Archived: Cairn House

Updated 25 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.

The inspection took place on 13, 20 and 21 September 2017. The first day of the inspection was unannounced.

The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC).

Before commencing the inspection we looked at information we held about the service. This included notifications that had been received. A notification must be sent to the Care Quality Commission every time a significant incident has taken place, for example where a person who uses the service experiences a serious injury. We checked any complaints, whistleblowing or safeguarding information sent to CQC. We also contacted the local authority and mental health commissioning team to request any information they had about the service.

During the course of the inspection we spoke to the owner, registered manager and two staff members. We also spoke to two people who lived at the home.

We looked around the home, including communal areas and people’s bedrooms. We viewed a variety of documentation and records. This included four staff files, three care plans, Medication Administration Record (MAR) charts, policies and procedures and audit documentation.

Updated 25 November 2017

We carried out an inspection of Cairn House on 13, 20 and 21 September 2017. The first day of the inspection was unannounced.

Cairn House is a care home providing personal care and accommodation for up to five adults with a mental health need. The home is a large semi-detached house situated on the main bus routes close to a busy slip road leading off Eccles Old Road onto the A6. The driveway and back garden are shared with the house next door, Lancaster House, which is also a care home owned by the same provider. At the time of inspection five people were using the service.

The home was last inspected on 25 and 27 January 2017, when we rated the service as ‘requires improvement’ overall. We identified nine breaches in six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including continuing breaches relating to premises and equipment, staffing and good governance along with additional breaches relating to safe care and treatment, management of medicines, person-centred care and receiving and acting on complaints.

We took enforcement action and issued the provider and registered manager with a warning notice in regards to good governance, to formally request action be taken to ensure quality assurance and auditing systems were in place and being utilised. We also asked the provider to take action to ensure people were actively involved in their care, ensure staff received the necessary support and professional development to enable them to carry out their roles effectively, assess the risk of and control the spread of infections, ensure the proper and safe management of medicines and ensure they had an system for the identifying, receiving, recording and handling of complaints.

At this inspection we identified five continuing breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including breaches relating to, staffing, safe care and treatment, management of medicines, person-centred care and good governance, two additional breaches in relation to safe care and treatment and record keeping along with one breach of the Care Quality Commission (Registration) Regulations 2009, due to a failure to inform the Commission of a notifiable incident. We also made two recommendations in regards to following best practice in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and investigating systems to evidence sufficient staff are employed to meet people’s needs. We are considering our enforcement options in relation to the regulatory breaches found.

At the time of the inspection the home had a registered manager. 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.

We found remedial action had been taken to address previously identified issues with the overall décor and maintenance of the property. A schedule of works had been produced, which the provider and registered manager had overseen. Bedrooms and bathrooms had been re-decorated, damaged or broken fixtures and fittings had been replaced and attempts to de-clutter communal areas had taken place. We noted work was ongoing and the replacement of carpets had purposefully been left until last, to ensure all building and painting tasks had been completed.

We saw staff continued to be responsible for cleaning tasks, with checklists in place detailing what tasks were required in each room. Cleaning equipment was stored safely and securely and Control of Substances Hazardous to Health (COSHH) forms were in place for the cleaning products in use. We noted the provider had installed paper towel dispensers in bathrooms, to replace cotton hand towels. However hand hygiene guidance was not in place and liquid soap bottles were still being used rather than wall mounted soap dispensers.

We identified some issues during our review of medicines management. We saw the service continued to not use ‘as required’ medicine protocols or topical medicine charts. Daily audits of the Medicine Administration Record (MAR) charts had also not been completed consistently. We identified some aspects of good practice especially around the receipt and booking in of medication.

Each person we spoke with told us they felt safe. The home had safeguarding policies and procedures in place, although did not have a dedicated safeguarding file and log of referrals, with referrals stored electronically in email folders. Staff had been trained in safeguarding vulnerable adults and had knowledge of how to identify and report any safeguarding or whistleblowing concerns.

People who used the service and staff we spoke with felt there was enough staff on shift, this was due to people reportedly being very independent and requiring minimal assistance. However the home did not have a system or tool in place to show staffing levels met the dependency levels and needs of people using the service.

We looked at three care files in detail, which were stored electronically on a laptop. We found limited improvements and additions had been made since the previous inspection, with gaps in information and an overall lack of detailed guidance for staff to follow, to ensure people’s needs were being met. We saw mental health care plans and risk assessments had been created to sit alongside people’s existing care plans; however at time of inspection these had not been implemented.

We found the service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Training in both areas had been facilitated and staff had a reasonable understanding of both sets of legislation. However we did not see any evidence of a MCA / DoLS policy in place.

Staff told us training had improved with a number of sessions being held over the last six months. These included training in mental health awareness, which is imperative to the nature of the service and had been a noticeable omission at the previous inspection. Although the training matrix had not been fully updated at time of this inspection, we were still able to confirm sessions had been held. Following the inspection the registered manager updated and forwarded evidence of this to the us.

The provider’s action plan following the inspection in January 2017 stated staff would receive supervision on a bi-monthly basis, however our review of staff records demonstrated this was not being done. Whilst there had been an increase in the frequency of meetings, staff had only completed two meetings since January.

People told us they enjoyed the food provided by the service and received enough to eat and drink. People could choose when and where to eat, with meals being prepared for people to eat later, if they did not wish to eat at the allocated meal time.

Throughout the inspection we noted a relaxed, yet positive atmosphere within the home. People we spoke with were complimentary about the staff and the standard of care received. Resident meetings had been held and people were offered the opportunity to suggest agenda items, as well as being informed about things relating to the home.

We saw a new auditing and quality monitoring system had been introduced, which had been designed by the provider. However this had not been used fully or effectively and none of the issues noted during inspection had been identified by the registered manager or the auditing process.

We noted some issues in fire safety processes when reviewing safety procedures and checks. Not all checks had been carried out in agreed timescales and personal emergency evacuation plan (PEEPS) were still not in place.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after an