Archived: Carrington House

Carrington House is a residential care home providing personal care without nursing for up to 44 older people. At the time of the inspection there were up to 33 people living in the home.

The home is purpose built and has a mixture of single bedrooms which were either en-suite or had access to communal bathrooms. It is spread over three floors with shared living spaces such as dining rooms and lounges.

People’s experience of using this service and what we found

People were not always receiving safe care. Concerns were found with risks such as pressure care and moving and handling. Care plans lacked details and guidance to support staff to follow best practice. Medicines were not always managed safely. Systems to manage safeguarding people from abuse were not effective. People were not supported by enough suitably qualified and experienced staff.

As part of the COVID-19 pandemic we look at the infection control practices in care homes. Staff did not understand how to safely use personal protective equipment (PPE) such as gloves, masks and aprons. Throughout the inspection we observed staff incorrectly wearing masks such as below their nose or under their chin. The registered manager had not accessed support from the local authority to help change the culture until we prompted them. During the inspection contact was made after prompting by the inspection team.

People were not always supported in a dignified and respectful way. This was not in line with the provider’s vision. Staff’s interactions with people were task based and a lack of social interaction was witnessed. The management were not always facilitating a positive culture.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not well led. The registered manager lacked understanding of their roles and responsibilities. Concerned found during the inspection had not always been identified by the management or provider. The provider’s policies and procedures were not always being followed. Quality assurance systems were not effective at driving safe and quality care. During and following the inspection the provider produced action plans to mitigate immediate risks to people.

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 Good (published 31 October 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about the management of risks. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the management of risks, eating and drinking and infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, people being treated with dignity and respect, protecting people from abuse, capacity and consent and effective management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Carrington House is a care home new to provide personal care and accommodation to up to 44 people. The home specialises in the care of older people. At the time of the inspection there were 28 people living at the home.

At the last inspection in September 2017 the service was rated overall as Requires Improvement.

Although at this inspection in September 2018, we found the provider still needed to make further improvements to the way they managed medicines, we also found evidence that previously showed the serious risks to people, had been reduced.

The provider had appointed a new manager, they had only been in post for eight weeks but clearly had a commitment to improvement. This was clear as when we raised the issues around medicine management they began to implement improvements at once. Although the new manager had submitted their application to become the registered manager of Carrington House, this had not been finalised. Therefore, in this report when we speak about the registered manager, we refer to them as being, 'the new 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.

Since the inspection the new manager has sent us further evidence showing how they have already improved the way they monitor medicines in the home, and we have recommended the provider carries out further reviews of how they manage people’s medicines. These improvements meant at this inspection we could change the overall rating to Good.

At this inspection we found that although improvements had been made, there were still some aspects of medicines management that needed further improvements and we have recommended the provider reviews how they currently manage peoples medicine and strengthen their approach. However, people did tell us they felt safe living at Carrington House and staff understood how to recognise and report signs of abuse or mistreatment.

Accident and incident reporting was robust. There were risk assessments to show any risks to the person using the service and to the staff supporting them and guidance in people’s records on what action staff should take to support people that presented with concerning behaviours. There were enough staff available to keep people safe and the provider's recruitment processes minimised the risk of unsuitable staff being employed.

People were protected by staff who followed good infection control practices. Staff were provided with PPE (personal protective equipment) such as gloves, hand gel and aprons.

The provider had systems in place to assess people’s needs and choices. Nobody we spoke with (for example people who used the service and staff) said they felt they had been subject to any discriminatory practice. People said staff had the right skills, knowledge and experience to deliver effective care and support and records showed staff received training which enabled them to carry out their roles effectively.

The provider supported people to eat and drink enough, and to maintain a balanced diet. There were several pleasant dining areas and people said the meals were nice. People also had access to quiet space and outside areas where they could entertain family and friends as well as access to daily activities that helped reduce social isolation.

Staff told us they felt supported in their roles. There were records of individual appraisals and regular supervision with a manager. Staff worked closely with external agencies and made sure people had access to health care services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were involved in decisions about their care and were able to make choices about how and when their care was provided. This included their personal care and support. There were no restrictions on visiting the service and friends and relatives were welcomed and there was a system in place to manage and investigate any complaints.

The provider was committed to continuously improving the care and support at Carrington House and staff were able to learn from mistakes through avenues such as staff meetings.

Further information is in the detailed findings below

At the last inspection in January 2017 the service was rated overall Requires Improvement.

At the inspection in January 2017 we found improvements were needed in a number of areas to make sure people received a safe, effective, caring, responsive and well led service. We found that medicines were not always safely managed, people were not fully protected against the risks of abuse and people were not being assessed in accordance with the Mental Capacity Act 2005. There were insufficient appropriately trained staff to meet people’s needs and the provider’s quality monitoring systems had not been effective in identifying and addressing shortfalls in the service.

Following the last inspection the provider sent us an action plan outlining how they were addressing the issues raised to improve the standard of care and support people received. At this inspection we found improvements had been made in all areas identified in the last report.

A new registered manager had been appointed who had a commitment to on-going improvement to ensure people received a good standard of care and support. 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. Whilst we acknowledge the dedication of the registered manager and staff team and the improvements made, the time period since the last inspection does not enable us to be certain that the improvements made can be sustained.

Some improvements were needed to make sure medication administration practices were fully effective in addressing people’s needs. On the first day of the inspection there were no clear guidelines in place for use of ‘as required’ medication. This meant that people who were unable to recognise the need for, or verbally express their wish, may not always receive these medicines in a consistent manner. Staff were not always pro-active in making sure people’s individual stock of medicines was sufficient to meet their needs. This had resulted in one person not having a specific prescribed medicine for four days.

The provider had systems in place, such as a robust recruitment process which helped to minimise the risks of abuse to people. Staff knew how to recognise and report any instances of abuse. All staff felt confident that any issues reported would be appropriately dealt with. People told us they would be able to speak with staff if they were unhappy with any aspect of their care. One person said, “I would speak to [registered manager’s name] or staff if I wasn’t happy.”

People received effective care because staff had the skills and experience required to meet their needs. . One person commented, “I totally trust them to do things right.” Staff monitored people’s physical health and sought advice from outside professionals to make sure they received the treatment and equipment they required.

People had their nutritional needs assessed and met. People were complimentary about the food served at the home. Comments included, “Food is good, there’s always plenty to eat” and “Very good food.”

Staff were very kind and caring and respected people’s privacy and dignity. One person said, “When they help you with getting washed and dressed they help you with little things like making sure your clothes match.” People were able to spend time in the privacy of their rooms or in communal areas. One person said, “I’m used to being on my own, I prefer it. They don’t impose but they do take me out for coffee and come and chat to me. They don’t pry.”

People were kept informed about activities in the home and were able to join in with things that interested them. People were able to follow their own routines and staff respected people’s lifestyle choices. Everyone we asked said they were able to make choices about their day to day lives. One person said, “You can please yourself. They are all very open-minded - there are no rules or regulations.”

The provider and management were open and honest and shared information with people and staff. They listened to concerns and learnt from mistakes. There were systems in place to seek people’s views and they took account of feedback received.

Further information is in the detailed findings below

The service is registered to look after 44 older people who may be living with dementia. On the days we inspected there were 36 people living at the service. The service offers residential care without nursing. Nursing care is provided by the community nursing team.

There was a registered manager employed to manage the service. 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.

People were not protected from abuse from other people living at the service. Not all staff understood how to identify abuse. There were also not enough staff with the provider’s required training to keep people safe. Staff had not received appropriate training, supervision and support to carry out their role effectively; safeguarding training was one of the topics staff were not all completing. Staff were recruited safely.

People were not always being assessed in line with the Mental Capacity Act 2005 (MCA). Where they had been completed they were not completed correctly. Applications to deprive people of their liberty had been made without completing an MCA assessment first. There was no one in the service trained to carry out assessments in line with the MCA. All staff had not received introductory training in the MCA so all staff did not understand their responsibilities under this law. This meant people’s human rights were not being respected.

Medicines were not always managed safely. Staff were administering insulin without the training and competency checks being in place. Stocks of medicine were not always recorded and one person’s medicine stock was seen to be out of date. The administration of insulin was taken over by the district nurses during the inspection. Following the inspection, the provider was ensuring a full medicines audit was undertaken.

Risk assessments were not always in place to manage people’s risks. People’s health, behaviour and risks associated with their medicine were not being risk assessed and care plans did not give staff the information required to deliver care safely. People living with dementia did not have care plans in place to meet their needs. People were not having their needs reviewed to assess whether the service could still meet their needs as they became more complex.

People’s health needs were identified but the system of making timely referrals was not operating effectively. Health professionals told us how systems to ensure staff were up to date with people’s health needs for non-urgent visits caused issues for them as they were unable to check people’s records and ensure continuity of care.

People’s records were written in a personalised way. However, people’s end of life care was not being planned with them. Treatment and escalation plans were completed by the person’s GP. No other advanced planning was in place to support people to make decisions about how they wanted to be supported by the staff at their end of life.

People had their nutritional needs met. People liked the food and the kitchen was well organised in meeting people’s dietary needs, likes and dislikes. There were systems in place to prevent cross contamination where this was required to keep people safe.

People spoke highly of how staff treated with them. People said staff treated them with respect and ensured their privacy and dignity were maintained. Staff were observed speaking with people with respect and supporting people in their own time. Staff missed the opportunity to support a person who became distressed at lunchtime. Staff were also task focused and did not respond and support people when they were saying they were bored. Activities were provided by activity staff but outside of this, little happened to stimulate and support people. Health professionals we spoke with felt the staff were caring.

The provider and registered manager had a number of audits and checks in place to review how the service was running. These had not identified the concerns on this inspection. Staff raised concerns about the management of the service. Staff did not feel listened to. People were asked their view of the service. Relatives were also contacted to request their opinion.

We have found breaches of the regulations. You can read at the back of the full report what action we have told the provider to take.

There were care plans and assessments in place which guided staff about people's individual needs and we found that staff were trained to carry out care safely. There was a clear process for risk management and delegation. Evidence showed that that the workforce were encouraged and supported with a mix of new and experienced staff. We saw that the wider group to which the service belonged encouraged and developed leadership qualities for senior staff.

We observed that people were relaxed and happy in the home. One person told us 'the young lady I have had several times to help me I've got to know and we have quite a laugh'.

We found that people could be confident that they received their medicines at the right time as medicines were handled safely. We saw that the staff worked closely with other agencies to ensure people's healthcare needs were met.

There were established arrangements for on-going monitoring of the quality of services and devising actions for improvement. The views of people and relatives were actively sought about what went on in the home and we found that they had significant influence on the service.