Caritate Nursing Home

Updated 4 March 2023

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 Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Inspection team

The inspection was carried out by one inspector.

Service and service type

Caritate Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we sought feedback from the local authority, and we reviewed the action plan provided. We reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed 2 people's care plans and risk assessments. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service. We spoke with the 2 providers.

Updated 4 March 2023

About the service

Caritate Nursing home is a residential care home providing personal and nursing care to up to 24 people. The service provides support to people of all ages with a range of health needs, physical disabilities and people living with dementia. At the time of our inspection there were 22 people using the service.

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

Medicine records were not always accurate. A recommendation, which was made in our last report, had not been actioned and the same concerns remained. Some people did not receive their medicines as prescribed. A recent audit had not identified the issues found at this inspection.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; there was a lack of policies and systems in the service to support best practice. Some people were being restricted without an appropriate authorisation. The registered manager did not have a thorough understanding of the legislation laid out in the Mental Capacity Act 2005.

Staff had not been provided with regular supervision and appraisal. Training updates had not always been provided in a timely manner. The registered manager did not have access to some specific training details of the staff as they were held on a different system on another member of staff’s computer.

Nurses professional registration details with the Nursing and Midwifery Council (MNC), required for them to practice, were not routinely monitored. Risks were not always identified or safely managed. Staff did not always have the necessary guidance in care plans to help them support people to reduce the risk of avoidable harm.

Everyone in the service had a care plan. However, it was not always clear from people’s care plans if they required specific care or monitoring. Monitoring charts were not formally checked regularly, so any gaps or concerns would not be identified in a timely manner. Some guidance in care plans was not always being followed by care staff. Staff were not always aware of people’s specific care needs.

People’s communication needs were identified. However, care plans did not contain adequate specific guidance for staff around supporting people who did not have the ability to communicate verbally.

Care plans did not always contain direction for staff regarding the provision of oral care for people who were not having any food or drink orally. However, we were shown that staff were recording when they carried out mouth care on room-based records.

Infection control processes and procedures were not always robust. Prior to this inspection the registered manager had agreed to all staff dispensing with the wearing of face masks, even when working closely with people such as during personal care. This was not in line with the current guidance. The registered manager took advice and re-instated the wearing of masks immediately upon the inspector’s arrival.

There was a lack of robust governance of the service provided. The registered manager had delegated most audits and processes to other staff but did not have oversight of their actions or the information gathered.

There was a designated activities staff member to assist people. However, some people reported being bored and we saw no activities taking place during this inspection. Interactions between staff and people was task based.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The registered manager was not aware of the guidance and people were not being supported in line with the underpinning principles of Right support, right care, right culture. Although other agencies had provided additional support and guidance, specifically for these people, this had not been implemented or used to improve people’s experiences. They were not given opportunities to access their local community or take part in meaningful pastimes that mattered to them. Staff did not have the necessary skills to effectively engage with them.

Some people living at the service were cared for in bed due to their health care needs. These people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. These mattresses were set correctly for the person using them.

People told us they were happy with the care they received, and people said they felt safe living there. Staff knew how to keep people safe from harm.

People looked happy and comfortable with staff supporting them. Staff were caring. People were supported by staff who knew them well. Many staff had worked at the service for a long time.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (Published 28 November 2017). At this inspection the rating has deteriorated to requires improvement

Why we inspected

We received information of concern in relation to the governance of the service, staff support and restrictions in place for some people that may not have been appropriately authorised. We carried out a focused inspection covering Safe, Effective and Well led.

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caritate Nursing Home 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 monitor the service and will take further action if needed.

We have found breaches in relation to medicines management, consent, staff support, and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.