Archived: Carrick

Updated 8 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors over two days. Two inspectors were present in the service on each inspection day. The service’s medication management processes were reviewed remotely by a third inspector. The inspection team on the second site visit also included specialist advisor who was a social worker with experience of supporting autistic people.

Service and service type

Carrick is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 did not have a manager registered with the Care Quality Commission. However, a manager, registered at another service operated by the provider, was leading the service at the time of this inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We met everyone who lived at the service and spoke briefly with one person about the quality of care they received. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We used our quality of life tool to investigate people’s lived experience of care. We also spoke with five members of staff and the acting manager. We reviewed a range of records. This included people’s care records, staff rotas and the provider’s policies and procedures. Medication records were reviewed remotely.

We continued to seek clarification from the provider to validate evidence found. We looked at incident reports, daily care records and quality assurance information. We also spoke with two people’s relatives to gather their feedback on the service’s current performance.

Updated 8 September 2022

About the service

Carrick is a residential care home providing personal care and accommodation for up to five people with learning disabilities or who are autistic. Five people lived at the service at the time of this inspection. One person had their own self-contained accommodation and the remaining four people lived in the main house. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

The service was not able to demonstrate how they were meeting all of the underpinning principles of the statutory guidance Right Support, Right Care, Right Culture.

Right support

One person’s support needs had significantly increased, and this had impacted on other people’s safety and well-being. Prior to the new manager’s arrival in the week prior to the inspection, staff had not received appropriate support and guidance to help them meet this person’s needs.

The numbers of staff on duty each day had increased since the last inspection and in the month prior to the inspection the staffing numbers had been safe. However, staffing arrangements at Carrick remained challenging. The service had significant numbers of staff vacancies and had been unable to recruit additional staff. The service had become dependent on a small group of agency staff to achieve the required staffing levels. These agency staff continued to be permitted to work excessive hours each week and had regularly worked over 84 hours per week with limited opportunities for rest. These working practices exposed people and the staff to ongoing risk of harm.

The provider had not made sure that necessary, pre employment checks had been completed for agency staff working in the service.

People were protected from abuse. Appropriate referrals had been made to the local authority when significant incidents occurred. The new manager had a good understanding of local safeguarding procedures.

Right care

Medicines were not manged safely. Records were incomplete and it was not possible to establish if people had received their medicines as prescribed. Staff skills in relation to medicine had not been regularly assessed.

Additional training had not been provided to staff on how to meet people’s communication needs. This continued to limit opportunities for people to participate in decision making.

Access to the community had improved for people since the last inspection. People had been offered regular opportunities to go out and people were being supported to engage in more activities. Sensory items were available to people in the lounge and plans were being developed to improve access to the garden.

Right culture

The culture of the service remains of concern. There was no registered manager in post and limited leadership support had been provided prior to the new manager’s arrival in the week prior to our inspection. This, in combination with the small number of agency staff regularly working excessive hours, meant there was a risk of a closed culture developing. This had not been identified and there were no plans in place to mitigate the risk.

The provider has again failed to demonstrate to the commission that there were appropriate systems in place to ensure people were protected from financial abuse. We have shared our concerns in relation to this issue with the local authority.

The provider’s quality assurance systems had failed to ensure the service achieved compliance with the requirement of the regulations.

The new manager had impacted positively on staff morale. Staff were complimentary of the new manager’s approach and told us, “I have been really impressed with the manager, she is really nice and is a good manager. I know they are looking for a full-time manager and I hope we get someone like that.”

The new manager had a good understanding of the Mental capacity act and appropriate applications had been made to the local authority for the authorisation of potentially restrictive care plans.

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 Inadequate. (Report published 17 May 2022). Breaches of the regulations were identified. At this inspection we found not enough improvements had been made and the provider was still in breach of the regulations.

Why we inspected

We received concerns in relation to a significant increase in the number of incidents occurring in the service. A decision was made for us to inspect and examine those risks and the performance of the service. We also undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have again found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this report.

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 Person centred care, Safe care and treatment, Safeguarding, Staffing, Governance and the Fitness of staff to work at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.