Background to this inspection
Updated
14 April 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 28 January 2015 and was unannounced.
The inspection team consisted of three inspectors and an expert by experience in older people and older people living with dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection we reviewed the information we held about the service. This included speaking with the local authority contracts and safeguarding teams. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This document was not returned to us.
On the day of our inspection we spoke with seven people who lived at Carr Green Nursing Home, one visitor, two nurses, four care workers, the activities coordinator, handyperson and cook and the registered manager.
We spent time observing care in the lounge and dining room and used the Short Observational Framework for Inspections (SOFI), which is a way of observing care to help us understand the experience of people using the service who could not express their views to us. We looked around the building including all occupied bedrooms, bathrooms and communal areas. We also spent time looking at records, which included five people’s care records, three staff recruitment records and records relating to the management of the service.
Updated
14 April 2015
We inspected Carr Green Nursing Home on 28 January 2015 and the visit was an unannounced comprehensive inspection.
Our last inspection took place on 3 September 2014. At that time, we found breaches of legal requirements in five areas. These included; care and welfare, cleanliness and infection control, safety and suitability of premises, staffing and assessing and monitoring the quality of the service. We served warning notices for the breaches in relation to safety and suitability of premises and assessing and monitoring the quality of the service. In these notices we asked the provider to make improvements to the safety and suitability of the premises by 24 October 2014 and assessing and monitoring the quality of the service by 21 November 2014. The provider sent us an action plan telling us they would make improvements to ensure they no longer breached regulations in the other three areas.
Carr Green Nursing Home provides both personal and nursing care for up to 25 older people. The accommodation is all on one level and consists of a lounge, dining room and 25 single bedrooms. At the time of our visit there were 15 people using the service. The number of people using the service had reduced as following our last inspection placements were stopped by the organisations who commission and pay for the service.
The service has 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 and associated Regulations about how the service is run.
We found the provider had not taken appropriate action to ensure they met the requirements of the warning notices and to ensure they no longer breached regulations.
We found fire doors that were not closing properly or were being wedged open. This meant they would not be effective at holding smoke back in the event of a fire.
A current gas safety certificate and electrical installation certificate were not in place. This meant we could not assure ourselves the installations were safe.
The temperature of the building was variable with some areas being draughty and additional heaters were in some bedrooms to maintain a comfortable temperature. The hot water coming out of some of the bedroom taps was in excess of 60 degrees centigrade and posed a scalding risk.
We contacted West Yorkshire Fire Service and the Health and Safety Executive following our visit to report these concerns.
The medication system was not well managed and medicines were not being stored at the right temperatures. The medication policy was out of date and there were no protocols in place to make sure any ‘as required’ medication was given appropriately.
We saw induction training for new staff was completed in one day and this covered 10 or 11 topics. Staff had not received any practical moving and handling training in how to use hoists or other equipment safely.
We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).
People told us the food was good and we saw people were offered a choice of meals at breakfast and lunchtime.
People told us they liked living in the home and staff were kind and caring. People also told us they enjoyed the activities on offer in the afternoons.
We found people’s care records were not always up to date and did not reflect people’s current care needs. They also lacked assessments of risks to some individuals and information about what action staff needed to take in order to reduce those risks.
We found the service was not well led. The lack of effective quality monitoring systems meant the provider was not identifying its own deficiencies and acting upon them. There were significant areas which were having a detrimental impact on the care and well-being of people using the service.
We found on-going breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.