Care Home: Chimera

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What the care home does well The pre admission process is comprehensive and clear with thorough assessments to determine whether the home can meet peoples` needs. There are good quality and easy to follow care plans and assessments in place. People have good access to local District Nurses, General Practitioners and specialist health care when required. Medicines are well managed with safe systems in place for the administration, recording, storage and disposal of them. Staff treat people with dignity and care, respecting their individual choices and preferences and activities are centered around the person`s abilities. There is a varied menu on offer and people are supported to maintain a balanced diet. People should be confident that complaints will be listened to and acted upon and that staff are trained to protect them. People live in homely, clean and comfortable surroundings. The staff team are well trained to meet the health and social needs of people. What has improved since the last inspection? A random inspection has taken place since the last key inspection and it was noted in this report that Mrs Holden had made improvements to the service provided. Since that visit further improvements have been made which in all, have met all of the outstanding requirements in the previous two reports. Areas of improvement include medication storage and administration, aspects of recruitment, care records, environmental health and safety, staff training and record keeping. What the care home could do better: Two good practice recommendations have been made following this visit, one of which has been carried forward from the previous report as it was unable to be checked at this time. It is recommended that the home continue to explore more permanent methods of making the unguarded radiator in the bathroom safe and identify and implement one, as soon as practicably possible. It is good practice that a full employment history is sought from any potential staff member, including the details of any last care position worked in and reasons for leaving. Key inspection report Care homes for older people Name: Address: Chimera 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 1 6 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Chimera 21 Alum Chine Road Westbourne Bournemouth Dorset BH4 8DT 01202767144 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Marise Anne Lena Holden Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 7. 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: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 25 Over 65 7 0 1 5 0 3 2 0 1 0 Brief description of the care home 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. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of this inspection was to assess all of the key standards and improvements made since the last key inspection. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. A random inspection has also been carried out since the last key inspection on the 15 March 2010 and the information gathered from that visit ,was also considered. This unannounced inspection was carried out over one day by two inspectors. The term we is used throughout the report to reflect the findings of the Care Quality Commission. The visit took place on 16 June between 10:30am and 12:45pm. The registered Care Homes for Older People Page 6 of 25 manager and owner, Mrs Holden,was present throughout the inspection. The inspection involved observations of and talking with people who live or were staying at the home, the staff on duty and the manager. Three people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into or staying at the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: Three peoples care files were seen and one of these people had been admitted to the home since the last inspection. There was a clear pre admission assessment of needs that Mrs Holden had carried out before admission. The information from this assessment was then used to base the care plans upon. Mrs Holden told us that people are offered a free trial stay at the home before making a decision whether to move in or not. We spoke to the person who had recently been admitted and they told us they had visited for the day before making a decision and were very happy living at Chimera. They thought the staff were good and their needs were being well met. Care Homes for Older People Page 11 of 25 Evidence: The home does not offer an intermediate care service. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Three peoples care records were looked at. The plans are clearly based upon the initial information gained during the pre admission process, are person centered and give clear instructions to staff as to how to meet these needs. Appropriate assessments are completed and updated as needs change and all documentation showed evidence of regular reviews. Daily evaluation sheets completed by the staff, demonstrate a good awareness of individuals needs and preferences and record details well, showing how people were spending their day and how their care needs were being met. All care records also now contained photographs of each individual resident. A clear record is kept of when healthcare professionals visit a person or are involved in their ongoing care and these included GPs, dieticians and specialist nurses. It was clear from records seen that Mrs Holden is very proactive in contacting outside Care Homes for Older People Page 13 of 25 Evidence: professionals when she has any concerns about the residents healthcare needs. Clear medication records were seen to be kept for each person with photographs and details of any allergies noted and no gaps seen in the MAR charts. Blank MAR charts are also now available for use when a new person is admitted to the home. Staff observed had good relationships with the people living at the home and were patient and encouraging. There was a calm atmosphere within the home with staff observed chatting with people and providing assistance where needed. People spoken with said they were well looked after and felt that staff were very caring and kind. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to participate in social activities and are given choices to maintain their quality of life. Evidence: When we visited 3 of the 5 people living at the home were seated in the lounge. The television was on and one person was reading a book. Some of the residents are very frail and rarely go out, however enjoy living at the home and the company of the homes dogs. During our visit one person was visited by a local religious minister as they are no longer able to go out and attend church as they would like to. Some of the residents are more able and go out as they choose, with one person planning to take a cruise shortly. Care files reflect peoples personal preferences and what they enjoy and daily notes show that they engage in their chosen activities. The home has an open visiting policy and there are no restrictions on visitors. Food is homecooked on a daily basis and menus are based upon what people enjoy Care Homes for Older People Page 15 of 25 Evidence: eating. People can choose when they eat and individuals can have different meals. Food was served during our visit and looked wholesome and appealing. Mrs Holden also told us that residents eat quite a lot of fruit. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that ensures any concerns or complaints are listened to and well managed. People are well cared for by staff who have received training in the protection of vulnerable adults. Evidence: The complaints policy is clearly displayed in the main entrance hall and is also included within the homes Statement of Purpose. Chimera maintain a complaints book for the recording of any complaints or concerns received and actions taken. The home has not received any complaints since the last inspection and none have been received by the Commission since the last report. People we spoke with knew who to talk to if they were unhappy with any aspect of their care and were happy to approach staff. There have been no safeguarding referrals made since the last key inspection. Staff have attended training in the Protection of Vulnerable Adults (POVA) and are aware of the different ways vulnerable people are at risk of abuse and how to respond. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: A tour of the premises found the home clean, tidy and well maintained, with no offensive smells. Rooms were seen to be personalised with peoples belongings and homely and comfortable. Several improvements have been made to the environment of the home following requirements and recommendations made in previous reports this year, ensuring that Chimera remains a pleasant and safe place to live. The radiator in the bathroom remains uncovered although the home are taking temporary measures to reduce the risks to people when the bathroom is in use. This was discussed with Mrs Holden who continues to look into a more suitable alternative and will make changes as soon as a suitable solution is identified. The laundry is sited in the cellar and is suitably equipped to manage the laundry from a small home. Staff have also completed infection control training and this was seen to be well managed around the home. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staffing levels ensure that peoples needs are well met by suitable staff who are appropriately trained and supervised. Evidence: On the day of the inspection there were 5 people living at the home. Sufficient staff are employed to meet the needs of the people living at Chimera and 2 staff were on duty on the day of inspection, including Mrs Holden. At night time there is one waking staff and one sleeping-in member of staff. No new members of staff had been recruited since the last inspection. Therefore the existing good practice recommendation, regarding gaining full employment histories, has remained and will be looked at during the next visit. Discussion with staff and staff training records showed that staff complete an induction programme. A complete training matrix kept on the wall, showed that staff had now attended mandatory training as required and other specialist training to help them meet the needs of people living at the home. This included training on the Mental Capacity Act. People spoken with in the home said they felt well looked after and that staff were Care Homes for Older People Page 19 of 25 Evidence: always available when they needed them. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made within the home in several different areas since the last visit. Outcomes for people are now good and people can be confident that the home is well managed and they are kept safe. Evidence: Mrs Holden is a registered nurse and has owned and managed Chimera Residential Home since 1993. Mrs Holden is still working towards her NVQ level 4 management qualification, however during discussion she felt that this would be achieved by September 2010. People living at the home are given questionnaires to get their feedback on living at Chimera and audits were seen relating to medication and finances. Staff meetings are held and Mrs Holden told us that her NVQ assessor would be attending the next one as part of her assessment. Regulation 37 forms are submitted to the Commission as required and body maps are Care Homes for Older People Page 21 of 25 Evidence: now in place to record any injuries people may have. Mrs Holden told us that the home does not hold any money for people living there and they are either responsible for their own or have a representative to manage this. Health and safety records were sampled and showed that health and safety matters were well managed, including the fire safety. Regular testing of equipment and services was seen and routine maintenance checks well recorded. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, was ongoing. Mrs Holden told us that Chimera uses several different independent sources to manage all aspects of the homes health and safety training and management of equipment. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 It is recommended that the home continue to explore more permanent methods of making the unguarded radiator in the bathroom safe and identify and implement one, as soon as practicably possible. It is good practice that a full employment history is sought from any potential staff member, including the details of any last care position worked in and reasons for leaving. 2 29 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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