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.