About the service:

Carisbrooke Nursing Home is a nursing home for older people. The service accommodates 25 people in one adapted building. The service was providing personal care, nursing, and intermediate care to 19 people at the time of the inspection.

People’s experience of using this service:

Since the previous inspection, the service had made improvements to the safety of people’s care and quality assurance.

People told us they felt safe living at Carisbrooke Nursing Home. There was a relaxed atmosphere between people and staff. Staff knew people well and were kind, caring and attentive.

People were protected from the risk of harm. Risks were managed safely and safe processes were in place. Where some risks had been identified relating to safe moving and handling, the service had worked with other professionals to resolve these.

Staff had enough time to meet people’s needs and spend time with them in conversation. Staff had the skills and knowledge to meet people’s needs effectively.

People received care and support that was flexible and responsive to their needs. Staff supported people who were staying for intermediate care to achieve their goals. This meant people were able to return to their own homes.

The service had carried out a number of improvements to the environment in the past year. Some areas of the service were in need of redecoration and refurbishment. The registered manager told us they had plans to continue with their ongoing maintenance.

Quality assurance processes ensured people received high quality care. Since our previous inspection, the registered manager had put further checks in place.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

More information is in the full report.

Rating at last inspection:

Requires Improvement (The report was published on 28 February 2018).

Why we inspected:

This was a planned inspection based on the previous rating.

We received concerns about moving and handling. We followed these up at this inspection.

Follow up:

We will continue to monitor intelligence we receive about this service until we return to visit as part of our re-inspection programme. If we have any concerns, we may inspect sooner.

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

This unannounced inspection took place on 3 an 4 January 2018. Carisbrooke is a nursing home. People in nursing 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.

Carisbrooke is a large detached property set within its own grounds and is registered to provide care, nursing and intermediate care services for up to 25 older people. Accommodation is provided over two floors, with a passenger lift providing access between floors. On the day of our inspection, 22 people were living at the home.

The registered manager was also the registered provider, in this report we have referred to them as the 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.

People were not always protected from the risk of avoidable harm. Where risks had been identified, action had been taken to minimise the risk, such as using pressure-relieving mattresses. However, there was no system in place to ensure mattresses were set at the correct setting. There was no guidance in risk assessments to guide staff on what the correct setting should be for the person.

Some people's files did not have a Personal Emergency Evacuation Plan (PEEP) to provide guidance for staff and others to support people to reach a place of safety in an emergency. Fire information documentation available to emergency services was not up to date and did not contain a list of current services users or their evacuation plans. This meant staff and emergency service staff did not have all the key information they needed to assist people from the building in the case of an emergency.

People were not always protected by safe and robust recruitment procedures. We looked at the recruitment files for three staff. We found two of the files did not contained details of each staff member's full employment history or the reasons for any gaps in their employment. This meant the provider could not be assured they had taken sufficient action to ensure staff were of good character.

The registered manager had quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided at Carisbrooke. We found the registered manager used a variety of systems to monitor the home. However, governance systems had not identified a number of concerns we found at this inspection. Although systems were in place to identify and record accidents incidents, there was no consistent system in place for analysing and identifying patterns to prevent a reoccurrence.

The registered manager had not always notified the Care Quality Commission (CQC) of significant events, which had occurred in line with their legal responsibilities.

People told us they felt safe living at Carisbrooke. One relative told us "I feel confident to go away and be relaxed in the knowledge that my mother will be well cared for at all times and safe." People remained protected from the risk of abuse because staff understood how to keep people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns.

People told us they were happy living at Carisbrooke. One person said, “I love it, the staff are helpful and kind, do anything for you.” Another said, “It’s very nice, they are very kind.” A relative told us they felt staff supported their mother well, and were friendly, kind and approachable. People told us staff treated them with respect, maintained their dignity and were mindful of their need for privacy.

People

This comprehensive inspection was unannounced and took place on 27 May 2015.

Carisbrooke is a care home with nursing, which provides accommodation and personal care for up to 23 people. People who live at the home are older people, some of who were living with dementia and physical disabilities. Carisbrooke also offer Intermediate Care facilities.

There was a registered manager in post. A registered manager is a person who is 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 the associated regulations about how the service is run.

Staff had received training in the Mental Capacity Act and how this related to Deprivation of Liberty.

People were protected from risks and each had a risk assessment as part of their care plan, which detailed risks with mobility, skin integrity, use of equipment and nutrition. However, some of these were hard to read. Each person had a Treatment Escalation plan and a Personal Emergency Evacuation Plan.

At our last inspection (July 2014) we found that people were not protected from the risks associated with the administration of medication. At this inspection in May 2015 we found that action had been taken to address this and the risks previously identified reduced as far as possible. People received their medication in a timely and safe way. A medication audit system had been introduced and the home was using a monitored dosage system supplied by the local chemist.

People had access to primary healthcare services.

We saw that staff engaged appropriately with people. Staff were skilled at anticipating people’s needs and spoke to them in a respectful way, ensuring they understood. People’s care was delivered discreetly, protecting people’s privacy and dignity.

People’s care needs had been assessed prior to admission and care plans formulated that reflected those needs. Plans were reviewed regularly. Input was sought from specialist colleagues (for example: speech and language therapists, community psychiatric nurses, Parkinson’s Disease specialist nurse) to inform care.

A programme of activities to help meet people’s interests was in place five days per week.

There were clear systems in place for managing any safeguarding concerns. Staff understood what constituted abuse and what they would need to do if they had any concerns.

We saw there were robust procedures in place for staff recruitment. Staffing numbers were sufficient to meet people’s needs and we saw that care was given in a professional and timely way. A programme of staff training was in place to ensure that the staff were equipped with the knowledge they needed to carry out their role.

The home had a clear complaints policy. Although some staff felt that their suggestions for improvements were not heard, and some staff were not permitted to write in care plans. However, the minutes of staff meetings showed that some suggestions had been implemented and all staff were reminded to write on care plans as needed. Some care plans were difficult to read.

We saw that some anonymous concerns had been raised with the Care Quality Commission These had been followed up by the local authority quality team and not substantiated. There had been one staff grievance and the registered manager had used an external management consultancy firm to deal with this.

People were consulted about the operation of the home and how improvements could be made. The home was undergoing some modernisation work with the installation of air conditioning in some clinical areas and a programme of redecoration. Some new beds were also on order.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

One person we spoke with said "Couldn’t be looked after any better anywhere". Another person told us "I would of course prefer to be at home but I like it here".

The service was not safe because people had not been protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage medicines.

Systems were in place to make sure that the manager and care staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission [CQC] monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place. Relevant senior staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The service was effective because we found that people's consent had been obtained for care and treatment provided to them by the service. However this had not been consistently recorded when people had received treatment or when care plans had been reviewed.

People's health and care needs had been assessed with them or their representative and they had been involved in writing their plans of care. If people had been assessed as not having the ability to be involved a best interest decision had been made by the person’s representatives.

Is the service caring?

The service was caring. We spoke with six people who live at Carisbrooke nursing home. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; “All the staff are excellent. This is a very sought after nursing home".

When speaking with and observing care staff during this inspection it was clear they genuinely cared for the people they supported. They told us about people's individual health and social care needs and how these needs had been met in an individual way.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive. We spoke with six people who lived at Carisbrooke nursing home. We saw from records that planned care and treatment had been provided in line with people's individual care plans. Aspects of people's needs or care had been linked to risk assessments. Specialist health needs had been identified where required and appropriate health care professionals had been consulted and involved in providing care.

Is the service well-led?

The service is well led. The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

We saw there was an effective system in operation which had been designed to enable the provider to regularly assess and monitor the quality of the services provided. For example during 2014 the manager had sought "Opinions of Carisbrooke" from people who had received services at the home.

At our last inspection in February 2013 we identified five areas of concern. At this inspection we found that improvements had been made in all these areas.

On the day of our inspection 20 people were living at the home and receiving care from the service. We, the CQC, spoke with three people, two visitors the owner, the clinical lead nurse, one care worker and the cook. We looked at three care plans.

One person described the home as a “lovely” Another person told us the owner/manager was “a diamond” and the care was “excellent”.

People had clear assessments of their needs and plans and strategies were in place to meet them. We saw that care workers interacted with people in a relaxed and respectful manner. People had access to age appropriate social activities. During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life.

Systems were in place to support the ongoing development of the quality of services provided and to support the manager and staff.

The records that were in place were up to date and fit for purpose

During this inspection we spoke with eight people using the service, with four relatives and with six members of staff.

People using this service, and relatives, told us that they had a very positive experience. They received care from compassionate care workers who were described as “lovely”, “so kind” and “the best”. One person told us that the people living here came first above everything else. However, we found that some risks to people's health, welfare and safety were not being adequately managed.

Nursing care plans lacked detail. For example, they did not provide information about how pressure sores should be prevented or how risks from dehydration should be managed. Nursing judgements of the care provided did not demonstrate that nurses had evaluated the available evidence relating to people's care. In general records were not kept in a way that supported people's safety and welfare.

Whilst there were enough staff on duty, care workers and nurses had not received the training they needed to support them to carry out their roles and responsibilities. Some had not had training in moving and handling, medicines management, safeguarding, mental capacity and deprivation of liberty. Not all staff had received supervision.

Recruitment procedures in relation to recently recruited staff were incomplete. For example, three staff who had recently started to work at the home had done so before mandatory Independent Safeguarding Adults checks had been undertaken.