Background to this inspection
Updated
24 April 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of two Inspectors, a nurse specialist, a pharmacist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type.
Carders Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of the inspection the service did not have a manager registered with the Care Quality Commission. There was a home manager who had recently transferred from another area and intended to register with the CQC. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed all the information we held about the service including statutory notifications the service has sent and feedback we had received. We contacted the local authority and Healthwatch for additional information and feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
During the inspection
We spoke with 14 people who used the service about their experience of the care provided. We spoke with 19 members of staff including the manager, deputy manager, unit managers, human resource manager, care workers, laundry staff and the chef. The Expert by Experience made telephone calls following the site visit and spoke with 18 relatives.
We reviewed a range of records. This included 11 people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
Following inspection we spoke with a further three relatives. We continued to seek clarification from the provider to validate evidence found.
Updated
24 April 2021
About the service
Carders Court is a care home providing nursing and personal care to 149 people aged 65 and over at the time of the inspection. The service can support up to 150 people. The care home comprises of five separate units each supporting up to 30 people and a separate office block with kitchen and laundry. One unit provides nursing care, two units provide residential care and two units provide support for people living with dementia. One unit with dementia also has a separate area where people are discharged from hospital to be assessed before returning home.
People’s experience of using this service and what we found.
People and relatives we spoke with were generally positive about the service and felt they were well cared for. However, outcomes for people varied considerably across the home and we found one unit in particular was experiencing significant pressures.
Medication was not being managed safely and we identified several concerns that required improvement. We identified health and safety risks and risks in relation to people's pressure care, nutrition and hydration need and choking risks. We observed a lack of monitoring of people's health care needs, around epilepsy and diabetes.
Care plans did not always reflect people's needs and there were concerns around the capacity of the current call bell system. Staffing levels were not always sufficient and we observed people calling out for help.
Complaints had not been managed effectively and there had been a distinct lack of managerial oversight at the service. The new manager had not been in post long, but had started to address concerns and responded proactively to our feedback.
People and their relatives told us the staff were caring and very kind. We observed pleasant interactions between staff and residents and feedback we received about unit managers was relatively positive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 17 September 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made and the provider was still in breach of regulations. We also found three further breaches of regulation.
Why we inspected
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 the service can respond to COVID-19 and other infection outbreaks effectively.
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people’s care needs. A decision was made for us to inspect and examine those risks.
We inspected and found there were concerns with people’s care needs, complaints and the management of the service so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive and well-led.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.
We have found evidence the provider needs to make improvements. Many of the concerns we identified related to the dementia unit that also supported people who had been discharged from hospital. The provider took action to mitigate the risks we found on inspection. They sent us an action plan immediately after the inspection. We met with the provider and the local authority to discuss the concerns identified. Following on from this meeting, a further meeting took place with the provider, the manager and the deputy manager. The provider agreed to voluntarily cease admissions to the discharge to assess unit. This has been effective and has reduced the risks considerably.
Please see the safe, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carders Court on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to medicines, risk management, staffing, complaints and governance at this inspection. We also made a recommendation about care plans.
Please see the action we have told the provider to take at the end of this report.
Follow up
We have met with the provider prior to this report being published to discuss how they will make changes to ensure they improve their rating to at least good. The provider has already submitted an action plan. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.