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 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 g

This inspection took place on 22 and 23 August 2017 and was unannounced.

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 effec

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.

On the day of our visit we spoke with the owner, manager, social workers relatives, staff and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at The Chimes.

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.