Sweet Homes Limited t/a Carshalton Nursing Home

Sweet Homes Limited t/a Carshalton Nursing Home is a care home providing accommodation, personal care and nursing to people over 65. The care home is registered to accommodate up to 33 people. At the time of our inspection eight people were living there. The service is provided in one adapted, three-floor building on a residential road.

People’s safety had improved. People’s risks were assessed and mitigated. The care home environment was safe, with some safety features improved after we identified them during our inspection. Staff were trained to safeguard people and meet their needs. There were enough staff available at all times to deliver care and support safely. Medicines were managed and administered appropriately, and staff practices reduced the risk and spread of infection.

The décor of the care home had improved. People’s bedrooms had been redecorated and refurbished. People’s needs were assessed, and they were supported to participate in the assessment process. Staff supported people’s oral hygiene and to eat and drink enough. 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. Staff received training, supervision and appraisal to enable them to deliver effective care.

We found the care people received had improved compared to the findings of our previous inspection. However, staff interaction and communication was inconsistent. We have made a recommendation about staff receive training to improve their communication with people who may be living with dementia. Staff supported people to celebrate cultural events and their spiritual needs were met. People were supported to make decisions about how they received their care and support.

The level of activity available to people in the service had increased and people had the opportunity to use other areas within the service and its garden if they wanted to. People were supported to maintain contact with their families, friends and faith groups and the provider hosted events to which they were invited. People receiving end of life care were treated with dignity while nursing staff ensured people were not in pain or distressed.

The provider had hired a consultant to improve the service’s quality assurance processes and action planning. Further improvements in quality checks were required as the provider’s audits did not identify the shortfalls we found. The service was also assisted by the local authority’s monitoring and support measures. The views of people were gathered in residents’ meetings and those of staff in team meetings. The service was in the process of transitioning to electronic care records to improve assessments, care plans and quality assurance. These will replace the provider’s paper-based care records.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 03 February 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of four regulations. However, not enough improvement had been made in relation to quality assurance and the provider remained in breach of regulation 17 Good Governance.

This service has been in Special Measures since 03 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out in line with enforcement action we had begun against the provider following our last inspection. 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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sweet Homes Limited t/a Carshalton Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to Good Governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sweet Homes Limited t/a Carshalton Nursing Home is a care home providing accommodation, personal care and nursing to people over 65. The care home is registered to accommodate up to 33 people in one building on a residential road. At the time of our inspection 15 people were living there.

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

People were at risk of avoidable harm. The provider failed to ensure the environment was always safe for people. We found cables dangling above the pillows on people’s beds creating a risk of strangulation. We found windows which were not restricted which meant people could fall from them. We also found water running at temperatures hot enough to scald and burn.

The provider failed to assess, monitor and mitigate known risks. People presenting with known risks such as those associated with falling and catheter use did not have risk assessments or detailed care plans in place. This meant staff did not have guidance about keeping people safe.

Poor hygiene practices put people at risk of infection. Clinical waste bins which were used for the disposal of soiled incontinence pads had missing and ill-fitting bags. People were not encouraged to wash their hands and we found toilets without soap and hand towels.

People were at risk of not receiving their medicine as prescribed. We found medicine on the floor in the communal area of the care home, an overstocked medicines room and the improper signing of medicines records.

The provider did not always work in partnership with others to reduce risks to people. Due to the concerns regarding nursing practices at the service, the local clinical commissioning group offered to provide a nurse to oversee nursing and medicines practices at the service. The provider refused to cooperate with this, despite their failure to identify and address the nursing failings we found.

The premises was not properly maintained. The décor in some people’s bedrooms was unpleasant. We found bare, stained walls and dusty dry sinks. These rooms were not homely and could not contribute to people’s mental well-being.

People were bored and unstimulated. People did not leave the care home. No activities were provided in the community and people had access to only one room for the entirety of each day. This was the day room where people did very little besides eat their meals and watch an exercise video.

People were not always well cared for. Staff did not brush people’s teeth and their oral hygiene suffered as a result. We observed that staff did not always speak to people in a caring and respectful way.

The provider’s quality assurance processes were inadequate. The service remained in breach of five regulations we found them to be in breach of in 2019. Quality checks did not reveal the significant failings we found in the safety of the environment; management of risk; administration of medicines; detail in care records and people’s quality of life.

We found staff were recruited through safe procedures and received supervision, appraisal and training. Timely referrals were made to healthcare professionals.

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

Rating at last inspection and update. The last rating for this service was Requires Improvement (published 10 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care, medicines, infection control and the care home environment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, the premises, person centred care, people’s dignity and the provider’s governance.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, 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.

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

At this inspection we found the provider had made adaptations to the environment to more effectively meet people’s needs. Bathrooms were refitted and turned into wet rooms that people were able to access.

Communal areas and people’s own rooms had been redecorated and as a result the décor of the home was significantly improved. People told us they were involved in choosing the colour schemes in their rooms.

People were not always protected from the risk and spread of infection. This was because some staff did not know the correct procedures for the safe cleaning of bodily fluid spillages. Additionally, not all of the specific-use cleaning equipment was in place to prevent cross contamination.

Staff protected people from the COVID 19 virus by adhering to the home’s policies and guidelines for preventing the spread of this virus. Staff wore face masks and ensured social distancing was maintained wherever possible. Hand sanitiser was made available around the home for staff and people to use. Visitors and staff were risk assessed and had their temperatures taken. Visitors were able to meet their family members at the home in a designated and covered area of the garden with the entrance from outside of the home. Notices displaying infection prevention guidelines were seen around the home and in the garden to remind people, visitors and staff of best practices to reduce the spread of the COVID 19 virus.

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

Rating at last inspection

The last rating for this service was requires improvement (Inspection September 2019, report published October 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether appropriate action had been taken since our last inspection in relation to the breaches of Regulation 15 (1) (c) (e) (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the requirements of the warning notice issued in October 2019.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carshalton Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sweet Homes Limited t/a Carshalton Nursing Home is a residential care home providing personal and nursing care to people over 65. The care home is registered to accommodate up to 33 people in one adapted building on a residential road. At the time of our inspection 16 people were living there.

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

The provider had not made the adaptations required to the environment to effectively meet people’s needs. People were unable to use the baths, the décor was in poor condition, the colour scheme was not dementia friendly and people had access to only one communal area.

There was a lack of stimulating activity provided to people by staff. People did not know how to complain. This information had not been made readily available to people. Most people’s bedrooms were not personalised.

People received their medicines as prescribed, but medicines were not stored securely in line with good practice. Staff were recruited using robust practices to ensure they were safe and suitable to deliver care. The manager ensured that staff received training and supervision.

Staff entered people’s bedrooms uninvited to hold telephone conversations whilst people were present in them.

The provider did not always act on feedback or on the shortfalls identified during quality audits. The service did not have a registered manager in post at the time of the inspection and has had four managers since the last inspection in 2018. The manager at the time of the inspection had been in the role for four months and told us they intended to register with CQC.

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.

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

Rating at last inspection

The last rating for this service was Good (published 7 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the suitability and maintenance of the care home environment. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Full details 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in March 2017 we found that the provider was in breach of Regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because not all staff had references taken up prior to employment, not all equipment was safe to use and governance systems had not identified the issues we found during the inspection. As a consequence the service was rated ‘Requires Improvement’. At this inspection we found that robust recruitment practices were in place, the environment and equipment were safe and quality audits had improved. As a result we have improved the service’s rating to ‘Good’.

Sweet Homes Limited t/a Carshalton Nursing Home is a ‘care home’. 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 service is registered to provide accommodation, nursing and personal care for up to 33 people. At the time of our inspection there were 14 people using the service.

The service had a registered manager in post. 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.

Sweet Homes Limited t/a Carshalton Nursing Home provides care to people over three floors of an adapted building on a residential road. The service is wheelchair accessible throughout. People had single occupancy bedrooms which did not have en suite facilities such as toilets or showers. There was a large bright dayroom on the ground floor which offered access to a large garden and was overseen by the nurses’ station.

People received safe care and support. Staff assessed people’s risks and implemented plans to reduce them. Staff were trained to identify and report any suspicions of abuse and improper treatment. People’s medicines were stored and administered safely. There were enough staff available to meet people’s needs safely. The home environment was clean and staff maintained a state of readiness to respond to an emergency.

People’s needs were assessed and met by trained and supervised staff. People were treated in line with the Mental Capacity Act 2005. Staff supported people to eat and drink well and ensured people had timely access to health and social care services.

Staff were kind and caring towards people. People and staff shared warm relationships that had been built up over time. Staff supported people to maintain contact with loved ones and made visitors to the care home feel welcome. People were treated with dignity and respect and were supported around their spiritual needs.

The service provided personalised care for people. People and their relatives participated in the development of care plans which detailed their preferences for care and support. Staff provided activities for people and supported people to maintain their independence. People and their relatives understood the provider’s complaints procedure. People approaching the end of their lives were treated compassionately.

The care home was well managed. Effective quality assurance processes were in place which resulted in shortfalls being identified and resolved quickly. The service worked with other agencies to benefit people and promoted links within the local community. The registered manager promoted an open culture and staff felt supported in their roles.

At our last comprehensive inspection of this service in January 2015 we rated the service ‘Requires Improvement’ overall and for the three key questions ‘Is the service safe’, ‘responsive’ and ‘well-led?’ This was because the provider had failed to operate effective fire safety procedures, ensure people living in the home had sufficient opportunities to engage in meaningful activities that reflected their social interests and have a Care Quality Commission (CQC) registered manager in post.

We asked the provider to make improvements and undertook a focused inspection in August 2015 to check they had followed their action plan and sufficiently improved to meet the regulations. At the time of that inspection we found the provider had taken the necessary steps to improve their fire safety arrangements and social activities programme.

The service now has a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Following this inspection, which we carried out on 14 and 22 March 2017, we have rated the service 'requires Improvement’ again. This was because the provider could not demonstrate they met all the regulations and fundamental standards. Specifically, we found equipment such as a swing arm grab rail in a toilet and all the radiator covers in communal areas were not always properly maintained which could be unsafe to use for their intended purpose. The provider had also failed to operate safe staff recruitment procedures and ensure they obtained two professional and/or character references in respect of all new staff they employed. Furthermore, although the provider had governance systems in place to monitor and review the quality of service delivery, these were not always operated effectively. Consequently, the provider had failed to identify a number of issues we identified at this inspection in relation to the safe maintenance of equipment and the proper vetting of new staff.

These failings represent three breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The breaches and issues described above notwithstanding, people and their relatives told us they were satisfied with the care provided by the service. We saw staff looked after people in a way which was kind and caring. Staff had built caring and friendly relationships with people. Our discussions with people living in the home, their relatives and community health care professionals supported this.

There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. There were enough staff to keep people safe. Medicines were managed safely and people received them as prescribed.

People were supported to eat and drink sufficient amounts of nutritious food that met their dietary needs. They also received the support they needed to stay healthy and to access healthcare services. Improvements had been made to the interior design and décor of the services environment, although the registered manager agreed further work was required to make Carshalton Nursing Home a more comfortable place for people to live.

Staff continued to care and treat people with dignity and respect. They also ensured people’s privacy was maintained particularly when being supported with their personal care needs.

People received personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. People were supported to maintain relationships with people that mattered to them.

People and staff spoke positively about the leadership style of the registered manager. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives, staff and external community health care professionals.

Following that inspection we asked the provider to take appropriate action to achieve compliance with these regulations. The provider sent us an action plan on 28 June 2014 setting out the steps they would take to achieve this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer one of 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. The summary is based on our observations during the inspection, from looking at records and from speaking with the home's deputy manager. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had taken appropriate steps to protect people using the service from the risk of abuse. They had done this by ensuring staff had received appropriate training and information to identify the possibility of abuse and to prevent abuse from happening.

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

The focus of the inspection was to answer five key questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

People told us they felt safe living at Carshalton Nursing Home. One person said 'I've always felt safe here' and another person told us 'The staff look after us and make sure nothing bad happens'.

However, although people told us they felt safe and we saw the services safeguarding procedures were robust; we found that not all staff had received up to date safeguarding adults training or fully understood their safeguarding prevention and reporting roles and responsibilities. This meant that people who used the service may have been placed at risk of abuse and neglect. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risk of abuse and neglect.

The home had proper policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one.

People were given medicines they had been prescribed when they needed them, and in a safe way. This was because the home had appropriate arrangements in place to manage medicines and staff understood how to handle medicines safely.

People were cared for in an environment that was safe, clean and hygienic.

People were protected from unsuitable staff because the provider had effective staff recruitment and selection processes in place.

Is the service caring?

People were treated with respect and dignity by staff. We saw staff were kind, attentive and patient when supporting people who lived at the home. One person told us "The staff are alright' and another said 'The staff treat you well here'.

People who were able to talk with us were positive about the standard of care and support they received at the home. Comments we received included, 'It's not a bad place to live', 'It's a very good home', and 'No complaints'.

People's diverse needs, preferences and interests had been recorded in their personalised care plans, and support was provided by staff in accordance with people's wishes.

People's relatives were regularly invited to complete a customer satisfaction survey and it was clear from their written comments that they were happy the overall quality of the care and support provided by the home.

Is the service responsive?

Staff were familiar with people's health care needs and took appropriate action to refer people to the relevant health care professionals, as and when required.

People who used the service and their representatives were regularly involved in reviewing care plans, which staff updated accordingly to ensure they reflected people's current needs.

In-house and community based social activities were available for people to participate in. However, we have asked the provider to note that we observed long periods of inactivity with people sleeping in their chairs and an over-reliance on the use of the television in the communal lounge/dining area. Furthermore, several staff told us they felt people's social needs and community involvement would be better served if the home employed an activities coordinator and had age appropriate rummage boxes that could also be used to aid interaction and engagement. This meant that people may not have been sufficiently stimulated.

Is the service effective?

People's health and personal care needs were assessed and clearly identified in their personalised care plans. This meant staff were provided with detailed guidance about how they should be meeting the needs and wishes of the people they supported.

People were provided with a choice of nutritionally well-balanced food and drink. People told us they were happy with the quality and choice of food and drink at the home. One person told us 'The food is very good here', and another person said 'We can pick what we want to eat from the menu'.

People received care from suitably trained and supported staff who were clear about their nurse or support worker roles and responsibilities.

Is the service well-led?

The service has not had a registered manager in post for over six months. We have written to the provider and asked them to tell us what they are doing to meet the conditions of their registration in relation to having a suitably qualified and experienced manager in day-to-day charge of the home.

The provider had effective systems in place to regularly assess and monitor the quality of service that people received. The service also learned lessons from mistakes and events that adversely affected the health and wellbeing of people who used the service, such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We asked the provider to send us an action plan to tell us what action they intended to take to meet these essential standards. The provider sent us an action plan stating that these concerns would all be addressed by the end of January 2014. At this inspection we saw that these issues had been addressed.

On 12th November 2013 we undertook an inspection visit to check that the registered provider had taken appropriate steps to comply with the warning notices. A number of improvements had been made to make sure that the premises were safe for people living there, working there or visiting. The home was clean and smelt fresh. Improvements had also been made to the management of waste products. However, we found that the supply of hot water to the home was still intermittent and there was no hot water supply to the first and second floors.

Following this the registered provider submitted an action plan informing us that they had taken steps to comply with the warning notices. Therefore we undertook a further inspection visit on 10th December 2013 to assure ourselves of their compliance. At this time we found that there was an adequate supply of hot water to all parts of the home.

During our inspections we have raised additional concerns about the bathing and showering facilities in the home. There was only one shower available to be used. Baths did not have any adaptations to make them easy to use for people with limited mobility. This limited people's ability to make choices about how they were supported with their personal care needs.

We have also highlighted shortfalls in relation to the standard of record keeping within the service.

At our last inspection in July 3013 we had raised concerns that the provider was not meeting the essential standards of quality and safety. The provider sent us an action plan to show how theses would be met. We carried out this inspection visit to check on the progress the provider had made in addressing our concerns and achieving compliance with the regulations of The Health and Social Care Act (2008).

We saw that some improvements had been made. However, we have raised serious concerns about the continued lack of cleanliness in the home. We also found exposed hot water pipes in one bathroom and a cupboard containing lift machinery unlocked. This could have been a risk to the people using the service.

We saw that there were some bedrooms without hot water and pedal bins in some bedrooms were broken. This meant that staff would not have been able to wash their hands effectively after delivering personal care to people.There was also evidence that waste products were not always disposed of appropriately. This may have put people using the service and staff at risk of exposure to a health care associated infection.

On the evening that we visited 19 people were living in Carshalton Nursing Home. Their feedback was generally very positive. They told us 'staff here are very kind' and 'we're very well looked after'.

People told us that the home was comfortable but we found that they may be at risk because the environment was not safely maintained. The surroundings in which the care was being provided did not promote the wellbeing of the people using the service, their visitors and staff members. The home was uncomfortably hot, some areas were malodourous and chemicals which would be harmful to people's health were left in unlocked cupboards.

We have also contacted the fire safety officer who will be undertaking their own inspection of the premises.

However, the people we spoke with all told us that they were very happy, they thought the staff were kind and they had no complaints. Their comments included 'I like the people here, they're all really nice', and 'they (staff) are so kind, they're all nice, you just have to ask them something and they do it or go and get someone'.

People told us that they were free to spend their days as they pleased. Some chose to sit in the communal area while others preferred to stay in their rooms. Those who were mobile were free to walk around the home as they wished. On the day we visited it was very sunny and several people had chosen to sit in the garden. Some people found it more difficult to communicate with us because of their dementia but we saw that they showed signs of positive engagement with the staff and their surroundings. We saw that staff were constantly interacting with people talking to them as they carried out their work and stopping to encourage them to have a drink.