Carisbrooke

Carisbrooke is a residential care home providing personal care and accommodation for up to 12 people who may be living with a learning disability and autistic people. Accommodation is provided over 3 floors. At the time of the inspection 10 people were using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were not supported to have maximum choice and control of their lives, staff did not support them in the least restrictive way possible and in their best interests; policies and systems in the service did not support this practice. Staff did not always follow the Mental Capacity Act key principles when making best interest decisions.

Medicines were not always managed safely. The provider did not give people care and support in a safe, clean, well equipped, well-furnished and well maintained environment that met their sensory and physical needs. Some areas of the home were visibly dirty.

Right Care

The provider did not ensure they always had enough appropriately skilled staff to meet people's needs and keep them safe. People could not always take part in activities and pursue interests that were tailored to them. The provider did not give people opportunities to try new activities that enhanced and enriched their lives.

Staff did not always receive training to enable them to meet the needs of people and keep them safe. However, we observed kind and caring interactions between people and staff during inspection.

Right Culture

There was a lack of effective monitoring in place and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection. There was a lack of oversight and leadership within the home.

People were not involved in developing the service. We have recommended the provider seeks advice and guidance to meet people's sensory and emotional well-being needs. The culture of the service did not always enable staff to continuously learn and improve. For example, lessons learned from incidents were not always analysed and shared with staff.

The service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture. Staff were not aware of the right support, right care, right culture guidance.

The manager was open and responsive to concerns raised during the inspection.

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

Rating at last inspection

The last rating for this service was good (published 7 August 2019).

Why we inspected

We received concerns in relation to health and safety, risk management, infection control and good governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

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, effective and well-led sections of this full 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 Carisbrooke on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk management, consent, infection control and good governance at this inspection. We have also made a recommendation in relation to training, design and decoration to meet people’s needs.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Carisbrooke is a care home providing personal care and accommodation for up to 12 people, who may be living with a learning disability. At the time of the inspection nine people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Carisbrooke is a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service

Maintenance issues were not always reported to ensure these were addressed promptly. This was rectified after inspection. We made a recommendation to improve this in the report.

The provider had systems in place to safeguard people from abuse. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to reduce the risk of recoccurrence. Systems were in place to recruit staff safely.

People were supported with good nutrition and could access appropriate healthcare services. Staff were equipped with relevant skills.

There was a very homely and welcoming atmosphere where people were supported by staff who were kind, caring and treated them with dignity and respect. People were relaxed and happy in the company of staff and the registered manager.

People received person-centred care from staff who developed positive, meaningful relationships with them. People had opportunities to socialise and participate in activities and entertainment of their choosing. Care plans were detailed and up to date about people's individual needs and preferences.

The environment was clean and free from malodours. People had personalised rooms.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

There was strong leadership at the service and people, relatives and staff spoke highly of the registered manager. There was a positive culture at the service where staff felt listened to and supported. There was a drive to continuously improve the service for people and the registered manager and staff team were very responsive to any areas for improvement identified. People using the service and staff had the opportunity to feedback about the service. There was a system in place to respond to any concerns.

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

Rating at the last inspection

At the last inspection the service was rated good (published 31 December 2016).

Why we inspected

This was a scheduled inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service had a registered manager in post. They had managed the service for 10 years. 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 the first rated comprehensive inspection in February 2015, we found there were shortfalls with the care records and there was a breach in regulation. We rated the service as ‘good’ in the safe, effective and caring domains and ‘requires improvement’ in the responsive and well-led domains. We rated the service as ‘requires improvement’ overall. We then completed a focused inspection in August 2015 to review the responsive domain and found the necessary improvements to the care records had been made. This inspection took place on 25 November 2016 and we found sustained improvements had been made in all areas and have rated each domain as ‘good’ and the service has been rated overall as ‘good.’

The safety of people who used the service was taken seriously and the registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. Staff understood the procedures they needed to follow to ensure people were protected from the risk of abuse. People we spoke with told us they felt safe living in the home.

Our observations during the inspection showed us people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs. We saw there was a recruitment system in place that helped the registered provider make safer recruitment decisions when employing new staff.

Assessments of people’s needs were completed and care was planned and delivered in a person-centred way. Care plans were regularly evaluated, reviewed and updated. Aspects of the care plan format were easy for people to understand by the use of pictures and symbols. We saw evidence to demonstrate people and their relatives were involved in their care planning.

Risk assessments had been developed to provide staff with guidance in how to minimise risk without restricting people’s independence. This included the management of their behaviours using the least restrictive options. People received their medicines as prescribed and had access to a range of professionals for advice, treatment and support.

People who used the service were encouraged to make their own decisions. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. Staff were overheard speaking with people in a kind, attentive and caring way. There were very positive comments from relatives about the staff team.

Staff received training that enabled them to support people safely and meet their assessed needs. The registered manager had been working with staff to develop their knowledge and autonomy in the day-to-day management of people’s care needs. We found staff were making progress and received regular guidance, support, supervision and appraisal.

People’s nutritional needs were met and in recent months staff had been supported to provide a more balanced and healthy diet for people. Staff monitored people’s food and fluid intake and took action when there were any concerns. People told us they enjoyed the meals.

Most people attended day services each weekday and participated in a range of recreational, therapeutic and sensory activities. People also accessed a range of community facilities and completed activities within the service. They were encouraged to participate in activities, outings and be active and healthy.

We found improvements in the way the service was managed. The quality monitoring system had been reviewed, developed and strengthened. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people.

A complaints process was in place which was accessible to people, relatives and others who used or visited the service. Staff were enabled to make suggestions to improve the quality of people’s care.

.

We found people received the care and support they needed. People were involved in a variety of social activities and one person told us, 'We are having a party and Santa is coming.'

People who used the service were provided with a balanced and varied diet. People we spoke with told us they liked the meals. Comments included, 'They make nice meals here, I like them' and 'The chilli is good, we are having that tonight.'

We found areas of the home were in need of redecoration, maintenance and refurbishment. There had been delays with the start of the works programme, but the manager confirmed this was due to start the following day. Relatives we spoke with told us, 'I'm happy with the home, it's always nice and clean' and 'The decor is not deluxe, but more than adequate.'

We found sufficient staff were available to meet the needs of the people who used the service. People told us they liked the staff. One person said, 'Staff are always here to help me.'

We saw there were systems in place to gain people's views and check if staff were following company policies. One person said, 'I like living here with my friends.'

We saw that a range of risk assessments had been completed in topics such as; falls, mobility, vulnerability and using appliances in the home. Care plans and risk assessments were reassessed on a yearly basis. Having accurate information about the people that used the service gave assurance that the staff were aware of their level of care and support required.

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. The home had a range of medication policies in place that outlined how to manage medicines effectively.

There were effective systems in place in relation to the recruitment and selection process. We looked at the employee files and saw that appropriate checks had been undertaken before employment had commenced. We noted that the border and immigration agency had been contacted and registration checks from the home office were in place for foreign employees.

We found that the service had received very few formal complaints. We looked at the complaints record and saw that the one documented complaint had been fully investigated. This ensured that when a complaint was received it was taken seriously by the provider.