Archived: Carr Hall Care Home

Updated 2 November 2017

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 08 and 11 September 2017, and on 09 October 2017 and the first day and 09 October were unannounced. The inspection team consisted of one adult social care inspector, one assistant inspector and one expert by experience who had experience in the care of an adult 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 service.

We had asked the provider to complete a Provider Information Return (PIR) prior to our inspection. 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. They completed the PIR which we reviewed and took into account when we made the judgements in this report.

Before the inspection we gained feedback from health and social care professionals who visited the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts and statutory notifications sent to us by the registered provider, about significant incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law. We reviewed information from the local commissioning group and the local authority. We also looked at information that had been shared with us from other professionals and comments and feedback that we had received from staff, relatives and visitors of people who lived at Carr Hall Care Home.

During the inspection we spoke with 10 people who lived at the service and two visitors. We spoke with five care staff, maintenance staff, the nominated individual, the registered manager and two directors from the company that operate the service. We observed staff providing care and support to people over the two days of the inspection and reviewed in detail the care records of six people who lived at the home.

We carried out observations of staff interactions, walked around the building to see if it was safe and clean for people who lived there. We also looked at service records including four staff recruitment files, supervision and training records, policies and procedures, complaints and compliments records, records of quality and safety audits completed and fire safety and environmental health records.

Updated 2 November 2017

This inspection was carried out on 08 and 11 September 2017 and was unannounced on the first day. Following our inspection visit in September 2017, we took action to restrict new admissions and asked the provider to complete an action plan on what actions they would take to address the concerns we found. A further unannounced visit was undertaken on the 09 October, 2017 to review the actions that the provider had taken.

We last inspected Carr Hall Care Home in July 2016. At that inspection, we found that people's safety was being compromised in a number of areas. This included how people's medicines were managed, managing risk of fire and infection, a lack of person centred care, safe care and treatment. There was also a failure to ensure staff received appropriate support, training, supervision and appraisal, a failure to undertake robust employment checks and a failure to provide good governance. Following that inspection the provider sent us an action plan detailing the improvements they would make in the home.

During this inspection we reviewed actions the provider told us they had taken since our last inspection to gain compliance against the breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified.

During this inspection we found the governance arrangements in the home were not effective enough to rectify the breaches found at the previous inspection. Insufficient improvements had been made and the provider had not followed the action plan and undertakings that they provided us after July 2016 inspection. The provider was still in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, safe care and treatment, staffing, fit and proper persons and good governance.

We found that there had been a further deterioration in the quality of care in other areas, which meant the provider was in breach of a further three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to seeking consent, maintaining the premises and equipment and failure to notify Care Quality Commission of significant events that affected the smooth running of the service. This meant that risks to people had increased.

Enforcement action was taken by the Commission in light of the significant work needed within the home to improve the quality and safety of the service being provided. The enforcement action was to prevent the service provider admitting new people to the home whilst those changes took place.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Carr Hall care home is registered to provide accommodation and personal care for up to 23 who are older people, have a physical disability or people living with a dementia. Nursing care is not provided. All rooms were of single occupancy and of these six were ensuite. Bedrooms were located across two floors of the home. At the time of our inspection there were 20 people who lived at the home.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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’s medicines had not been managed safely. Guidance for safe management of medicines had not been followed which included secure storage of medicines and a lack of robust recording for topical creams and thickening powders. The systems in place to monitor the use of medicines were not effective and regular medicines audits had not been conducted. Our visit on the 09 October 2017 identified that support had been provided by the local Clinical Commissioning Group and issues we identified had started to be addressed. An action plan had been provided by the medicines management team. The registered manager had started to address some of the concerns found however no formal medicines audits had been undertaken.

Risks to people were not managed in a safe way. People were offered an inconsistent approach following head related injuries as there was no clear guidance in place for staff to follow. We saw no evidence to demonstrate that action had been taken to seek advice from medical professionals after people had incurred head injuries. People could not be assured that they would receive appropriate support following a fall. During our visit of on 09 October we found that a falls management policy had been put in place and up to date falls protocols had been introduced and staff had started to follow these. However this needed time to be embedded to ensure consistence.

We looked at the risk assessments in place for people who used the service and these included skin and pressure area care, falls, moving and handling, mobility and nutrition. However we found shortfalls in other areas of risk management, including a failure to provide staff that were first aid trained. The risk assessments had not been completed and reviewed consistently when people’s needs had changed. We found similar inconsistencies with care plans.

When potential safeguarding incidents had been recorded we did not see these had been reported in line with local safeguarding procedures. There was safeguarding policy however this was not robust and did not reflect current practice and legislation. A significant number of staff had not received training in safeguarding adults. However staff we spoke with showed awareness of signs of abuse and what actions to take. During our visit of on 09 October we found that staff had received first aid training and risk assessments for two people at risk of choking had been updated and those at risk of falls had been referred to relevant professionals. However a significant number of care records were yet to be reviewed. The local authority safeguarding team had visited the home and were reviewing risks in the service.

People were not effectively protected in the event of a fire. Building fire risk assessments and Personal Emergency Evacuation Plans (PEEPS) were in place. However no fire drills had been undertaken since February 2014. We had previously asked the provider to take action about this during our inspection in July 2016. At this inspection in September 2017 we found there were obstructions on fire exits and fire doors had been wedged. We reported our findings to the service to the local fire safety department. During our visit of on 09 October we found that a fire safety inspection had been carried out by the fire safety officers. The fire safety officers found several concerns including shortfalls in the fire risk assessment, the fire doors and poor fire safety practices. They requested the provider to take action. On our visit on 09 October we found the provider had started to address some of the concerns however these had not been completed.

The provider had not adequately maintained and repaired the premises in a timely manner. We found the roof had been leaking for approximately 19 months. Attempts to repair had been made however we expected this to have been rectified. The water pressure in some rooms was very low preventing people from having access to hot water. Equipment had been maintained and serviced in line with regulations and manufacturer’s recommendations. Infection control measures were not robust and required further improvements. The premises had not been adapted to ensure that they were dementia friendly. During our visit of on 09 October we found the roof had not been fixed however the provider had ordered materials required to fix the roof. They informed us they had been a delay with the delivery. An electrician had assessed the risk of water ingestion in the electric systems and isolated the light fittings in the area affected. A specialist had reviewed the concerns with water pressure and ongoing investigations on how to rectify this were ongoing.

Safe recruitment practices were not always followed to help ensure only suitable people worked in the home. Guidance on safe recruitment had not always been followed.

People using the service had access to healthcare professionals as required, to meet their needs. We found