About the service:

Carden Bank Rest Home is a residential care home that was providing personal and nursing care to 14 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People had been placed at harm because medicines were not administered in a consistent and safe manner, which meant people did not have their medicines as prescribed. People were not safeguarded from abuse because staff had a poor understanding of the signs of abuse and their responsibilities to report suspected abuse. Risks to people’s health and wellbeing were not consistently identified, managed or risk management plans followed to keep people safe.

There was a lack of governance and leadership in the service and the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the provider exposing people to the risk of harm.

There were not enough staff available or effectively deployed to provide support in an unrushed way and to meet people’s emotional needs. Staff had not received effective training and support to support people in an effective and safe way. Competency checks were ineffective in identifying poor practice.

The culture within the home did not promote openness and people did not always feel able to complain about their care. The provider did not have effective system in place to learn when things went wrong, this meant areas of poor practice continued.

People did not always feel cared for and there was a lack of stimulation to maintain their emotional and mental health needs.

People’s nutritional needs were monitored and managed. Advance planning was in place to ensure staff were aware of people’s wishes if they became unwell. People were supported to access health professionals.

Rating at last inspection:

Good (report published 22 July 2017).

Why we inspected:

This inspection was brought forward and was completed in response to information of concern we had received from the local authority. We needed to check that people were supported safely and whether the provider was meeting the Regulations.

We found concerns during the inspection and there were breaches in regulations. We rated the key questions safe and well led as inadequate. The key questions Effective, Caring and Responsive were rated Requires Improvement. The overall rating is Inadequate.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on 25 January 2017. This was an unannounced inspection. At our previous inspection on the 29 October 2014 the provider was meeting all the regulations relating to the Health and Social Care Act 2008 but we identified some areas that required improvement in medicine management and staff recruitment checks. At this inspection we found improvements had been made.

The service was registered to provide accommodation for up to 14 people. At the time of our inspection there were 13 people using the service. There is no registered manager condition at this home as the registered provider managed the home on a day to day basis.

We saw improvements had been made in the management of medicines. The amounts of medicine in stock for each person were recorded to ensure a clear audit trail was maintained. Improvements had been made in staff recruitment. We saw that full checks had been completed before staff commenced employment, to ensure they were suitable to support people.

People told us and we saw there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff understood what constituted abuse or poor practice and systems were in place to protect people from the risk of harm.

People were supported by staff that received training and supervision and understood their needs and preferences. Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions when possible. Where people were unable to make decisions independently they were supported in their best interests and in accordance with the Mental Capacity Act. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach and supported people to maintain their dignity and privacy. People were supported to maintain relationships that were important to them and maintain their social interests. People knew who the provider was and they understood their responsibilities around registration with us. Staff felt listened to and were happy to raise concerns. People knew how to complain and we saw when complaints were made they were addressed. Quality monitoring checks were completed by the provider and they sought people’s opinions, when needed action was taken to make improvements.

This inspection was unannounced and took place on the 29 October 2014.

Carden Bank Rest Home is registered to provide accommodation and personal care support for 13 older people and 13 people were using the service at the time of our visit.

There is no registered manager condition at this home as the registered provider managed the home on a day to day basis.

At the last inspection on 23 May 2014 we asked the provider to take action to make improvements. This was because people that lacked mental capacity to make some decisions did not have assessments in place to demonstrate how these decisions were made in their best interest. The provider sent us an action plan after the inspection to confirm that these improvements would be in place by 31 July 2014. At this inspection assessments were in place that demonstrated that decisions were made in people’s best interest when they were unable to make these decisions independently.

At this inspection improvements were needed in the management of medicines, this was because people that kept their own medicines did not have a secure facility to keep their medicines in and some areas of medicines management did not have recording systems in place. This meant that the provider had not taken suitable precautions to ensure people’s medicines were managed safely. We recommend that the provider follows the guidance in ‘The handling of medicines in social care’ provided by the Royal Pharmaceutical Society of Great Britain 2007.

Improvements were needed to the recruitment practices in place. This was because the records held did not demonstrate that thorough checks had been undertaken to ensure a detailed work history was in place and that the correct references had been received.

People told us they felt safe and staff had a good understanding of safeguarding adults. Staff knew the procedure to follow if they identified any concerns or if any information of concern was disclosed to them.

People received care that met their preferences and promoted their independence. This was because staff had consulted with them and relevant people to ensure they were supported in an individualised way.

People’s care was reviewed on a regular basis to ensure their needs and preferences were met appropriately.

People liked the staff and told us that the care and support they received was to a good standard that met their needs.

People felt respected and told us that their opinions and views were listened to.

Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Audits were in place to ensure the service provision was regularly monitored and assessed to drive improvement.

This visit to Carden Bank was an unannounced inspection. At the time of our visit 12 people were using the service and one person was in hospital. The provider who also managed the service was not available. The deputy manager was on duty and available throughout our visit.

We looked at two people’s care records and spoke with these people to get their views on the quality of support they received. We also spoke with the staff that supported them. This is known as pathway tracking and helps us to understand the outcomes and experiences of a selected sample of people. We also spoke to five other people using the service to get their views on the quality of support they received.

Is the service safe?

People told us they felt safe and had no concerns regarding the staff that supported them. One person told us; “The staff are very nice and there’s always someone around if you need help.” Another person showed us their cordless call bell which they carried with them and told us; “It’s to call the staff with, if I need them. I don’t use it much, as there are staff around, but it’s just in case I need it.” We observed that two people with mobility needs were provided with cordless call bells. This was because fixed call bells in communal areas were not accessible to these two people. Staff confirmed that two additional cordless call bells were available. We were told that these call bells were not required as other people using the service were able to stand or walk without the aid of staff support.

All of the people using the service that we spoke with told us that staff were available to them as needed. One person said; “The staff are always around and available.”

We spoke to three people’s visitors. All three visitors confirmed that they were confident that their relatives were supported in a safe way. One visitor told us; “We went through such a difficult time before mum came here. The staff understand my mum’s needs very well and know how to support her.”

Capacity assessments had been undertaken for people that were unable to make decisions independently. However best interest decisions were not in place to demonstrate that when people lacked capacity they were supported in the least restrictive way that empowered them to make decisions when possible, and protect their rights.

At the time of our visit none of the people using the service had authorisations under the deprivation of liberty safeguards (DoLS) in place. This legislation is in place to protect people who are unable to make their own decisions about their health and wellbeing. However one person’s records stated that they had an authorisation in place although this had stopped and staff spoken to were aware of this. We discussed this with the registered manager who confirmed that this person’s records would be updated to reflect this.

Is the service effective?

Information in people’s care plans included how they wished to be cared for. People we spoke with confirmed that they were able to follow their preferred routines. One person requested a bath on the afternoon of our visit and staff supported them to do this. This person told us; “I enjoy a bath in the afternoon and the staff are always happy to help.” Another person discussed the different hobbies they enjoyed and told us; “I keep myself busy throughout the day, I’m very happy here, it’s a lovely place.”

Visitors we spoke with confirmed that their relative’s needs were met and their preferences respected. One visitor told us; “The staff look after my mum very well, she always looks well-presented which is important to her.” Another visitor told us; “My mum can’t walk around anymore so she spends all day sitting but she hasn’t got any pressure sores, she has pressure relieving equipment in place. I think the care she gets is very good,”

Is the service caring?

People using the service told us that they liked the staff and found them friendly and supportive. We observed a positive working relationship between the care staff and the people they supported.

At the lunch time meal staff demonstrated patience and gave encouragement when supporting people with their meal. Staff supported people to do things at their own pace. One person confirmed this by saying; “The staff never rush me, they know I can’t do things quickly any more. “

All of the people we spoke with confirmed that the staff were caring. One person said; “The staff are lovely, they are very caring. I wouldn’t want to live anywhere else now, this is my home and I’m very happy here.” Another person said; “I’ve lived here for a long time and know all the staff well, they are all nice and I think they do a marvellous job.”

Is the service responsive?

People’s needs had been assessed before they moved into the home and their care plans and risk assessments had been developed from this assessment. We saw that care packages included people’s needs and preferences and people told us that staff followed their agreed care plan. From discussions with people using the service and observations, we saw that the support provided to people matched the information recorded in their care plans. Care records seen had been reviewed on a regular basis with the involvement of individuals and their representatives.

Visitors told us that their relatives healthcare needs were met at the home. One visitor said; “If there are any issues the staff call the doctor and they always keep me informed.”

Is the service well-led?

Staff were kept up to date with training that was relevant to their job. Staff we spoke with told us that they found the training useful in ensuring they worked to current practices.

Regular meetings were held with people using the service to get their views and satisfaction questionnaires were sent out to people and their relatives. People told us their views were listened to and their preferences met.

Meetings for staff were held to ensure they were kept up to date with any changes. The records seen showed that these meetings were also used as a learning opportunity for staff. Staff were also given opportunities to express their views through regular supervision and satisfaction questionnaires. One member of staff told us; “The owner is very good, she works hard to ensure the staff and people using the service are supported well.”

Audits were in place to monitor the service provided and any actions identified were addressed.

A record was kept of complaints and the actions that had been taken to resolve these. We saw that all complaints received had been addressed and responded to in a timely way.

The staff had a good knowledge of people’s support needs and we saw they were respectful to people when providing this support. People were relaxed and one person told us, “I get on very well with the staff. I can talk to them and trust them.”

We saw that people’s agreement was gained before staff provided care or support. When people were unable to make decisions about their care, the provider had not acted in accordance with the law, to ensure decisions were made in people’s best interests.

People using the service had care records which recorded how they wanted to be supported. Information was not always reviewed promptly to ensure the information matched any identified risk or changes to people’s care.

There were enough staff on duty to provide care and support to people. One person told us, “You couldn’t get any better than the staff here. I can’t praise them enough.”

People were formally consulted about the care they received. Systems were not in place to demonstrate the provider could monitor and improve the quality of the care delivered.

We inspected this service because we received concerns that arrangements had not been made to keep people safe. The concerns were that communal areas were too warm and not ventilated, and people did not have enough to drink. There were also concerns raised about infection control standards in the bathroom and toilet areas.

During our inspection, we found that rooms to the front of the property were warm. Fans to help people to keep cool during the hot weather had been purchased but were not generally being used in all areas where they were needed. People told us they had drinks throughout the day and were happy with the care and support they were receiving.

We saw that adapted seats on the two toilets were not secure which presented a risk to people when using these facilities and they had not been cleaned thoroughly. There was a lack of hand wash and towels in the toilet. This meant suitable infection control standards were not being maintained.

We carried out this inspection to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with six people, two visitors and three members of staff.

We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people’s communication style and responded appropriately. We saw staff recognised people’s rights and were respectful to people using the service.

People were happy with the care and support they received. They were supported to have their health and personal care needs met. People told us they enjoyed living at the home, they said their dignity and privacy were considered and respected. They said they were offered choices in their daily living, for example when to get up and retire, a choice of food and activities.

We checked to ensure medication was stored and administered in a safe way and found medication was managed appropriately.

Staff told us they enjoyed working at the home. They said that all the checks were made to ensure they were fit to do their job. Staff felt they worked well as a team and supported each other in order to do a good job.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.

We visited the service in February 2011 and left compliance actions in relation to care planning, recruitment and fire evacuation procedures. We carried out this visit to ensure the service had complied with these actions and reviewed how people were being supported in the home since our last visit.

People dressed in their own style and if they needed support, staff helped individuals to continue to take a pride in their appearance; staff provided any personal care where required and people in the home were well-presented.

People could choose how to spend their day and were able to go into the community independently or with staff. People told us they liked living in the home and the staff knew how to provide support.

Staff liked to develop good relationships with people and would spend time talking and taking an interest in people's lives. Staff told us that reviewing the plans of care with people had helped them to learn more about people and were interested in their past experiences.

There were procedures in place to make sure that complaints were listened to and acted upon, and to protect the well being and safety of people who lived in the home. People told us they were able to speak freely and were confident any concerns identified would be dealt with.

People who use the service told us that the home was always kept clean and they could bring furniture and personal items to the home, and said ‘its always lovely here, they always keep the home nice.’

There were activities arranged and individuals could choose whether to be involved. People were able to go out with staff or alone in the local community and events were planned for people who wish to visit local attractions. Family and friends could visit the home whenever they wanted to, and people can go out to family homes and continue to enjoy family events. People told us,

‘We visited Trentham Gardens, it was lovely there, we enjoyed that.’

‘I tend to do jigsaws and art, and often go out and help with the gardening here.’ ‘We’re getting older, we do enough.’

People told us that the home had a very good cook and confirmed they were provided with a good choice of food and refreshments and were asked what meal they would like to eat. People told us, ‘The cook here is great, and she makes wonderful puddings.’ People could choose either to have their meals in the dining room or in their own rooms

People dressed in their own style and if they needed support, staff helped individuals to continue to take a pride in their appearance; staff provided any personal care where required and people in the home were well-presented.

Staff liked to develop good relationships with people and would spend time talking and taking an interest in people's lives. Staff had a good knowledge of the care needed and what people wanted. People told us, ‘this is a lovely place, the carers are wonderful,’ and ‘the staff always ask us what we want, nothing is too much trouble.’

There were procedures in place to make sure that complaints were listened to and acted upon, and to protect the well being and safety of people who lived in the home. People told us they were able to speak freely and were confident any concerns identified would be dealt with, and said,

‘I feel safe here, with all the carers around.’

‘You have to tell people if you are not happy with something, it’s no good keeping things to yourself.’