Archived: Cartref Residential Care Home t/a Alverant Limited

Updated 23 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 14, 15, 17 and 18 May 2018 and was unannounced. The inspection was carried out by two adult social care inspectors.

The inspection was prompted in part by information of concern received from a person who completed a ‘Your experience’ form. The intelligence received by CQC highlighted a number of areas of concern relating to the operation of the care home and the management of risk.

The concerns included: governance and leadership; staffing levels; management of medicines; standard of personal care provided to people and safety issues relating to the welfare of service users.

During the inspection we found evidence to support the intelligence received. The provider is therefore working in partnership with the local authority to ensure: the home has effective management and leadership to develop the service and improve standards; the provision of additional staff to mitigate risk and working to address environmental risks.

On this occasion we did not ask the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service provided by Alverant Limited (the Provider).

We looked at all the information which the CQC already held on the provider. We also spoke with representatives from Halton Borough Council who were present during the inspection, in order to obtain any information that they held about the service. We took any information to us into account.

During the inspection we spoke with the owner / nominated individual; three senior carers (one of which was acting as the manager); four care assistants; the cook on duty; a visiting health care professional; an electrician; four people who used the service and three relatives. We also spoke with the director of adult social services, a divisional manager, quality assurance manager and a quality assurance officer from Halton Borough Council. We also attended a meeting with 16 relatives of people using the service.

We undertook a Short Observational Framework for Inspection (SOFI) observation during lunch time. SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We also looked at a range of records including: four care plans; four staff files; training records; rotas; complaints and safeguarding records; medication; policies and procedures and maintenance. Records were also requested relating to governance and quality assurance and these could not be located.

Updated 23 June 2018

The inspection took place on the 14, 15, 17 and 18 May 2018 and was unannounced.

Cartref Residential Care Home t/a Alverant Limited was previously inspected in January 2018. No breaches were identified at that inspection and therefore an improvement plan was not requested.

We commenced an unannounced focused inspection of Cartref Residential Care Home on Monday 14 May 2018. This inspection was undertaken as the CQC had received information of concern regarding the operation of the care home in areas relating to: governance and leadership; staffing levels; management of medicines; standard of personal care provided to people; safety issues relating to the welfare of service users and failure to notify CQC of reportable incidents.

The inspection team initially inspected the service against two of the five questions we ask about services: is the service ‘safe’ and ‘well led’. We identified risks and concerns within the service so we decided to undertake a comprehensive inspection of the service so that we could expand our inspection activity to include our remaining three key questions. They are: is the service ‘effective’; ‘caring’ and also ‘responsive’.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: need for consent; safe care and treatment; safeguarding; premises and equipment; receiving and acting on complaints; staffing; fit and proper persons employed and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

Cartref is a 'care home' operated by Alverant Limited (the provider). People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home provides accommodation and personal care for up to 24 older people, many of whom have dementia care needs. Respite care is also offered. The home is situated in the historic village of Farnworth in Widnes, Cheshire.

At the time of our inspection the service was accommodating 21 people. Accommodation is provided on the ground and first floor of the large Victoria property which is situated within its own grounds. There is a large car park at the front of the building for visitors to use and a garden with seating areas at the rear of the building.

The home did not have a Registered Manager. 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.

During our inspection of the service we identified that there had been no proper scrutiny or monitoring of the service by the provider. Furthermore, there was a clear lack of leadership and direction for staff working in the care home.

Systems and procedures relating to governance; quality assurance; medicines management; staffing; service, staff and service user records; safeguarding and the management of complaints were not robust. This had contributed to significant failings within the service which had the potential to place the welfare of people using the service at risk.

We found that the environment was in need of refurbishment and maintenance and was not appropriate or safe for people using the service.

We observed that staff interactions were warm and kind but noted examples were people’s privacy and dignity have been compromised. We also noted that people had access to a limited range of activities and did not always receive personalised care that was responsive to their needs.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that provider found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care service the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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