We carried out a review of the data available to us about The Chimes on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Chimes, you can give feedback on this service.
The registered manager had established effective infection prevention and control procedures which were understood and followed by the staff. The registered manager had introduced a screening process for visitors when entering the building, which included health and temperature checks as well as the provision of personal protective equipment (PPE) and lateral flow device testing for COVID-19.
Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection.
There were plentiful supplies of PPE and stocks were carefully monitored. Staff had been trained in infection control practices and posters were displayed throughout the home to reinforce procedures. We observed staff were using PPE appropriately. There were sufficient staff to provide continuity of support should there be a staff shortage.
The layout of the service and the communal areas were suitable to support social distancing. The premises had a good level of cleanliness and was hygienic throughout. Housekeeping and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was calm and peaceful, and we observed staff were attending to people’s needs. One person told us they were happy living in the home. They commented, “We are very well looked after and the staff are lovely.”
The provider’s infection prevention and control policies and procedures were up to date and audits had been carried out on a regular basis. The provider also had a business contingency plan and had developed guidance and risk assessments in relation to the current pandemic.
The Chimes is a residential care home in an adapted domestic property in St Annes, providing personal care to 19 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 20 people.
People’s experience of using this service and what we found
The service was safe. The provider had systems to protect people from the risk of abuse and improper treatment. Staff managed people’s medicines well and kept the home clean and tidy. Staff managed risks well and had plans to follow in case of emergencies.
People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively, following good practice guidance. Staff supported people with their healthcare needs and worked well with external healthcare professionals. The service met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be independent and to regain life skills. We received very positive feedback about the caring approach of staff.
The service put people at the heart of the care they received. Staff used detailed assessments to identify people’s needs and preferences and worked to ensure people were happy with the care they received. If people were not happy, they were confident they could speak with staff to make improvements. The service made sure people were supported to communicate and planned activities to enhance people’s wellbeing.
The service was led by a registered manager and senior staff who everyone described as approachable, well-organised and caring. The culture at the service was open and inclusive. Senior staff understood their responsibilities and monitored the quality of the service using a range of systems. Where areas for improvement were identified, the registered manager involved people who used the service and staff to shape improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 18 July 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Some bedrooms have en-suite facilities. At the time of our inspection, 17 people lived at the home.
The Chimes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
This inspection took place on 04 and 15 May 2018 and was unannounced on both days.
The last inspection of this service took place on 21 and 22 August 2017. During that inspection, we found a number of breaches of the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. These related to regulation 9 (Person-centred care), regulation 11 (Need for consent), regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment), regulation 14 (Meeting nutritional and hydration needs), regulation 17 (Good governance) and regulation 18 (Staffing).
Following the last inspection, we met with the provider to discuss our concerns and asked them to complete an action plan to show what they would do and by when to improve the all the key questions to at least good. At this inspection we found the provider had made improvements in all areas. You can see more information about this in the detailed findings of the report.
However, as some key questions were rated as ‘Inadequate’ at the last inspection, although the provider has made improvements, we need to see improved practice, sustained over time, in order to award a rating of ‘Good’ for these key questions.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
The provider had systems to safeguard people against abuse or improper treatment. Staff had received training to spot abusive or inappropriate practices and knew how to report them. The service followed a robust recruitment process to ensure only suitable candidates were employed.
Staff assessed risks to the health and well-being of people who used the service and plans were put in place to lessen these risks. Environmental risk, for example around fire safety, had been assessed and appropriate plans put in place to lessen risks. The service promoted positive risk taking in order to help people maintain as much independence as possible.
The service ensured a sufficient number of staff were deployed at all times. Staff retention had improved and more staff were available to cover shifts at short notice, if required. The registered manager reviewed staffing levels against people’s needs to ensure there were always enough staff.
The service followed best practice guidance in relation to the management of medicines. An electronic system was used to manage stock, order medicines and record administration. Staff confirmed the system helped to reduce the risk of medicines errors.
Staff had received training to reduce the risks related to the spread of infection. We observed staff follow good practice guidance whilst undertaking their duties. The home was clean and tidy during our inspection.
The provider had systems which recorded any adverse incidents or events. We saw analysis of accidents and incidents was undertaken in order to make positive changes to reduce the risk of recurrence.
People’s needs and choices were assessed and care and treatment provided in line with current legislation and guidance in order to achieve effective outcomes for people who lived at the home.
The service ensured staff had the skills, knowledge and a good level of support in order to meet people’s needs effectively. Staff received a thorough induction when they began working at the home, alongside additional training and regular supervision form senior staff.
People’s nutritional needs had been assessed and care planned in order to meet them. People’s specific dietary needs were monitored and catered for appropriately.
Staff supported people to live healthier lives and to receive ongoing healthcare support. People were supported to attend appointments and healthcare professionals visited the home when required.
The service followed good practice guidance in relation to obtaining consent from people. Where people lacked capacity to consent, the service followed best interests processes, as outlined by the Mental Capacity Act 2005 code of practice.
We received consistently positive feedback about how caring the service was, including staff and management. People were able to make their own choices and express their views. People, their relatives and staff were actively involved in shaping the service delivered.
The service ensured the care and support delivered to people was personalised and responsive to their needs by way of ongoing assessment and care planning. People and their relatives confirmed they were involved in this process.
The service had employed an activities coordinator. They had carried out work to find out what activities people would like to do and had helped to improve activity provision at the home.
The provider had a complaints policy. People we spoke with, and their relatives confirmed they would have no hesitation in making a complaint and felt any concerns would be dealt with swiftly and appropriately.
The provider had systems in place to assess, monitor and improve the quality of the service provided to people. We saw improvements had been made in all areas since our last inspection.
The service used a variety of methods to gain people’s views and experiences of using the service. These included ongoing informal conversations, as well as meetings and satisfaction surveys.
The Chimes is registered to provide 24-hour care for up to 21 people. The home is situated close to St Annes town centre and is a large corner property with garden and paved areas around the building. There are three floors, two of which have lift access, two lounges and a dining area.
Some bedrooms have en-suite facilities. At the time of our inspection, 17 people lived at the home.
The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection visit a manager had been recruited by the provider and was managing the home but had not yet registered with CQC.
We last inspected the service on 20 March 2015, when we found the provider was meeting legal requirements. At that time, we rated the service as ‘Good’. During this inspection, we found a number of breaches of the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. These related to person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. You can see what action we have told the provider to take at the back of the full version of the report.
The provider had not established systems and processes in order to protect people who used the service against the risks of abuse and improper treatment. Staff had not received training to give them the skills and knowledge to recognise abuse and how to report it.
The provider had not properly assessed the risks to the health and safety of people who lived at the home and done all that was reasonably practicable to mitigate those risks. We found risk assessments were out of date and were not always reflective of people’s current circumstances.
Suitable systems were not in place to manage and mitigate the risks associated with fire safety. The provider had not ensured premises and equipment was safe and used in a safe way. The provider’s fire risk assessment had not been reviewed and was not suitable. Staff had not received fire safety training. Checks on fire safety equipment had not been undertaken.
The provider had not ensured medicines were managed safely. People were left without prescribed medicines for four days. The provider did not follow best practice guidance for managing medicines.
The provider had not ensured a sufficient number of suitably qualified, competent, skilled and experienced staff were deployed at all times. The provider had not ensured staff received appropriate training and supervision as was necessary to enable them to carry out their role effectively.
The provider was not operating effective systems in order to assess the risk of, prevent, detect and control the spread of infections.
The provider had not ensured care was provided only with the consent of people who used the service. Where people lacked capacity to consent, the provider had not acted in accordance with the Mental Capacity Act 2005. The provider was restricting people and depriving them of their liberty without lawful authority.
The provider had not ensured people received suitable food and hydration in order to sustain good health. Monitoring of people’s food and fluid intake was poor. Professional guidance had not been sought for one person who experienced difficulties in swallowing.
Systems were not in place to ensure the care delivered to people met their needs and took account of their preferences. People were not routinely involved in reviewing the care delivered to them.
The provider had not established systems and processes, which were operated effectively in order to assess, monitor and improve the quality of the service. The provider had not carried out audits in key areas, such as care planning and medicines management.
The provider had not maintained an accurate, complete and contemporaneous record in respect of each person who used the service, including a record of the care provided to them. Record keeping was poor, with large gaps in recording. There was no check undertaken on records.
The provider operated sufficient recruitment practices, in order to ensure only suitable people were employed to work with people who may be vulnerable by virtue of their circumstances.
Contact details for advocacy services were available at the home for people who did not have friends or family to act on their behalf.
People we spoke with told us they had developed positive and caring relationships with staff who supported them. We witnessed positive and caring interactions during our inspection. People’s privacy and dignity was respected and promoted by the staff team.
The provider had a procedure to manage complaints. People told us they felt confident any concerns they raised would be addressed.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
You can see what action we have asked the registered provider to take at the back of the full version of the report.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
We met with the management team following the inspection. We found the management team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided all the information we requested.
We inspected The Chimes on 20 March 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. The Chimes provides care and support for a maximum of 20 older people. At the time of our visit there were 20 people who living at the home. The home is situated close to St Annes centre. The building is a corner property on three floors. Some rooms have an en suite facility. There is a lift access to the first and second floor. Car parking facilities are available at the side of the home and there is street parking outside the home. The service provider is registered to provide accommodation and personal care.
The service is required under its registration to have a registered manager in place.
A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was no registered manager at the service at the time of our inspection, as a new manager had recently been appointed. This person was in the process of applying to the Care Quality Commission for registration.
Staffing levels were determined according to people’s individual needs, and there were enough staff available at the service. We saw that extra staff are provided where people’s needs change and when they require extra support. People using the service were protected from abuse because the provider has taken steps to minimise the risk of abuse. Decisions relating to people’s care are taken in consultation with people using the service, their next of kin and other healthcare professionals. This ensures their rights were protected.
Staff received training that was relevant when supporting the needs of people living at the home. Staff were supported through good links with local community healthcare professionals. This ensures people receive effective care and support relating to their healthcare and social care needs.
There was a relaxed atmosphere at the home. People told us they enjoy living there and their relatives told us that staff were supportive and approachable. People were able to take part in activities that they enjoy and receive support from the staff if required.
Staff members took into consideration the Mental Capacity Act (2005) for people who lacked capacity to make decisions. People’s mental capacity was assessed and there was information available in the service for the staff that helped them support a person with fluctuating capacity.
We saw consistent approaches from staff with staff explaining to people before they undertook a care process, other staff gave the person information about the care and support they were in receipt of. Where people using the service lack capacity to understand or make certain decisions relating to their care and treatment, if appropriate, best interest meetings are held which involve family members, independent mental capacity advocates, and social workers.
The service and staff respected and involved people in the care they received. For example, all the care plans viewed showed the person’s choices and personal preferences. The care planning process had involved the person or their relative when they were written and their views were reflected in the plans. People told us they had input into the menus or activities at the home and we saw that the choice of meals was varied.
We looked at the systems relating to medicines management and saw that the records relating to medicines were accurate and up to date. People were supported to receive the correct medicines at the right time. Staff working at the home received appropriate training in medication administration.
Staff were provided with effective support, induction, supervision, appraisal and training. The service had a system to manage and report accidents and incidents. When action plans were needed to monitor people's safety these were produced. The service had a quality assurance and, where appropriate, governance systems in place.
During the inspection we looked at care planning, staffing levels and staff records. We also talked with residents about the home. Comments were positive and included, 'Since the new management took over the place is excellent.'
We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs.
We found some care records for residents were not all up to date. Therefore people may be at risk of not having the right information available, to provide the up to date care residents may need. The new manager told us new systems were being introduced to improve recording of peoples care. We were shown new care records being put into place. The manager said, 'I have just taken over at the home and putting in place new paperwork for recording residents care.'
Staff we spoke with were satisfied with the amount of people on duty during the day and night. One staff member said, 'I feel we have enough staff to provide quality care for the residents.'
There were a range of audits and systems in place to monitor the quality of the service being provided.