Archived: Cartref Residential Care Home t/a Alverant Limited

Cartref Residential Care Home t/a Alverant Limited was previously inspected in January 2018. No breaches were identified at that inspection and therefore an improvement plan was not requested.

We commenced an unannounced focused inspection of Cartref Residential Care Home on Monday 14 May 2018. This inspection was undertaken as the CQC had received information of concern regarding the operation of the care home in areas relating to: governance and leadership; staffing levels; management of medicines; standard of personal care provided to people; safety issues relating to the welfare of service users and failure to notify CQC of reportable incidents.

The inspection team initially inspected the service against two of the five questions we ask about services: is the service ‘safe’ and ‘well led’. We identified risks and concerns within the service so we decided to undertake a comprehensive inspection of the service so that we could expand our inspection activity to include our remaining three key questions. They are: is the service ‘effective’; ‘caring’ and also ‘responsive’.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: need for consent; safe care and treatment; safeguarding; premises and equipment; receiving and acting on complaints; staffing; fit and proper persons employed and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

Cartref is a 'care home' operated by Alverant Limited (the provider). 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 care home provides accommodation and personal care for up to 24 older people, many of whom have dementia care needs. Respite care is also offered. The home is situated in the historic village of Farnworth in Widnes, Cheshire.

At the time of our inspection the service was accommodating 21 people. Accommodation is provided on the ground and first floor of the large Victoria property which is situated within its own grounds. There is a large car park at the front of the building for visitors to use and a garden with seating areas at the rear of the building.

The home 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.

During our inspection of the service we identified that there had been no proper scrutiny or monitoring of the service by the provider. Furthermore, there was a clear lack of leadership and direction for staff working in the care home.

Systems and procedures relating to governance; quality assurance; medicines management; staffing; service, staff and service user records; safeguarding and the management of complaints were not robust. This had contributed to significant failings within the service which had the potential to place the welfare of people using the service at risk.

We found that the environment was in need of refurbishment and maintenance and was not appropriate or safe for people using the service.

We observed that staff interactions were warm and kind but noted examples were people’s privacy and dignity have been compromised. We also noted that people had access to a limited range of activities and did not always receive personalised care that was responsive to their needs.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that provider found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care service 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.

.

The service was last inspected in December 2015. The overall rating was Good, but the Safe standard was not met and ‘required improvement’. This was mainly due to low staffing levels, but the home is now fully staffed.

Cartref 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.

Cartref Care Home provides accommodation and personal care for up to 24 older people, many of whom have dementia care needs. Respite care is also offered. The home is situated in the historic village of Farnworth in Widnes, Cheshire. The service is provided by Alverant Ltd. At the time of our inspection the service was accommodating 23 people. Accommodation is provided on the ground and first floor of the large Victoria property which is situated within its own grounds. There is a large car park at the front of the building for visitors to use and a garden with seating areas at the rear of the building for people to access.

Whilst we had no complaints from people living in Cartref or their relatives about the amount of staff on duty in the home we noted that only two care staff were on duty between the hours of 9.00pm until 8.00am. An on call out of hours rota was also in place to address any emergencies. We spoke with the provider and recommended that the night staffing levels be reviewed with a view to three staff being on duty between the hours of 9.00pm and 8.00am.

At the time of the inspection there was no registered manager in place at Cartref. 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.

The deputy manager and two senior care staff were present during our inspection and they were open and transparent throughout the inspection process and were seen to interact with people using the service, their representatives and staff in a caring and helpful manner.

We saw that people living at Cartref Care Home presented as clean, appropriately dressed and happy in their appearance. Staff demonstrated an understanding of the need to safeguard people’s dignity, individuality and human rights and the importance of providing person centred and compassionate care.

We saw lots of positive interactions, banter and humour being exchanged between staff and people living in the home appeared comfortable and relaxed.

Holistic assessments of need had been undertaken and care plans and risk assessments produced to ensure staff understood how to meet needs of people living in the home and to keep people safe. The deputy manager told us he was in the process of auditing and updating care recording processes to ensure clear consistent detailed information continued to be recorded in all care files.

Recruitment practices identified that relevant checks had been completed before staff were offered employment and staff files were organised.

Staff received training, supervision and support to enable them to understand their role and how to deliver person centred care. We saw that all mandatory training had been updated and staff supervision had recommenced.

Policies and procedures relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been developed. They provided guidance to staff on this protective legislation and detailed the process involved to protect the rights of people who may lack capacity. Likewise, systems were in place to safeguard people from abuse and to ensure complaints were listened to and acted upon in a timely manner

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. People also had access to health care professionals and referrals were made for specialist input when required.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits. Whilst the system had not been fully utilised due to lack of management, we saw that the deputy manager had recommenced the audits and he provided copies of these at the time of our visit.

Medicines were ordered, stored, administered and disposed of safely.

During our inspection we found that the people living at Cartref looked well cared for and were dressed appropriately for the weather on the day. We spoke with relatives of people living at the home and they made comments such as "I have no issues with the home' and "they look after my relative very well". One person said "the staff are wonderful they look after my relative but also take time to support me in what is a very difficult time."

Staff received on-going training and support and demonstrated through observations and discussions that they provided personalised safe care to the people living at Cartref. Comments about staff and services provided included; "staff members are very helpful', 'good relationships, kind caring people, superb" and "we feel safe living at this home."

The manager has systems in place to monitor and review the quality of the services provided.

People told us that they were offered choices in relation to aspects of daily living, such as when they would like to get up or go to bed, what they would like to eat and what they would like to do during the day. When asked if they felt as though they were treated with respect, one person said "very much so" and another said "absolutely".

People told us they got their medicines when they needed them. One person said "I look after my own medicines. They give me a week's supply at a time." Another said "They always give me my medicines on time".

The people we spoke with were very complimentary about the staff and said there were enough to meet their needs. Comments included: "The staff are very good, I have no problem with any of them"; "The staff are decent people"; "The staff are very nice, if I buzz for them they come straight away to help me".

People said they regularly saw the registered provider and their views were sought. One person said "The manager never changes, no matter what happens, she's always pleasant". Another said "The owners are very nice and the manager is my best friend".