Carnalea Residential Home

Carnalea Residential Home is a care home providing personal care to up to 55 people. The service provides support to older people with varying care needs including, dementia, diabetes, Parkinson’s disease, epilepsy and mental health needs. At the time of our inspection there were 42 people using the service.

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

The provider had ineffective systems in place to monitor people’s safety and well-being. Risks were not always identified and mitigated against. Accidents and incidents were not effectively reviewed and monitored to learn lessons and minimise the risk of them happening again. Medicines were not always managed well. Systems to monitor people’s medicines were not robust to pick up issues, which meant people may not receive their medicines as prescribed and required.

New staff were not always recruited safely as there were gaps in their employment history and references were not robustly followed up.

Although there appeared to be sufficient staff on shift, some people told us they had to wait when they needed assistance. The provider did not have a system for measuring people’s assessed needs against the numbers of staff required to meet those needs. We have made a recommendation about staff deployment.

Systems to monitor the safety and quality of the service people received were not effective. Most audit systems were not completed and those that were, were not robust and did not identify concerns. Care plans did not provide the detail and guidance necessary to provide consistent care. Most people said staff were attentive and friendly, but some people felt they did not get the attention they needed. The provider did not have adequate management and oversight of the service.

The provider held meetings with people to hear their views and with staff to update information. The provider had not undertaken any surveys to gain feedback from people, relatives or others involved in the service.

People told us they felt safe and secure in Carnalea Residential Home. Staff understood how to protect people from abuse and knew how to raise concerns. The service was clean and safe infection control procedures were followed.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 March 2021).

Why we inspected

We received concerns in relation to leadership and governance and staff culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carnalea Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, medicines safety, staff recruitment and the monitoring of quality and safety at this inspection.

We have also made a recommendation in relation to staff deployment.

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.

Carnalea Residential Home is a residential care home providing personal care and accommodation for up to 55 people aged 65 and over. There were 38 people living at the service at the time of inspection.

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

People told us, “We are generally happy. The staff are amazing, they always get things sorted, there are no problems”. Another person told us, “It’s very clean, they are always cleaning”. A relative told us, “It’s a nice facility, not the plushest but it is a practical safe environment".

We have made a recommendation about the management of some medicines.

We have made a recommendation about updating records following equipment checks.

Electronic care planning systems had been in place since January 2021. Updated person-centred care plans and risk assessments had been created, detailing individual support needs and how to minimise risks to people.

Staff protected people’s privacy and dignity in their practice and encouraged people to maintain their independence by enabling them to do as much as possible for themselves.

Staff training was up to date and the service had used external healthcare professionals to assess competency in meeting specialist needs of people.

Improvements had been made to layout and design the communal areas, allowing for more choice and control as to how people wish to spend their time.

Social activities were limited due to the COVID-19 pandemic, however schedules maximised use of time available and were varied.

Food standards and selections had been improved with a new chef and a member of staff employed to support breakfast times. Mealtimes were observed and waiting times had been significantly reduced and people were given a choice regarding where they would like to eat.

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 registered manager had a positive approach to dealing with complaints.

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 6 June 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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carnalea Residential Home on our website at www.cqc.org.uk.

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.

Carnalea Residential Home is a residential care home providing personal care to up to 55 people aged 65 and over. There were 44 people living at the service at the time of inspection. People had varying care needs, including, living with dementia, Parkinson’s disease, epilepsy and diabetes. Some people could walk around independently and other people needed the assistance of staff or staff and equipment to help them to move around.

For more details, see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Meaningful activity to meet people’s individual needs to support their well-being and prevent the risk of social isolation was sometimes limited. One person said to us, “The lovely girl who does the games is frightfully jolly but there is often not much offered that I fancy joining in with, so I tend to stay in my room and feel a little cut off.”

Some people continued to wait long periods in the dining area before their meals were served. One person commented, “I would say there is quite a bit of waiting around for meals.” Some communal areas of the service were noisy, and people told us they were not happy with this.

Records to show how decisions were made on behalf of people who lacked capacity did not always evidence how particular decisions were made in their best interests.

Care records were not always accurately kept, and monitoring procedures did not always pick up where areas needed action taken to improve.

Improvements were needed to the recording of some individual risk assessments.

Processes used to check the suitability of new staff were not always robust enough to make sure only suitable staff were employed.

Staff did not always update their training in a timely manner to make sure their skills remained up to date. We have made a recommendation about this.

People’s personal toiletries were kept in communal bathrooms, increasing the risk of spreading infection. We have made a recommendation about this.

People could be assured their medicines were managed in a safe way.

Staff protected people’s privacy and dignity and supported and encouraged people to maintain their independence.

The provider now had enough staff to meet the needs of people living in the service, following a period of being short of staff.

The response to complaints had improved and a more positive approach was now taken by the provider and registered manager.

People said they felt confident to speak to the registered manager and raise any concerns they had.

Rating at last inspection: Requires Improvement (Report published 11 September 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: We inspected this service earlier than planned as we had received information from more than one whistleblower since the last inspection, raising concerns about people’s care.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Requires Improvement.

Carnalea Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Carnalea Residential Home provides accommodation and support for up to 55 older people. There were 48 people living at the service at the time of our inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had suffered a stroke, some people required support with their mobility around the home and others were able to walk around independently.

A registered manager was employed at the service by the provider. 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.

At our last inspection on 17 May 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated Requires Improvement.

Restricted visiting hours and areas where people could receive their visitors meant people’s rights and choices within their home were neglected.

Mealtimes were not organised to ensure a good experience for people eating their meal. People were not always satisfied with the food and choices available.

The verbal and informal complaints of people and their relatives had not been listened to. People were not happy with all aspects of the service provided. Complaints were not seen as an opportunity to make improvements to the service provided.

The provider and registered manager missed opportunities to make improvements as their monitoring systems did not identify all the areas that required further development to enhance the lives of people. An open and listening culture had not been created to ensure people’s basic rights were at the forefront of the service provided.

Risk assessments around people’s personal care needs were in place. However, these did not always reflect individual or changing needs. Fire evacuation drills were not carried out regularly as advised by the Kent Fire and Rescue service.

The design and decoration of the premises did not support a dementia friendly environment. We have made a recommendation about this.

People’s care plans did not always address all their individual needs or their personal histories. Care plan reviews were carried out but did not always take into account people’s changing needs.

Staff knew their responsibilities in keeping people safe from abuse. Procedures were in place for staff to follow and staff were able to describe these.

Accidents and incidents were appropriately recorded by staff, action was taken and followed up by the registered manager.

The procedures for the administration of people’s prescribed medicines was still managed and recorded appropriately so people received their medicines as intended. Regular audits of medicines were undertaken to ensure safe procedures continued to be followed and action was taken when errors were made.

The registered manager carried out an initial assessment with people before they moved in to the service. People were involved in the assessment, together with their relatives where appropriate.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Some improvements were required to ensure people’s basic rights were understood by the registered manager and staff.

People had access to a range of activities to choose from. Some people preferred their own company and pursued interests such as reading or watching TV and this was respected by staff.

People were supported to gain access to health care professionals when they needed advice or treatment. The registered manager had developed good relationships with local health care professionals and referred people when they needed.

There continued to be evidence of the caring approach of staff. People and their relatives described staff as caring, saying they were confident in the care they received. Staff knew people well and were able to respond to their needs on an individual basis.

People had the opportunity to develop end of life care plans to outline their wishes if they chose to.

Suitable numbers of staff were available to provide the care and support people were assessed as requiring. The provider continued to make sure safe recruitment practices were followed so only suitable staff were employed to work with people who required care and support.

Staff told us the registered manager and provider were approachable and listened to their views and suggestions. Training was up to date and staff were encouraged to pursue their personal development. Staff continued to have the opportunity to take part in one to one supervision meetings to support them in their role. Staff meetings were held to aid communication within the team and to provide updates and feedback.

All the appropriate maintenance of the premises and servicing of equipment was carried out at suitable intervals.

The provider had displayed the ratings from the last inspection, in May 2016 in a prominent place so that people and their visitors were able to see them.

During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 17 and 19 May 2016. The inspection was unannounced.

Carnalea residential home is registered to provide accommodation and personal care services to up to 55 people. There were 43 people living at the home on the day of our inspection.

Many people living at the home required full support with their personal care and others could lead a more independent life with minimal support. The home had been extended to provide more space and larger rooms. The newer, extended part of the home was well planned, bright and airy where all rooms had en-suite facilities. The older, original side had character with well kept original features. Doors led out to beautiful gardens with comfortable garden furniture, well used by people. It was a lovely sunny day on the day of our inspection and people were sitting outside enjoying the sunshine. The gardens included a well maintained functioning vegetable patch for the benefit of people living at the home.

Although a manager was employed, they had not yet registered with the Care Quality Commission. They had however started the application process. 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.

People and their relatives told us they felt safe living at Carnalea. They knew who to speak to if they had any concerns and were confident they would be listened to. Staff were clear of their responsibilities in keeping people safe from abuse and knew how to report concerns and who to. Individual risk assessments were carried out with people to ensure their safety was maintained when receiving care and support. These were reviewed regularly so any changes in people’s needs were identified and managed appropriately.

People’s care and support needs were assessed before moving into the home so the manager could be sure they were able to cater for the needs of the individual. Following this, care plans were developed with the involvement of people, and their relatives where appropriate. Care plans recorded the step by step guidance for staff in how to provide individual care to each person. These were reviewed regularly to make sure they were up to date in order to provide the right care at all times.

There were suitable numbers of staff to be able to provide the personal care people had been assessed as needing. Care staff were not expected to undertake cleaning or cooking duties as experienced cooks and domestic staff were employed. This meant care staff could concentrate on providing the care people required. Safe recruitment methods had been used when employing new staff to make sure only suitable staff were employed.

A training plan was in place and all staff received the training they required to carry out their role well. Staff told us how they had been encouraged and supported to progress up the career ladder within the home. Staff were supported through one to one supervision sessions and regular staff meetings, giving them the opportunity to raise concerns or to make suggestions for improvement.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The manager had taken steps to comply with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. People were not being restricted and their rights were being protected.

People and their relatives said the staff had a caring approach and looked after them well. There was a good atmosphere in the home where people and staff appeared happy and relaxed. Dignity and privacy was respected by staff who understood the importance of this to maintain people’s self-respect.

People were happy with the activities on offer and there was plenty to choose from. An enthusiastic activities coordinator looked for new activities to introduce and gained people’s ideas in order to implement them. These were planned ahead and people were given information so they were able to decide what they might like to join in.

Accidents and incidents were investigated and responded to well as were complaints, although there were few of these. The registered manager and the provider took the opportunity to learn from incidents that had happened to be able to prevent similar things happening in the future and to improve the service provided.

Surveys were carried out each year to gain the views of people. The provider carried out an analysis of the results to provide feedback and to make improvements where necessary. The provider produced a newsletter monthly and amongst other things, feedback from surveys was reported.

People, their relatives and the staff thought the home was well run and the manager was approachable and supportive. The provider was talked about positively by staff and was evident in the home every day, providing support to people and staff.

We observed that staff treated people with dignity and respect. Staff were polite and interacted well with people. Staff understood the needs of the people who lived in the home.

People who lived in the home told us they felt well cared for and comments included, "I am very lucky here. You can always have a laugh and joke with the staff”. “They always knock on my door before they come in”. “I feel I am well cared for”. Relatives spoke positively about the care their loved ones received.

Staff understood the importance about giving people choices and listening to what they had to say.

The service had effective systems in place for minimising risks associated with infection control. All areas of the home were clean, there were no unpleasant odours, and staff received regular training updates to refresh their knowledge.

There were appropriate recruitment procedures in place. Staff had received induction and training appropriate to their role.

People knew who to talk to if they had any concerns about the service and were confident they would be dealt with.

There was an effective system to regularly assess and monitor the quality of service that people received.

People we spoke with all told us that they were happy in the home and that they felt that they were well looked after. Comments included "I am well cared for and glad I moved in here" and "I get lots of care".

Relatives we spoke with told us they were happy with the care provided to their loved ones. They said, "I am happy I found this home, they are very supportive" and, "You have to give credit where credit is due, they really look after everyone here".

People who lived in the home were treated with dignity and respect. People were offered choices in their daily lives, although care plans did not always formally record the decision making process.

People's needs were assessed before moving into the home. We observed that staff read and understood care plans which meant that they knew what care and support to provide to people.

People told us that they felt safe in the home and staff understood their roles in relation to protecting people.

We saw that people were provided with a range and choice of meals.

People were supported by a stable staff group in sufficient numbers, who understood the different needs of the people they cared for.

People we spoke with did not have any complaints about the service and were confident that if they had any concerns they would be dealt with immediately.