Caroline House

Caroline House is a residential care service that provides support for upto 28 older people living with dementia, mental health needs and sensory impairment. Accommodation was arranged over two floors with stairs and a lift connecting each level. There were 21 people living at the home at the time of the inspection. Two people were currently in hospital.

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

There were governance systems being used to consistently drive improvement within the service. However were areas that needed to be further developed to ensure people's safety and well-being. For example, there was a lack of clear and accurate record keeping regarding some people's hydration support. Environmental audits had not identified two radiators that were hot to touch and not covered, and whilst accidents and incidents were recorded and analysed, preventative measures to prevent a re-occurrence were not documented to guide staff.

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. People had care plans and risk assessments which meant people’s safety and well-being was promoted and protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Medicines were given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained and comfortable. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. Accidents and incidents were recorded and lessons learnt from complaints and incidents were recorded.

The home had an effective management structure which provided good leadership for staff and communicated effectively with people, relatives and professionals. Families, visitors and staff were positive about the management and care team, saying they were approachable and welcoming. Staff were positive about their roles and felt valued for the work they did.

The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response.

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 Good (published 22 March 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the age of the last rating.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

The provider took immediate action to mitigate risk to people during the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caroline House on our website at www.cqc.org.uk.

Follow up

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

At our last inspection we rated the service good overall. At the last inspection, the provider had failed to adequately assess the risks to the health and safety of service users which was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had taken sufficient steps to ensure that health and safety had been assessed and improvements made to ensure risks were minimised. At this inspection we found the evidence continued to support the rating of good overall. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained overall Good.

There is a registered manager in post. 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 told us they felt safe at the service and staff understood what procedures they needed to follow to keep people safe. Risks to people's health and safety were assessed and measures were put in place such as updating fire evacuation procedures. Safety checks of the environment and equipment were carried out to ensure they were in good working order. The service was currently working above their identified staffing levels.

Staff had development plans in place which ensured that they were supported to complete training and gain qualifications. People's nutritional needs were met and staff sought advice from healthcare professionals in relation to people's diets. People said they liked the food and staff knew what they likes and didn’t like. People were supported to access health services such as GPs, speech and language therapists and district nurses.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were happy at the home and liked the staff and other people they lived with. People told us they thought the care they received was excellent People were enabled to maintain relationships with their families and friends.

People told us that they were involved in their care. People had their preferences taken into consideration such as tailoring activities for people and decorating their bedrooms in a style that they liked.

The registered manager was approachable and staff felt able to be open. Staff and people who use the service were encouraged to give their views and put forward ideas for improving the service. People told us they knew who the manager was and found her approachable,

Further information is in the detailed findings below.

There was a registered manager in post. 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.

At the last comprehensive inspection on the 6 and 10 October 2016, the service was rated as ‘Good’ overall and Requires Improvement in the 'effective' domain. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Need for Consent. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We identified concerns in relation to infection control and staff deployment. Due to these concerns, we also considered whether the service was safe. We therefore looked at two key questions, is the service safe and effective? This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Caroline House on our website at www.cqc.org.uk

The service had made improvements since the last inspection. Decision specific mental capacity assessments were now in place. Staff had received training on the Mental Capacity Act 2005 (MCA) and understood the importance of obtaining consent from people. Deprivation of Liberty Safeguard (DoLS) applications had been made and any associated conditions had been documented and acted upon. However, we found new concerns in relation to infection control and staff deployment. The rating for the safe domain of this service has been revised from ‘Good’ to ‘Requires Improvement’.

During the inspection, we identified concerns with the management of infection control. Certain areas of the service had a malodour and some people’s beds had been made with stained linen and food debris still within the bed. Some people’s individual continence aids also omitted a strong odour and risk assessments had not always been reviewed or updated. We have identified a new breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

Systems were in place to determine staffing levels and people and staff felt staffing levels were sufficient. However, the deployment of staff was not always safe. We have identified this as an area of practice that needs improvement.

Staff were not consistently knowledgeable about the people they supported. Staff were not consistently aware that one person required fluid thickener in their drink. A number of people required the use of falls sensor mat. Care plans and risk assessments had not always been updated to reflect whether they required the use of the sensor mat just at night or during the day. We have identified this as an area of practice that needs improvement.

Staff knew how to recognise and respond to abuse. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

Arrangements for the supervision and appraisal of staff were in place. Staff told us they felt supported and recognised the part that regular scheduled supervision played.

People's health and wellbeing was continually monitored and the registered manager regularly liaised with healthcare professionals for advice and guidance. People received medicines on time and records of people's health and emotional wellbeing had been maintained. People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank.

There was a registered manager in post. 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, relatives and staff spoke highly of the service. One person told us, “The way they treat you, is very nice.” Another person told us, “They do all they possibly can for you here, I have no complaints.” A visiting relative told us, “My mother made pictures and knitted squares, she never did that before coming here.”

The requirements of the Mental Capacity Act 2005 (MCA) were not being met. Decision specific mental capacity assessments had not been completed and the provider was unable to demonstrate how they were working within the principles of the Act.

Deprivation of Liberty Safeguard (DoLS) applications had been made. However, care plans failed to reflect if people were subject to a DoLS and what conditions were attached to their DoLS authorisation. The provider’s DoLS policy failed to reflect current policy and practice.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Yes I think there are enough staff. “ Staffing levels were based on the needs of people, however, the provider was unable to demonstrate this assessment and how they calculated and determined staffing levels. We have made a recommendation about the implementation of a systematic approach to determining staffing levels.

A range of activities were in place and people spoke highly of the activities provided. One person told us, “I never feel lonely, too much going on.” Dedicated activities coordinators were in post and activities included arts and craft, bingo, quizzes and external outings Links with the local community had been established and the local Parish Church regularly visited the home. However observations demonstrated that meaningful activities were not available in the morning. We have made a recommendation about the promotion of meaningful activities.

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “Excellent food, we eat everything up.” Special dietary requirements were met, and people's weight was monitored, with action taken when required. Health care was accessible for people and appointments were made for regular check-ups as needed.

Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency. Accident and incidents had been recorded and monitored to identify any themes or trends.

Feedback was regularly sought from people, relatives and staff. ‘Resident’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas.

People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk. Assessments had been carried out and personalised care records were in place which reflected individual needs and preferences.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People and their relatives were complimentary about the caring nature of staff, one person told us, “The staff are definitely kind and caring.”

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

People told us that they were treated with kindness and respect and that they had given consent to the care that was given. We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We looked at the systems and processes that the home had in place to ensure the people who used the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We examined processes and records in relation to hygiene and infection control and saw that these had ensured that the premises were clean and hygienic. We saw that the risk of infection was minimised by the systems in place.

Appropriate checks were undertaken before staff began work.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints raised were resolved to people's satisfaction with information used to change practice.