Archived: Cartref Residential Care Home

Detailed findings

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found the service was not safe. Staff had a lack of understanding and knowledge of safeguarding which meant people were not protected from the risk of abuse. We found evidence of institutionalised practices and inappropriate communication which showed a lack of respect towards people and undermined their dignity. Staff told us they felt some people were being bullied and the records showed instances where people had not been allowed to do something because of the way they had behaved. As a result of this we notified the safeguarding team at the local authority.

We found people's lives were restricted by the routines imposed on them which were for the benefit of the staff rather than the needs and preferences of people who used the service.

We found there were insufficient staff to meet people's needs and there was no evidence to show staff had received the training they required to ensure they were skilled and qualified to meet people's needs. There was no call bell system in place for people to be able to summon help easily from staff, particularly at night when there was only one 'sleep in' staff member on duty. One person told us they would have to shout for help if they needed it at night.

We found the location was not meeting the requirements of the Deprivation of Liberty Safeguards. We found the manager and the staff showed a lack of understanding of their duties and responsibilities under the deprivation of liberty safeguards.

Is the service effective?

The provider did not support staff to deliver care to an appropriate standard. Staff we spoke with showed a lack of understanding of best practice when caring for people with learning disabilities.

Recruitment processes were satisfactory and records showed appropriate checks were being carried out before staff started work. However the provider was not able to provide evidence to show that appropriate induction and ongoing training was being delivered to staff. Staff had received regular supervision sessions with the manager but had not received appraisals.

Is the service caring?

We spoke with six people who used the service and they told us they were happy with the care and support they received and enjoyed the activities they took part in at the provider's local community centre. We spoke with one relative who described the home as 'absolutely wonderful'.

We found the care was not person-centred and people's choices and preferences were not always taken into consideration. People were not given opportunities to access community services individually or independently. We found people were not always treated with respect and observed practices that undermined people's dignity.

Is the service responsive?

The service sometimes responded to people's views but this did not always happen. People's lives were restricted as staff were avoiding risks rather than working with people to manage the risks. We found people's daily lives were organised on a group basis which meant everyone did everything together including holidays, activities and shopping. We saw people had requested to do activities independently but this had not been facilitated.

We found shortfalls in the care records which we considered could impact on the care people received. One person who was staying at the home for a short break had no care or support plan. Another person had sustained several falls yet there was no risk assessment or care plan to guide staff or show how the risk was being managed.

People had health action plans but these were blank or partially completed. These should identify the actions needed to maintain and improve the health of the person.

Is the service well led?

We found leadership in the home was poor. Staff were relying on intuition to provide care and support rather than being guided by good practice, which resulted in poor outcomes for people who used the service. There were no effective systems in place to monitor the quality of service people received. There was no evidence to show that people were actively involved in making decisions about care or their daily lives.

We found maintenance works were not being dealt with in a timely manner. We found other health and safety matters which concerned us and following our inspection we contacted other agencies who carried out visits to check the premises were safe and meeting requirements.

People were very positive about their care and told us they liked the staff. One person said 'I didn't like where I was before but I really like living here'. Another person said 'I like going out, we have fun here'. One person said 'I like my room and the posters I've got'. Another person said 'The food is good, my favourite is the lasagne'.

People told us about how they spent their days and were enthusiastic about the different activities and interest they had. Some of the events they told us about were takeaway evenings, film nights, going out to and meeting people at a social event on a Friday night and arts and crafts sessions at a local centre during the week.

People described the staff as 'great', 'really nice' and said that 'they'll always help you'.

We found that people's care records were being updated and reviewed by the provider.

There were good systems in place for managing medications and recruiting staff, which means that people in the home are kept safe.

There was evidence to show that quality assurance systems have been put in place to ensure people are receiving a quality service.

We spoke to people who used the service and they told us that they had been included in decisions about what care and support they received and when this would be available. They told us that 'I love living here, it's fantastic' and 'the staff are lovely, I have chosen how I wanted to decorate my bedroom and we all decide what meals we have'.

We spoke with two members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Cartref. They told us that they were well supported by managers of the home and there were good opportunities for training.

Cartref is a small family run home; we had no concerns about the quality of care and support people received but in order to safeguard people from harm more robust quality monitoring systems need to be implemented as well as some improvements to care plans and risk assessments.