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Archived: Carham Hall Good

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Inspection carried out on 24 March 2016

During an inspection to make sure that the improvements required had been made

Carham Hall provides accommodation, personal care and support for up to 22 older people, some of whom are living with dementia. At the time of our inspection there were 17 people living at the service.

We carried out an unannounced focused inspection of Carham Hall Care Home on 24 March 2016. At the last inspection on 29 and 30 July 2015 we asked the provider to take action to make improvements to governance arrangements and this action has been completed.

A registered manager was in post, who was also one of two registered providers for the service. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 a relative told us they were happy with the way the service was managed. Two people told us they felt a bit cold and we told the provider who arranged for the heating to be turned up immediately and said they would monitor the temperature in the service.

Systems were in place to monitor the quality and safety of the service. Audits in key areas such as medicines management, infection control, health and safety, and care plans had been carried out.

CQC had been notified of incidents in line with legal requirements.

Staff told us they felt well supported and that the provider, manager and deputy were visible, accessible and approachable. A reviewing officer told us that they had no significant concerns about the service and found that when any minor concerns were raised with the provider and manager that these were acted upon. A District Nurse told us they had no concerns about the service and that when they asked for things to be done that they were carried out. People told us that they felt the service was well run.

Regular meetings were held and surveys were provided to people using the service, relatives, staff, and other stakeholders, to obtain their views about the service. The views of people in the surveys we read had been acted upon.

The service had accessed and was involved with a quality improvement initiative designed to improve the quality of the experience of people living with dementia in the service.

The service maintained links with the local community and supported people to participate in traditional local celebrations.

Inspection carried out on 29 and 30 July 2015

During a routine inspection

Carham Hall provides accommodation and personal care and support for up to 22 older people, some of whom are living with a form of dementia or cognitive impairment. At the time of our inspection there were 18 people living at the service.

This inspection took place on 29 and 30 July 2015 and was unannounced.

The last inspection we carried out at this service was in October 2014 in response to concerns that had been raised directly with the Care Quality Commission (CQC). At that time we found the provider was not meeting one of the regulations relating to respecting and involving people who used the service. At this inspection we found improvements had been made in this area.

At the time of our inspection there was a registered manager in post who was also one of the providers who ran the business as a partnership with a second 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.

Safeguarding policies and procedures were in place and staff were clear on the different types of abuse and their own personal responsibility to protect people from abuse and report any incidents of abuse that they may witness or suspect. People told us they felt safe living at the home and comfortable in the presence of staff.

Risks that people were exposed to in their daily lives had been assessed, such as risks associated with mobility. Most environmental risks within the home had been assessed and measures put in place to protect the health and wellbeing of people, staff and visitors.

Staffing levels were sufficient to meet people’s needs and staff were not rushed. People had their needs met in a timely manner on the days of our inspection. Staff told us there were times of the day, such as in the morning when people were being assisted to rise from bed, where they felt more pressured, but overall there were enough staff members on duty to meet people’s needs.

Recruitment procedures ensured that staff were appropriately skilled and of suitable character to work with vulnerable adults. Records showed that staff were trained in a number of key areas such as moving and handling and infection control. In addition, staff had received training in areas specific to the needs of the people they supported, such as training in challenging behaviour with dementia and low vision awareness. Staff told us they felt supported by the registered manager and they received supervision and appraisal.

The Mental Capacity Act 2005 (MCA) was appropriately applied and the best interest’s decision making process had been followed where necessary. Some records related to decisions made in people’s best interests were not appropriately maintained. One of the providers told us that this would be addressed and that in future the decision making process would be better documented.

People told us, and records confirmed that their general healthcare needs were met. General practitioners were called where there were concerns about people’s health and welfare and other healthcare professionals if relevant. People told us the food they were served was good and we saw there was a variety of wholesome food on offer. People’s nutritional needs were met and any concerns about their food and fluid intake, or changes in bodyweight, were monitored and referred to dieticians if needed.

Our observations confirmed people experienced care and treatment that protected and promoted their privacy and dignity. Staff displayed caring and compassionate attitudes towards people, and people and their relatives spoke highly of the staff team. Staff were aware of people’s individual needs and care was person-centred. Overall people’s care records were well maintained. Some records would benefit from more detail to make people’s needs and how to support them clearer to the reader and those members of staff who may not yet know the person well. People told us they were supported to engage in activities within the home if they wanted to. People and their relatives told us they would appreciate more excursions locally.

The environment of the home was suitable for people’s needs and adaptations had been made where necessary such as the addition of handrails in corridors. People had unlimited access to outdoor space which they told us they appreciated and which benefitted their wellbeing.

The provider gathered feedback about the service from people and staff via meetings and questionnaire surveys. There was a complaints policy and procedure in place although there had not been any complaints for us to review.

Whilst the providers had some overall care monitoring tools in place such as handover books and tools to monitor people’s personal care and food and fluid intake, there was a lack of quality assurance systems and processes. The providers could not evidence that they regularly reviewed the performance of the service through, for example, effective auditing, and that where any issues were identified, they were addressed with a view to driving improvements forward. Checks on the building and equipment used in care delivery were undertaken, although a lack of effective monitoring meant that some of these checks had fallen slightly outside of the recommended timeframes for being redone.

We found there was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 17, Good governance, as referred to above. You can see what action we have asked the provider to take at the back of the full version of this report.

Inspection carried out on 21 October 2014

During an inspection in response to concerns

We carried out this inspection in response to concerns about room sharing and decision making arrangements. Due to their health conditions and needs, some of the people we spoke with were not able to share their views about arrangements for supporting informed decision making about significant matters. During our visit we spoke with six people who used the service and the provider, the registered manager, the deputy manager, two care workers and the office administrator. We inspected three people’s personal care records and, with permission, the majority of people’s bedrooms.

We looked to see whether people living in the home were being supported to make their own decisions and their capacity appropriately assessed.

We considered all the evidence we gathered under the regulation we inspected. We used the information to answer two of the five questions we ask as part of our inspection approach;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found;

Is the service safe?

This was a responsive inspection to follow up information of concern. We did not look specifically at this area.

Is the service effective?

We looked at room sharing arrangements and care records and found people, or those legally empowered to do so, were not always supported to make informed decisions about significant matters affecting their care and welfare. We saw contradictory information regarding people’s mental capacity and important decisions, such as room sharing with unrelated people and voting rights, were not always made with the involvement of people themselves or those legally entitled to support them. We have told the provider they need to take action to address our concerns.

Is the service responsive?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service well led?

We found there was a manager in post, registered with the Commission in line with legal requirements.

Inspection carried out on 2 April 2014

During a routine inspection

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report .

Is the service safe?

We found equipment was regularly serviced and tested to make sure it was safe and working effectively.

The provider had in place effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in this process. We saw that particular needs were identified for example, dietary needs or dementia care in individual’s plans.

Staff training is provided that takes account of the needs of the people in the home. For example we saw training in dementia and catheter care had been provided.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them. People told us, “Staff are wonderful, they are all so caring.” A relative said, “This home is excellent, I could not ask for better care for X.” A visiting professional told us, “This is one of the best homes in the area and I would recommend it to anyone. The staff always ensure people get the best care possible. I have been impressed by the care that I have seen.”

People’s preferences, interests, aspirations and diverse needs were recorded and staff were able to give examples of these when we spoke to them.

Is the service responsive?

We saw evidence that the care staff identified changes in people’s needs and acted to make sure they received the care they needed. For example, there was evidence that loss of weight was quickly identified and action taken to seek and act on advice from health professionals.

We saw there were systems in place to ensure any repairs or failures in equipment were addressed promptly.

Is the service well led?

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff said they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Staff had regular supervision and staff meeting which meant they were able to feedback to the management of the home their views and suggestions. Staff we spoke with confirmed their views were listened and account was taken of them.

Inspection carried out on 9 April 2013

During a routine inspection

We spoke with three people about their experiences of the care and support they had received. People spoke positively about the care and support they received at Carham Hall. One person said, “I could not have been better looked after by the staff.” Another person told us, “The staff are very helpful, every one of them. I would highly recommend anyone to come here. We have excellent meals.” A relative told us, “I am absolutely satisfied with the care and X has come here because I was so pleased with the care my other relative received here.”

We saw relationships between staff and people were good and there was a relaxed atmosphere. People’s privacy, dignity and independence were respected.

People’s needs were assessed and care and treatment delivered in line with their individual care plan.

People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were made aware of the complaints system. Their comments and complaints were listened to and acted upon.

Inspection carried out on 13 July 2012

During a routine inspection

We spoke with four people who lived at the home to find out their views on the care provided at the home. One person said, “I like living here, I have everything I need. Good food, comfortable room and nice staff, what more could I want.” Another person said they were very satisfied with the support provided. They said “I am happy with the home, I am very comfortable here and everyone is very kind. The staff know what I need help with and they are always cheerful. We go out for trips in the home’s bus and I enjoy that.” Another person told us “I like the food and my room is very comfortable. I have been able to bring some of my own things from my house so it is more like home to me now. The staff are lovely, they have a joke and a laugh with you. I couldn’t manage at home so I feel safer here because there is always someone around to help me if I need it.”

Inspection carried out on 7 March 2011

During a routine inspection

People said that they were very satisfied with the support provided by the staff. They said that staff were helpful and kind. One person said that he felt that he was well cared for, had a comfortable place to live and found everyone respected his dignity and privacy. He said that staff know his preferred daily routine and are there to provide the assistance he needs.

People said that the staff know their jobs and they thought that they had the training they needed. They said that the food was good and that there was always a choice at mealtimes. People told us that they were very happy with the accommodation.