.R01.S.doc Version 5.2 Page 15 On the day of inspection the home was found to be clean with no unpleasant odours. A tour of the promises was made and it was evident that residents were able to bring their own possessions to personalise their rooms. All of the hot water outlets had been fitted with thermostatic mixer valves in order to protect residents from scalding water and radiators covered to protect them from burns. A recommendation was made at the last inspection that the home is assessed by an occupational therapist for appropriate adaptations. Since that time this has been done in order to meet the needs of one resident whose mobility has deteriorated. As reported earlier new ramps have been provided to access the garden area and a new ramp has been fitted to the front entrance of the home. Raised toilet seats are provided and specialist profile beds purchased for all of the residents. Specialist pressure mattresses are also available for residents who need these. The exterior of the home has CC TV monitoring equipment for security of the home. Within the home the doors leading out of the home are covered by cameras and the home should ensure that any CC TV is used for security purposes and not monitoring of residents. The home has four air conditioning units for use during very hot weather. The home has infection control policies and procedures and staff have received training in this field. Gloves and protective clothing is provided for the staff. The home has a contract for the disposal of clinical waste. The laundry area is sited away from food preparation areas and the washing machines have a disinfection cycle. DS0000004012.V305556.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 The Quality in this outcome area is excellent good adequate poor. This judgement has been made using available evidence including a visit to this service. Staff are suitably trained and there are sufficient numbers of staff to meet residents’ needs, however failure to carry out CRB checks before start work at the home can pose a risk to residents. EVIDENCE: The majority of the staffing is provided through family members with most of the family living on site on the first and second floor of the home. Since the day care service has been added, higher levels of staffing are now provided. In general there are always two members of staff on duty within the home. During the night time period there is one awake and one asleep member of staff on duty. A rota was seen that reflected the above level of staffing. Cooking and cleaning is done through the general levels of staffing. All staff who cook or prepare food have been trained in basic food hygiene. All new staff are given induction training that is compliant with the standards set by Skills For Care. Staff receive core training in health and safety, basic food hygiene, moving and handling, first aid and fire safety. The percentage of staff who have been trained to the standard of NVQ level 2 has not reached 50 and it is recommended that this is set as a training objective. The records for the new member of staff who has started working at the home since the time of the last inspection were seen. This person was known to Mrs Holden before employment, and references had been obtained, however it was found that this person did not have a current CRB and neither had a PovaFirst DS0000004012.V305556.R01.S.doc Version 5.2 Page 17 check been sought. It is a requirement that this person does not work in the home until these checks have been returned and the home must comply with the requirements of Regulation 19. DS0000004012.V305556.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 The Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the interests of the residents. Both residents and the registered manager are placed at risk with the current arrangements and recording of monies held by the registered manager. Health and safety of residents is promoted within the home. EVIDENCE: Mrs Holden is the registered manager of the home and is currently studying for NVQ level 4 in management and care. She has also been trained as an RGN. From speaking with residents and from the discussions with Mrs Holden it was clear that the home was being run in the interests of the residents. At the last inspection a requirement was made that Mrs Holden maintain more detailed and robust records in cases where she holds money on behalf of DS0000004012.V305556.R01.S.doc Version 5.2 Page 19 residents and that money is held securely or banked individually in an interest bearing account. It was found at this inspection that this requirement had not been met. The importance of satisfying this requirement was discussed. It was found that checks and servicing of equipment was taking place to the required timescales. It is recommended that the home purchase a new accident book that complies with data protection and confidentiality of residents. DS0000004012.V305556.R01.S.doc Version 5.2 Page 20 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 3 8 3 9 3 10 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X 3 DS0000004012.V305556.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Where residents request assistance with management of their personal finances, robust records detailing income, expenditure and balances must be held and all money must be held securely or banked for them individually in an interest bearing account. This requirement is repeated from the inspection of 20/03/06 Timescale for action 1. OP35 17 07/08/06 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. 2. Refer to Standard OP9 OP33 Good Practice Recommendations It is recommended that where entries of prescribed medications have to entered by hand, a second person checks and signs the record. The registered person should publish the results of the survey undertaken making it available for prospective residents and other interested parties. The record of accidents in the home should be held in accordance with Data Protection legislation, advice on recording formats is available from the Health and Safety Executive. DS0000004012.V305556.R01.S.doc Version 5.2 Page 22 3. OP37 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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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