The Care Quality Commission (CQC) has rated Carrick in Truro inadequate overall, following inspections in January and February.
Carrick is a residential care home providing personal care for up to five people with learning disabilities or autistic people. The service is run by Spectrum (Devon and Cornwall Autistic Community Trust).
CQC carried out an unannounced inspection after receiving information of concern about inadequate staffing levels and staff working excessive hours. At the time of the inspection five people were living at the service.
Following the inspection, the overall rating for the service has dropped from requires improvement to inadequate. The ratings for safe and well-led have also dropped from requires improvement to inadequate. Responsive has dropped from good to inadequate. Effective and caring have dropped from good to requires improvement.
The service is now in special measures which means it will be kept under review and re-inspected to check that improvements have been made. If significant improvements have not been made, CQC will take further enforcement action.
Deborah Ivanova, CQC’s director for people with learning disability and autistic people, said:
“When we inspected Carrick, we were very concerned to find the service was regularly short staffed and often operating at minimum, and sometimes below, safe staffing levels. Some staff were working excessive hours, and one member of staff was routinely working in excess of 84 hours a week.
“I am really concerned to hear staff were working such long hours. This exposes people to risk of harm and poor quality of life and it resulted in the service being unsafely staffed on at least one occasion.
“It is particularly disappointing to find this was still an issue, as we told the provider they needed to address insufficient staffing levels after our last inspection. They responded by using agency staff to support the service, but some agency staff were having to work 14-hour shifts, which is far too long. This came to a head when one member of staff fell asleep while on duty. Although this was investigated internally, the provider failed to alert safeguarding authorities and had permitted staff to continue to work excessive hours.
“The acting manager had limited leadership experience and was often having to provide care and support to people due to the staffing issues. This meant they had little time to focus on making improvements in the service. We are aware that recruiting and retaining staff to work in adult social care has been particularly challenging for providers since the start of the Covid-19 pandemic, particularly in the south west. However, the provider should have intervened to support the acting manager and ensure the service was operating safely.
“As well as not having enough staff to keep people safe, staff shortages also meant people weren’t supported to be as independent as they could be or encouraged to learn and develop new skills. They were not always given help to wash and change their clothes, or to go out of the home when they wanted to. This had impacted on one person in particular and staff had identified possible causes of incidents as boredom and frustration that their freedoms were restricted.
“We heard routines were created in the service for the benefit of staff and not the people living there. For example, one person who needed more help to get up in the morning, was left in bed until staff had time to deal with them. All of this is indicative of an environment where the people living there become reliant on staff to meet their basic needs, instead of being supported to be as independent as possible.
“We have told the provider to make urgent improvements to ensure that people and staff are safe, and we will monitor the service closely to ensure these are made and fully embedded. If they are not, we will not hesitate to take further enforcement action.”
Inspectors found the following during this inspection:
- Leaders, and the culture they created, did not assure the delivery of high-quality care. The provider did not ensure that managers and staff were clear about their roles, and understood quality performance, risks and regulatory requirements.
- People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People were referred to by staff as a group, and not treated as individuals. Staff did not support people appropriately to make day to day decisions and choices. Low staffing level unnecessarily restricted people’s ability to leave the service when they wished.
- People did not consistently receive person centred care appropriate to their needs. Accurate care records were not being maintained.
- The provider’s quality assurance systems were ineffective and action plans developed to address issues identified at the last inspection had failed to drive improvements in the service’s performance.
- Safeguarding incidents had not always been shared with the local authority and the provider had not worked collaboratively with partners to ensure people’s safety.
- Risks in relation to scalding and hot water temperatures had not been appropriately managed.
- Inspectors identified issues in relation to the management of people’s financial affairs by the provider. They requested additional information to demonstrate people were appropriately protected from financial abuse, but this information was not provided.
- The service did not have effective systems in place to ensure all staff training was regularly updated and staff had not received regular supervision.
- The provider failed to promote people’s dignity by supporting and enabling them to have control of their diet, instead staff planner people’s meals with no input from them about what they would like to eat.
- The provider failed to learn lessons when things went wrong. Risk assessments completed following incidents had not been followed. This meant action had not been taken to minimise the risk of similar events reoccurring.
However:
- Staff were recruited safely. Necessary checks had been completed, before new staff started work, to ensure they were suitable for employment in the care sector.
- Care plans included information about events and incidents likely to cause people to become anxious or upset. This included details of possible triggers, descriptions of how they were likely to express their anxiety and guidance for staff on how they should respond to help people to manage their anxiety.
- Records showed physical restraint and other restrictions were used appropriately and for the minimum time necessary.
- Personal Emergency Evacuation Plans were available for everyone who lived at a Carrick. These documents provide staff and emergency personnel with guidance on the support people would need to evacuate the building.
- Accidents and incidents had been appropriately documented. Where injuries had occurred the records of these incidents had been reviewed by the provider. Some additional guidance or suggestions had been made on changes in approach that could be attempted.
- People received their medicines safely and as prescribed. Staff understood how to support people with their medicines and there were appropriate processes in place to ensure ‘as required’ medicines were used appropriately.
- People were supported to access health and care services as necessary and were appropriately supported to manage their oral health needs.
- The provider was effectively controlling and preventing the spread of infection and following government guidance in relation to care home visiting.
- Improvements had been made to the service’s environment.
- The provider had a system in place designed to ensure all complaints were recorded and investigated.
Full details of the inspection are given in the report published on our website.
Notes to editors
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