We carried out a review of the data available to us about Caroline House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caroline House, you can give feedback on this service.
We found the following examples of good practice.
Measures were in place, and clearly communicated, to prevent relatives & friends, professionals and others visiting, from spreading infection at the entrance and on entering the premises. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home.
People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection. Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using video calls, regular newsletters to family members, visiting in the communal garden or through meeting at a closed window.
A testing scheme for all staff and residents had been implemented, known as ‘whole home testing’. The provider undertook regular 'whole home testing' as well as testing any suspected or symptomatic residents or staff. People and staff had individual risk assessments in place, and adjustments had been made.
Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading to other people and staff members. Staff had received training from an infection control specialist. Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.
Communal areas such as the dining area and office were used creatively to help with infection and prevention control (IPC) and social distancing. For example, the office had been re-arranged providing an area for staff to complete training and have breaks safely.
The provider had supported people using their preferred communication methods to share key information about the pandemic and ensure people’s wellbeing was supported. For example, through social stories and easy read documentation. Easy read refers to the presentation of text in an accessible, easy to understand format.
The provider had strengthened their community links during the pandemic. For example, the local GP surgery had implemented a weekly call with the service to ensure people continued to have access to their services and had their healthcare needs met.
Contingency plans were in place to manage ongoing or future outbreaks or other events effectively. The provider collected data and regular reports from the service. To support the service during the outbreak of coronavirus, tasks that could be completed remotely were delegated to other skilled employees within the organisation. This was a supportive measure for the registered manager and staff team to support their well-being during the outbreak.
Following the outbreak of coronavirus within the service, the registered manager participated in a review of their experience and management of the outbreak to identify good practice, lessons learnt and recommendations. This was then shared and implemented across the organisation in all their services.
Further information is in the detailed findings below.
Caroline House is an nine-bedded residential care home that was providing personal care to people who have a learning disability, sensory impairment, physical disability and health care needs.
The service was registered to provide support to up to nine people and there were nine people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the provider had arranged this service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.
People’s experience of using this service and what we found
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
We observed sufficient staffing levels during the inspection and saw staff were unhurried in their interactions with people. The provider had appropriate policies and systems in place to protect people from abuse. Staff received regular support and supervision and were trained to meet the needs of people living at the service.
People received their medicines as prescribed and there were safe medicines administration systems in place. The home was clean and tidy, and staff were trained in infection control. The provider had processes in place to learn from incidents and accidents and to ensure that people were supported safely.
Comprehensive care plans identified people's needs and the choices they had made about the care and support they received. The provider supported staff to deliver care and support in line with best practice guidance and to support good outcomes for people. The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when they needed it. People told us they liked the food and had enough to eat and drink.
There was a strong emphasis on person-centred care. Staff were friendly and caring when supporting people and staff spoke about people with genuine interest and affection. Staff proactively supported people using their preferred communication methods to be involved in making decisions about their care. People were supported with individualised activities.
The provider had an ‘open-door’ culture and staff were positive about the registered manager. The registered manager demonstrated an open and positive approach to learning and development. There was a strong culture of organisational learning to help drive ongoing improvements. People and staff were encouraged to regularly feedback about service delivery and share ideas and suggestions on how the service could be improved.
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 12 February 2019) and there were multiple breaches 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 we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Rating at last inspection: Good, published 13 June 2017
About the service: Caroline House is a residential care home that was providing personal care to eight people living with a learning disability at the time of the inspection.
Why we inspected: This was a comprehensive inspection brought forward due to information of risk or concern. The inspection was partly prompted by an incident which had a serious impact on a person using the service and that this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of the specific incident, which may be subject to criminal investigation, we did look at associated risks.
Follow up: As the service is rated as requires improvement, we will request an action plan from the registered provider about how they plan to improve the rating to good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.
More information is in Detailed Findings below.
Caroline House is a service registered to provide accommodation for nine people with a learning disability. On the day of our visit there were eight people living at the home. Care was provided over two floors in the main house and in a separate bungalow in the garden. The home is located in a residential area close to community facilities.
The service 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 and associated Regulations about how the service is run.
People told us that they felt safe. Staff knew how to safeguard people from potential abuse and how to raise any concerns appropriately.
People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had been minimised to better protect people's health and welfare.
The provider had robust process in place for the safe recruitment of staff. Records demonstrated appropriate checks were undertaken to ensure staff were suitable for the role they were employed to undertake. There were enough staff deployed to meet the care and support needs of the people living in the home.
The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People had been involved in their meal choices and we saw they had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.
The provider had provided staff with appropriate support through induction, supervision, annual appraisals and training.
People had developed very caring relationships with each other and the staff. People and their relatives were extremely positive about the staff that supported them. Staff took time to chat to people and show interest in how they spent their time. People were encouraged to make their own day to day decisions about their care and maintain as much independence as possible.
Staff told us the registered manager demonstrated open and supportive leadership. The culture of the service was person centred, open and transparent.
Complaints policies and procedures were in place and were available to people and visitors. People told us they were confident that they could raise concerns or complaints and that these would be dealt with accordingly.
Caroline House is a service which is registered to provide accommodation for nine people with a learning disability who require personal care. There were 14 members of staff plus the manager who provided support for people. On the day of our visit there were eight people living at the home. Care was provided over two floors in the main house and in a separate bungalow.
The last inspection was carried out in October 2013 and no issues were identified. This inspection was carried out on 22 October 2014 and was unannounced.
The service did not have a registered manager, however an application had been submitted to the Care Quality Commission and was under consideration. 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 and associated Regulations about how the service is run.
People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults and staff had a good awareness of the correct procedures if they considered someone was at risk of harm.
Care records included guidance for staff to safely support people. People had risk assessments and risk reduction measures for staff to follow.
People told us the food provided was plentiful and good. People had a meeting each week to plan menus and staff provided support to people to help ensure meals were balanced and encouraged healthy choices.
Recruitment checks were carried out on newly appointed staff so people could be confident they received care from suitable staff. Records confirmed all the required recruitment checks had been completed. Staffing numbers were maintained at a level to meet people’s needs.
The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). CQC monitors the operation of DoLS which applies to care homes. Whilst no-one living at the home was currently subject to DoLS, the manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS.
People were supported to take their medicines as prescribed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely.
Each person had a plan of care that gave staff the information they needed to provide support to people. Staff received specific training to meet the needs of people using the service. Staff were able to develop their skills by means of additional training. Relatives said the staff were knowledgeable and people said they were well supported by staff.
Privacy and dignity was respected and staff had a caring attitude towards people. To provide additional support each person was allocated a key worker (A key worker is a person who has responsibilities for working with certain individuals so they can build up a relationship with them. This can help and support them in their day to day lives and give reassurance to feel safe and cared for).
Staff were observed smiling and laughing with people and supporting them to take part in a range of activities inside and outside the home. People attended day services and two people attended an evening class at a local college.
There was a policy and procedure for quality assurance. Quality audits were completed by the manager. These helped the manager and provider to monitor the quality of the service provided to ensure the delivery of high quality care..
The provider had also achieved ISO 9000 which is an external quality management accreditation. Obtaining this accreditation helps the provider to focus on continually improving the service it provides for its staff and for the people who use their services.
The service delivery was open and transparent and the manager said they operated an open door policy and welcomed feedback on any aspect of the service. There was a stable staff team who worked well together and they confirmed they were well supported by the manager. People and staff were provided with opportunities to make their wishes known and to have their voice heard.
We spoke with the other four people generally, and where possible obtained their views. We observed how staff supported people, talked with staff, and looked at records. We spoke with two relatives of people and they told us that they were very happy with the support and care their relative received from the home. They said they were involved with reviews, and said that they thought the staff did a great job. We spoke with three members of staff. They told us they liked working at the home and that they felt it offered a good service to the people that lived there. Staff said they felt supported and knew who to go to if they had concerns. We looked at the care records for five people who used the service. Each person had an assessment of their needs, and a care plan including risk assessments. The area manager told us that all staff attended a comprehensive training programme to ensure that they were capable of delivering the service identified for the people that lived at the home.
You can see our judgement on the front page of this report
We also spoke with three relatives of people and they told us that they were very happy with the care and support their relatives received. They said that they were consulted about the care and support their relative received and that they were invited to reviews of their relatives' care. Comments included: 'A lot of positive changes have taken place since my relative moved to Caroline House', and, 'The staff always keep me informed of any changes and my relative is very happy at Caroline House'.
Relatives told us that they knew how to make a complaint if they needed to and said they were confident that any complaints would be dealt with appropriately.
We spoke with four members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.