Inspection on 26/08/08 for Chimera

This inspection was carried out on 26th August 2008.

CSCI found this care home to be providing an Poor 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 18/02/09

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 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Chimera 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT Lead Inspector Martin Bayne Unannounced Inspection 26th August 2008 09:00 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.V372305.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.V372305.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.V372305.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. Date of last inspection Brief Description of the Service: Chimera is a small care home catering for seven older people. Five resident’s rooms 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. Chimera DS0000004012.V372305.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 0 star. This means the people who use this service experience poor quality outcomes. We, the Commission, carried out an unannounced key inspection of the home over a two-day period on the 26th of August and 28th of August 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for older people and to follow-up on three requirements and four recommendations made at the last key inspection in November 2007. We also wanted to look into issues identified following a site visit made by a Registration Inspector with the Commission in July 2008. On the first day of our visit members of staff and the deputy manager assisted us, as Mrs Holden was not available. On the second day of our visit Mrs Holden assisted us throughout the day, providing us with records that the home is required to keep under the Regulations, and discussing how the care of residents was managed within the home. During the inspection we were able to speak with four of the residents and to a member of the district nursing service who was visiting the home. We also carried out a tour of the premises. Further information that helped form the judgements contained in this report came from the returned Annual Quality Assurance Assessment, AQAA. What the service does well: The home provides a ‘homely’, family environment. Full information about the home is provided through the Service User Guide being readily available at the front reception area of the home. Residents of the home in general gave positive feedback at the way they were treated, however there were areas that could improve dignity and respect for residents detailed below. Visitors are made welcome at the home. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 6 The home has a well-publicised complaints procedure. What has improved since the last inspection? What they could do better: The home must ensure that it complies with the conditions and categories of registration. Care plans must be reviewed to ensure that accurately inform staff of how to care for residents. The home must demonstrate that health and welfare needs of residents are met. Arrangements must be made to ensure that staff are trained in medication administration and that they follow the procedures for the home. Training should also be provided in update moving and handling and challenging behaviour. Only staff who have been trained and deemed competent can administer Insulin. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 7 Action must be taken to ensure that there is stock control of medicines received into the home. Medicines must be stored securely so as not to pose a risk to residents. More could be done to ensure that residents social and recreational needs are assessed and met. Records should evidence how these needs have been met. Adult protection training for the staff should be provided by an external training provider to ensure that staff are aware of how to identify and report any concerns of abuse. Hazards that posed a risk to residents, highlighted in the main text of the report must be minimised or removed. The upkeep of the premises and equipment could be improved. Two call bells were found to be not working. The extractor fan in the downstairs bathroom was not working and condensation was causing mildew and damp in some areas of the room. The base of the hoist in the bathroom was rusted and needs replacing. One of the tiles in the bathroom was cracked and also needs replacing. The bed rail on one resident bed was broken and needs repairing. The home must increase night staffing levels to those agreed at the time of registration and in accordance with the home’s Statement of Purpose. An accurate record must also be maintained of duty rosters and who worked what shift. Mrs Holden has yet to complete NVQ level 4 training. Improvements could be made regarding managing residents’ monies. Action must be taken to ensure that the fire safety system is tested at the required intervals. 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 Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 9 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.V372305.R01.S.doc Version 5.2 Page 10 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): 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has failed to observe both the conditions of registration and also rigorously apply admission criteria resulting in needs of some residents not being adequately met. EVIDENCE: Since the last key inspection in November 2007 one resident has been admitted to the home. This person had been attending the home for day care. Following a fall and refusal of hospital attention in May 2008, Mrs Holden had allowed this resident to stay at the home in breach of the home’s registration by accommodating over numbers. A warning letter was sent to Mrs Holden on the 9th May 2008 about this breach of registration. An alternative residential Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 11 placement was found for the resident whilst they continued to attend the home for day-care. Mrs Holden submitted an application to vary the number of people accommodated at the home. On the 22nd of June 2008 Mrs Holden informed the Commission that this person had refused to go back to their residential placement and again Mrs Holden allowed this person to be accommodated, breaching the home’s registration on a second occasion. A variation of registration to increase the numbers accommodated at the home from six to seven residents was agreed in August 2008 with the Commission. Due to the fact that the newly admitted resident had been attending Chimera for day-care, Mrs Holden was aware of their needs and was satisfied that the home could meet these. We saw copies of assessments relating to this person’s needs. We had concerns however about the home admitting residents within the categories of registration as we found that two of the residents accommodated had a diagnosis of dementia. The home is registered to admit people with frailty of old age and does not have a registration to accommodate people with dementia. One of these residents had a social services care management assessment in which it stated, ‘Diagnosed with Alzheimer’s, disorientated in time and place. Memory loss, limited conversation. Confused thinking’. This resident has been living at the home since 2006 when this assessment was carried out. In January of this year there was an incident concerning an assault by this resident on a member of staff that rendered them off work for a two-week period. Staff spoken with during the inspection confirmed that they had not received training on managing challenging behaviour. The registered person must ensure that staff receive the appropriate training to fully meet people’s needs. The registered person must ensure that there are no further breaches of the conditions of registration, relating to either the number of people or categories of registration. Any further breach may result in enforcement action being taken. We saw that a copy of the Statement of Purpose for the home, as well as a copy of our last inspection report was available to residents and relatives by these being on display in the front entrance porch. The home does not provide an intermediate care service. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Standards of care and management have fallen in the home with care plans not being kept up to date, medication administration procedures not being followed and poor risk assessment and action to ensure good outcomes for residents. EVIDENCE: Concerning care planning and meeting the health and social needs of residents, we looked at a sample of three care plans. Generally care plans were sufficiently detailed to inform staff of how to support residents, however there were a number of issues identified. We saw that reviews of care plans had been taking place, but none have been reviewed since June 2008. Care Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 13 plans should be reviewed monthly or when the needs of residents change. We noted within one care plan for a residence suffering from diabetes that their record of visits by the chiropodist ceased in May 2008 when they had been seen monthly up until this time. In the case of another resident who had been supplied with an air mattress, their care plan stated that when in bed the resident should have their position changed two hourly and when within the chair one hourly. Regular changes of position are required to reduce the risk of pressure damage. Turning charts were not in place to monitor that this was happening. Care records identified that this person was also at risk of Deep Vein Thrombosis, and there needed to mobilise regularly to reduce this risk. On both days of the inspection this resident was in bed but we did not see any staff changing the position of this resident as dictated in the care plan. The residents we spoke with had no complaints about the way they were treated and in general gave positive feedback about the home. From observing interactions between staff and residents, it was evident that there was a good rapport between the two. We found however some areas where we felt that the dignity of residents was not being promoted. • We found on some residents’ chairs that black bin liners were being used to protect the cushions. On one chair an incontinence pad was also placed on top of the black bin liner. The use of bin liners does not promote dignity and the home must ensure that where required that appropriate continence aids be provided. Within one of the residents bedrooms there were three wheelchairs being stored as well as a hoist and boxes of incontinence pads. Bedrooms must not be used to store equipment belonging to other people. Within this person’s wardrobe some of their clothes were in bin liners and not hung up. Staff must ensure that people’s belongings are handled with dignity and respect. Since the home was originally registered, a conservatory has been built on to the back of the property. The only window in this resident’s room has an outlook directly into the conservatory, which is communal space for all of the residents. It was not evident whether the views of this person or their relatives had been sought regarding the lack of privacy available within this room. In another resident’s bedroom we found that there were no curtains provided. Mrs Holden informed that the resident, who has dementia had pulled them down. Within the care records for this person it was not clear what strategies were in place to promote their dignity when curtains were not fitted. This was also the room in which the baby monitor device discussed later in the report was identified and also the room where the bedroom door was jamming. The use of cameras within the home, discussed later in the report, does not support the dignity of residents. CCTV may only be used outside the home and must not be used to monitor either staff or people living within the home. DS0000004012.V372305.R01.S.doc Version 5.2 Page 14 • • • • • Chimera • • By allowing two people to lodge at the home using part of the registered premises also undermines the privacy and dignity of the residents. These individuals move freely within the home and garden. Daily recording notes and care plans referred to residents wearing ‘diapers’. We looked at how medication was recorded, administered and disposed of at Chimera. On the first day of our inspection, a member of staff was administering medication to residents. We found that all of the medication had been administered that morning to residents and the member of staff was then going back to the records to record what medication had been given. This practice is contrary to the home’s medication administration procedure in that medication should be given to residents individually with records being signed immediately before going on to administer medicines to the next person. This procedure should ensure accuracy in recording and is seen as good practice. We asked the member of staff whether they had received training in medication administration and were told that they had not. On the second day of our inspection, Mrs Holden told us that this member of staff had been trained in medication administration, however when we looked at this person’s training record there was nothing to indicate that they had received such training. All staff who administer medication to residents must be trained in safe medication administration and be aware of the procedures for the home. We asked a member of staff on duty about a resident who is insulin dependent. We were told that this resident used to administer their insulin themselves after the staff had drawn up the correct dose but the resident was now having their insulin administered by the staff. We asked if staff at the home had been trained and deemed competent by the district nurses to carry out this procedure. We were told that they had not been. The member of staff told us that Mrs Holden had informed that a training course was going to be arranged in the near future. We were told that owing to the increased frailty of this resident, one other member of staff, (who has now ceased working in the home) and Mrs Holden had been administering insulin for the last couple of weeks. We spoke with the resident concerned who told us that they used to administer their own insulin but currently, ‘They do it all for me’. When asked as to who gave the injection, the resident replied, ‘They stick the needle in’. An immediate requirement was made that staff must not administer insulin, as this is a nursing procedure and cannot be carried out by care staff unless they have received training and being deemed competent to carry out this procedure through the district nursing service. On the second day of the inspection Mrs Holden told us that in order to promote the independence of the resident, staff were drawing up the insulin and assisting the resident by holding the insulin delivery device, but that the resident themselves completed the administration process. A letter of 26th of Aug, given to us by Mrs Holden as a response to the immediate requirements made on the first day of the inspection informed, ‘This client is able to administer own insulin’. We looked Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 15 at the care plan for this resident concerning their medication. The last review was on the 28th of June 2008 which stated, ‘We are doing her medication. We set the insulin she gives it’. This does not provide adequate information and instruction as to what is expected of the staff in assisting this resident. We looked at the medication administration records for all of the residents. At the last inspection in November 2007 it was recommended that all medication administration records be kept in one folder so that they were easily accessible to staff when giving out medication to residents. We found that this recommendation had been complied with. We found that there was a photograph of each resident at the front of their medication administration records so that the person could be easily identified. Good practice guidance is that known allergies are recorded on the front of medication administration records. Known allergies or ‘None known’ were not being recorded and we recommend that this practice is adopted. At the last key inspection we recommended that where staff have to make hand entries onto medication administration records, that a second person signs and checks the record for accuracy. We found that this inspection that this practice had been adopted on some occasions but not for all entries. Concerning one person’s medication records, a hand entry had been made that a particular medicine should be administered once a day. This had not been signed and we found that further entries recorded this medication being given some days later twice a day. The home does not maintain a sample of staff signatures of people who administer medication. We recommend that this practice be adopted. We found that medication administration records in other respects had been completed correctly with there being no gaps in the records. Concerning storage of medication, the home provides within each resident’s bedroom a small lockable medication cabinet. We had been told at previous inspections that keys to these cabinets are kept out of reach of residents where residents were having medication administered by the staff. At the time of this inspection we were told that all residents were having their medication administered by the staff. We found the medication cabinet was not locked within the bedroom of one resident on the ground floor. There was also inadequate stock control of medication stored for this resident, as the their vanity unit was also being used for storing medication and equipment for administering insulin, some of which was out of date. There was a ‘blister pack’ containing some medication that should have been returned to the pharmacist at the latest by the 29th of February 2005. We also found some prescription cream that was also dated 2005. We also found another medication cabinet that was not locked in another resident’s bedroom. Mrs Holden informed us that the key had broken. By the time of the second day of the inspection, Mrs Holden had bought three safes so that lockable facilities for storing medication could be maintained in each resident’s bedroom. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 16 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. More recorded evidence should be maintained to demonstrate that social, recreational and leisure needs of resident are being met. Residents benefit from a reasonable standard of food provided. EVIDENCE: On both days of the inspection there were no group activities organised for residents but we did see staff talking and interacting with residents, although much of the time residents were left to interact on their own. Mrs Holden told us that normally staff would spend more time with residents but owing to the inspection there was not as much going on as there would normally be. The home has a variety of games and puzzles and there is a minibus to take people out on trips and outings away from the home. Sky TV is available as well as old-time music and books. The visiting library also visits the home. We found Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 17 there was little recorded within residents’ files to support what activities have been undertaken with residents. We did see that in most files there was some social history about each resident and it was clear from talking with Mrs Holden that she knew about residents’ interests, such as one resident who liked animals and another who had been a writer. Within one care plan that we tracked there was an activity sheet but there were only two entries on this and these were not dated. Residents are supported to maintain links with their families and friends and there are no restrictions on visiting times. Concerning the food provided in the home, feedback from the residents we spoke with was that generally the standard was quite good. On the first day of our visit there appeared to be limited choice offered to residents however on the second day we saw that there was a choice with residents are being asked what they would like to eat. At the last key inspection in November 2007 it was recommended that more detail the recorded of the food provided to residents. Mrs Holden showed us the records of food provided and these were now more detailed satisfying the recommendation. The record showed that there was a varied and balanced diet being offered to residents. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Resident benefit from the complaints procedure being well publicised and staff having received some training in adult protection. EVIDENCE: Since the last inspection there have been no formal complaints made to the management. We saw that the Statement of Purpose and Service User Guide are available to residents and the complaints procedure to the home is detailed within these documents. As reported at the last inspection the complaints procedure is also detailed within the terms and conditions of residence. As reported at the last inspection, the home has copies of policies and procedures relating to protection of vulnerable adults. We saw that adult protection forms part of the staff induction training but recommend that additional training be sought from an accredited trainer to ensure that staff both know of how to identify abuse and how to report this. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. A safe and well kept environment is not being maintained that could lead to accidents and injury of residents. EVIDENCE: The home is located within a short walk from shops and amenities of Westbourne. The home has parking to the front of the home for staff and visitors. The home was registered in August 2008 to increase the numbers of residents accommodated from six to seven residents. Five of the residents’ bedrooms are located on the ground floor and two on the first floor where Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 20 there is also a bathroom. The home has a communal lounge and dining room on the ground floor that leads to a large conservatory. There is a patio area to the rear of the home leading to the garden, at the bottom of which there are storage sheds, a summerhouse and shed used for laundry. On the first day of the inspection we found that there was a man sleeping in the summerhouse. We saw that there was a bed made up, a sofa, wardrobe and heater. We asked the staff who this man was and were told that Mrs Holden had allowed him to use the summerhouse temporarily. We were told that this man is provided with a meal each day and that he used the bathroom on the first floor. Mrs Holden, on the second day of the inspection, told us that she had allowed him to stay in the summerhouse on a temporary basis. Mrs Holden denied that he was being provided with meals and refuted that he was using the bathroom on the first floor. Mrs Holden also has another relative who lives on the first floor of the home and she confirmed that he uses the bathroom on that floor. This issue was discussed as we felt it was not appropriate that these two people should be using and having access to the registered premises. There was no written risk assessment as to the risks and impact imposed on residents living at the home; neither had a criminal record bureau check being carried out on either of these two people to ensure safety of residents living at the home. It was noted that the person being accommodated on the first floor was a smoker and the corridor and one resident bedroom smelt heavily of cigarette smoke. Mrs Holden told us that the gentleman in the shed would be leaving by the following week and that she would seek alternative accommodation for the other person residing within the home. We found that the premises did not provide a safe environment for residents. Apart from medication cabinets being open, with medication being available to residents in the home, other hazards were identified. • • • • • • • • We found batteries being charged for electric mobility scooters in the front porch. Wardrobes were not fixed to the wall and could be a risk to residents if pulled over. Within one resident’s bedroom we found three wheelchairs that were being stored there, and these were blocking the access to a fire exit. We found fire extinguishers were not wall mounted and one was being used to prop open the front door. We found that a door wedge was being used to prop open one residence bedroom door. The carpet within one bedroom was ripped and may pose a trip hazard. We found cleaning products such as a 5Ltr bottle of bleach and also other cleaning products around the home that had not been stored away. We found a window opening on the first floor that had not been restricted, which could pose a risk to a resident from falling from the window. DS0000004012.V372305.R01.S.doc Version 5.2 Page 21 Chimera • • • We looked within the bedroom of one resident and ongoing to leave the room found that the door jammed and was very difficult to open. This could cause a resident of the room to be trapped in their room. Generally we found all of the communal spaces very cluttered. Example in the dining area there were three televisions. We discussed this with Mrs Holden who agreed to going around the home and removing any unnecessary furniture, televisions, exercise machines etc. Dog excrement was seen on the patio on the first day of the inspection. It is noted that the dog excrement and cleaning products had been removed by the second day of the inspection. We found other areas of concern. At a previous inspection we had been told that there was a security camera within the home that monitored the front door and one that monitored the back door. We were able to determine at this inspection that there was one camera in the hallway that monitored the front door and two further cameras; one that overlooked the kitchen and one that overlooked the dining area. We also found that a baby monitor had been fitted in one of the resident’s bedrooms on the first floor and that the loudspeaker for this was located in the residents’ lounge. On the day of our visit it was possible to hear everything that was happening in this resident’s room, as the monitor was broadcasting in the residents’ living area. Mrs Holden told us that both the GP and social worker were aware that a baby monitor was being used. We looked at the care plan for this resident and there was no record of this being discussed with either the GP or social worker. The care plan informed that a pressure mat was being used so that staff would know if the resident left their bedroom. We did not see a pressure mat within this room. An immediate requirement was made that cameras and the baby monitor the removed from the home. We found that the home was not being kept in a good state of repair. Issues identified included: • A call bell in one resident bedroom was not working and another in one of the bathrooms. On the second day of the inspection we were informed that both call bells had been fixed and were now working. • The extractor fan in the downstairs bathroom was not working and condensation was causing mildew and damp in some areas of the room. The base of the hoist in the bathroom was rusted and needs replacing. One of the tiles in the bathroom was cracked and also needs replacing. • The bed rail on one resident bed was broken and needs repairing. We found areas where infection control measures could be improved in the home. We saw within bathrooms that liquid soap was provided but there were no paper towels and in some bathrooms cotton towels were being used. Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 22 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. Staffing levels do not meet needs of residents, particularly during the night time period and staff training and recruitment could be improved. EVIDENCE: On the first day of the inspection we arrived at 11 o’clock. We found two care staff on duty. There was also an agency member of staff who was sleeping on a couch in the resident’s living room. (On the second day of inspection, Mrs Holden told us that this agency member of staff had been provided with a bedroom within the home, and was no longer sleeping in the living room). We were told that on the previous night and the night before, the agency staff had been the only member of staff on duty. At the last inspection in November 2007 it had been agreed that during the night time period there would be one awake member of staff and one member of staff available doing a ‘sleep-in’ duty. This level of staff was also agreed in August 2008 at the point of us registering an increase in numbers from six to seven residents and is detailed within the home’s Statement of Purpose. The staff member who had worked Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 23 night duty for the three nights prior to the inspection confirmed that they had worked alone, and that there had not been a sleep in member of staff available. As previously stated within this report the care plan for one person states that they require changes of position throughout the night. It was not clear how this would be achieved to ensure the safety of both the person and the staff member. We asked to see a duty staff roster. The roster we were shown provided further evidence that the home is not adequately staffed. It informed that Mrs Holden was scheduled to be on duty in the home for the week ahead for four consecutive awake night then day duties; a continuous period of duty of 96 hours. This period of duty cover does not promote the health and safety of either the staff member or people living at the home. It also needs to be taken into account that Mrs Holden at the time had a part-time job managing a domiciliary care agency. The duty roster informed that Mrs Holden’s husband was responsible for administration and cooking, however we were told that he carried out sleeping duties as a care worker. The duty roster reflected that a further member of staff was employed as a cleaner and maintenance person, however they will also on the roster as a care worker. We asked to see the training records concerning this person relating to their training as a carer. Mrs Holden agreed to forward this person’s training records as these were not available. The duty roster did not reflect who was on duty as the ‘sleep-in member’ of staff. Duty rosters must reflect the persons who are working at the care home and a record of whether the roster was actually worked. Since the last key inspection in November 2007 there has been one new member of staff who has started work at the home. We looked at the recruitment records from this member of staff and found that all the recruitment checks detailed in Schedule 2 of the Regulations had been complied with. We recommend however 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. We looked at a sample of staff training records. We found that staff had been provided with training in areas such as: basic food hygiene, infection-control, first aid and some of the staff in dementia. We found that staff had been trained in moving and handling however in the case of two staff we saw from their training records that they were in need of refresher training. As detailed earlier in the report we found there was shortfalls in providing medication training to staff. We asked for the training records for one member of staff who was on the duty roster as a cleaner/maintenance person. These were not provided. Chimera DS0000004012.V372305.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 poor. This judgement has been made using available evidence including a visit to this service. There has been a decline in the way the home is managed. The home is not run in the interests of residents and does not provide a safe environment. EVIDENCE: Mrs Holden has owned and managed Chimera residential home since 1993. Mrs Holden is a trained nurse and she maintains her nursing registration with the registering body. At the last key inspection in November 2007 Mrs Holden told us that she was studying for her NVQ level 4 management qualification Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 25 and that she should complete this training by January 2008. On this inspection we were told that Mrs Holden had been unable to complete the NVQ level 4 management qualification as the assessor had ceased working for the training provider. A requirement was made that this NVQ training must be completed. At the time of the inspection as detailed earlier in the report, Mrs Holden was also working as a part-time manager of a domiciliary care provider. At the last inspection a requirement was made concerning residents’ finances. Mrs Holden informed us that she was currently having benefits for two residents paid into the bank account for the home. She was able to produce a detailed record of money and expenditure on the half of this resident. We discussed the situation with our view that the current practice was placing Mrs Holden and the resident at risk of allegations of financial abuse and that alternative arrangements for managing these residents’ money should be made. Concerning whether the home is run in the interests of residents we saw within resident’s files that they had been given questionnaires about their satisfaction with the service provided. We saw copies of minutes of residents and staff meetings, however the last meeting was convened in April 2008 and none had been held since that date. The evidence presented in this report indicates that there could be improvement in ensuring that the home is run solely in the interests of residents, not Mrs Holden’s family and the staff. We looked out of the fire logbook and found the tests and inspections of the fire safety system had not been recorded as taking place since the 4th of August 2008. We saw a certificate for a testing of the fire safety systems, including extinguishers and emergency lighting in March 2008. We saw a certificate for the servicing of the boilers in April 2008. We also saw that the home had a current employer’s liability insurance certificate. Concerning health and safety within the home, the hazards identified in the environment section of the report require that the building risk assessment is reviewed and steps taken to ensure that the home provides a safe environment for both staff and residents. Chimera DS0000004012.V372305.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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 1 Chimera DS0000004012.V372305.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. 2. 3. Standard OP7 OP8 OP9 Regulation 15 (2)(b) 12 (1) (a) 13 (2) Requirement Timescale for action 01/10/08 You are required to keep service users’ care plans under review. You are required to ensure that 01/10/08 assessed health and welfare needs of residents are met. You are required to ensure that arrangements are made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. • Insulin must not be administered by persons untrained and unauthorised to do so. • Medication must be stored securely. • Stock levels of medication must be appropriately maintained. 28/08/08 Immediate requirement made. You are required to ensure that the home is conducted in a manner which respects the privacy and dignity of residents. Matters to be addressed identified in Statutory Notice DS0000004012.V372305.R01.S.doc 4. OP10 12 (4) (a) (b) 25/10/08 Chimera Version 5.2 Page 28 5. OP27 18 (1)(a) issued. You are required to ensure that 28/08/09 there are sufficient staffing levels at night to meet resident’s needs. Immediate requirement made. You are required to maintain a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. Immediate requirement made. You are required to provide for staff, sleeping accommodation where the provision of such accommodation is needed by staff in connection with their work at the care home. 6. OP27 Schedule 4 (7) 28/08/08 7. OP27 23(3)[b] 23/10/08 8. OP30 9. 10. OP35 OP38 Statutory Enforcement Notice Issued. 18 (c ) (1) You are required to ensure that 01/11/08 staff receive training appropriate to the work they perform, including: • Challenging behaviour. • Medication administration. • Updated moving and handling. Schedule Action should be taken to ensure 20/10/08 4 (9) better protection regarding holding of residents’ money. 20/10/08 13 (4) You are required to ensure that the home as far as reasonably practical is free from avoidable hazards. Hazards identified included: • Batteries being charged for electric mobility scooters in the front porch. • Wardrobes were not fixed to the wall and could be a risk to residents if pulled over. DS0000004012.V372305.R01.S.doc Version 5.2 Page 29 Chimera • • • • • • • • • Within one resident’s bedroom three wheelchairs were being stored there, and these were blocking the access to a fire exit. Fire extinguishers were not wall mounted and one was being used to prop open the front door. A door wedge was being used to prop open one residence bedroom door. The carpet within one bedroom was ripped and may pose a trip hazard. Cleaning products such as a 5Ltr bottle of bleach and also other cleaning products around the home that had not been stored away. A window opening on the first floor that had not been restricted, which could pose a risk to a resident from falling from the window. The door jammed in one resident’s bedroom and was very difficult to open. This could cause a resident of the room to be trapped in their room. Communal spaces very cluttered. Example in the dining area there were three televisions. Dog excrement was seen on the patio on the first day of the inspection. 11. OP38 23(4)(c )(v) A Statutory Enforcement Notice was served concerning the downstairs bathroom to ensure it was free from hazards. You are required to ensure that arrangements are made for the DS0000004012.V372305.R01.S.doc 01/10/08 Chimera Version 5.2 Page 30 testing of fire equipment at suitable intervals. 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 OP9 Good Practice Recommendations Concerning how medication is managed in the home, we recommend that: • Where entries of prescribed medications have to recorded by hand, a second person checks and signs the record. • That any known allergies are recorded at the front of a person’s medication administration records. • That a sample of staff signatures of those staff trained to administer medication be maintained. It is recommended that more opportunities be investigated, provided and recorded of activities meaningful to residents. It is recommended that training in adult protection be provided to the staff from an accredited training provider. We recommend that paper towels and liquid soap be provided in communal bathrooms. 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. It is recommended that you complete NVQ level 4 training. 2. 3. 4. 5. OP12 OP18 OP26 OP29 6. OP31 Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Chimera DS0000004012.V372305.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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