Archived: Catterall House Residential Care Home

Catterall House is located on the outskirts of Garstang and is within easy reach of the Cities of Preston and Lancaster. Accommodation is provided for up to 24 older people who need help with personal care. Most bedrooms are of single occupancy. Bathrooms are located throughout the home. A variety of sitting rooms are accessible and a separate dining room is provided. A variety of amenities are available within Garstang village centre and public transport links are easily accessible.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

We last inspected Catterall House Residential Care Home in December 2016. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in July 2017 we found medicines were managed safely. We saw people received their medicines in safe way, at the time they needed them.

We observed care and support being provided in a safe way and people told us they felt safe. One person told us, “I’m safe enough.”

Staff were able to explain the actions they would take if they were concerned someone was at risk of harm or abuse. They told us they would report concerns to the registered manager, the Care Quality Commission or the Lancashire Safeguarding Authorities so further investigations could take place.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

Staff told us they received training and supervision to enable them to fulfil their role. Staff said they enjoyed the training and further training was available if this was required. We viewed documentation which evidenced staff received supervision and training.

We discussed staffing with people who lived at the home. People told us, “Sometimes I have to wait when I ring the bell, but it’s not for long.” And, “I think there’s enough here to look after us all.” During the inspection we saw staff were patient and kind with people who lived at the home. We saw people were supported at a pace appropriate to their individual needs.

People who lived at Catterall House Residential Care Home told us they considered staff were caring. One person told us, ““They’re really good, kind and patient, I can’t fault the staff”. We observed people being supported with kindness and compassion.

People who lived at the home told us activities were available for them to participate in if they wished to do so. One person said, ““I like reading, I get books from the mobile library. The home and relatives take me out”. During the inspection we saw people being supported to take part in activities which were important to them.

People told us they enjoyed the meals provided. We observed the lunchtime meal and saw this was a positive experience for people who lived at the home. Staff gently encouraged people to eat and we saw people enjoyed their meal.

We reviewed documentation which described the care and support people required. The documentation we viewed contained the social histories and interests of people who lived at the home. We saw if people required advice from other health professionals, referrals were made appropriately.

The registered manager carried out checks to ensure improvements could be identified. These included checks on care records, attendance at training and accidents and incidents. There was a quality survey in place, which was provided to people who lived at the home. This enabled people to give feedback on the service provided. We saw any actions as a result of this feedback was carried out when possible. This was displayed on a notice board within the home.

We noted some areas of the home smelt malodorous. We have made a recommendation about implementing actions from an external professional's infection control audit.

We found some areas of the home required redecoration. We discussed this with the registered manager and registered provider. We have made a recommendation regarding the documentation of action plans relating to this.

We saw window restrictors had been fitted to windows in occupied bedrooms. The registered manager told us bedrooms would be redecorated and window restrictors would be fitted as the rooms were re-furbished. We saw PEEP’S (Personal Emergency Evacuation Plans) were in place and fire doors were closed. This helped minimise the risk of fire spread and ensured staff had access to be able to evacuate people from the home if the need arose.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People who lived at the home told us they could speak with the registered manager if they wished to do so. We saw meetings were held for people to express their opinions and people who lived at the home and their relatives told us the manager was approachable.

Catterall House Residential Care Home is registered to provide care and accommodation for up to 24 people who require assistance with personal care. Bedrooms are of single or shared occupancy and bathrooms are located throughout the home. A variety of sitting rooms are accessible and a separate dining room is provided. Catterall House is close to public transport links and car parking space is available at the home. At the time of the inspection Catterall House Residential Care Home provided care and support to eight people.

At the time of inspection there was no manager in place who was registered with the Care Quality Commission. 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. The manager informed us they had started the process to apply to register with the Care Quality Commission, but had not yet submitted the application.

We last inspected Catterall House Residential Care Home on the 27 July 2016. We identified several breaches of regulation. We found risks to people who lived at the home were not always identified and action taken to minimise these risks. We also identified improvements were required to the cleanliness of the home and some aspects of the home were not secure. In addition we found policies were required to ensure staff were aware of the latest regulations, legal requirements and good practice guidance. We also found a system of quality audit was to be developed.

At the last inspection on the 27 July 2016 we asked the registered provider to take action to make improvements. We were provided with an action plan which detailed how the registered provider intended to ensure improvements were made. The action plan recorded improvements would be made by September 2016.

We undertook this focused inspection to check they had followed their plan and to confirm they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Catterall House Residential Care Home on our website at www.cqc.org.uk.

During this inspection carried out on the 01 December 2016 we found some improvements had been made. We saw risk assessments were in place to manage the risks associated with the environment. We viewed risk assessments for the kitchen and laundry and risk assessments for fire exits. We also saw appropriate risk assessments were in place to ensure individual risks to people were managed. Written plans were in place to manage these risks.

We looked at the cleanliness and suitability of the environment. We saw the environment was visibly clean and a cleaner had been employed to ensure the home remained so. We saw all fire doors had suitable equipment to enable them to be opened in the event of an emergency. We found one fire door could be opened without restriction. We have made a recommendation regarding this.

The manager told us they had started to rewrite key policies to ensure staff were aware of the latest relevant guidance and regulations. We were told this work was ongoing and we saw these were being completed. Staff we spoke with confirmed these were discussed with them to ensure they had an understanding of the purpose and processes in place. The manager also told us they had implemented a range of checks to ensure the home ran smoothly. This included audits of incidents and accidents, environmental checks and cleanliness checks. Staff we spoke with confirmed this. We were also informed by the manager they were developing a ‘business continuity plan.’ This was a plan that ensured staff were aware of the action to take in circumstances that may affect the running of the home. In addition we were informed a legionella risk assessment was being written.

We discussed staffing with people who lived at the home, the manager and relatives. People told us they considered there were sufficient staff available to meet people’s needs. One person who lived at the home commented, “There’s enough staff to help me.” None of the relatives we spoke with raised any concerns regarding the staffing arrangements at the home.

We reviewed staff files and found there were processes in place to ensure staff were recruited safely. Staff we spoke with confirmed checks had been carried out on their suitability for employment prior to starting work at Catterall House Residential Care Home.

We observed people being given their medicines. We found people were supported to take their medicines with patience and understanding. We saw ‘prn’ protocols were in place for those people prescribed ‘prn’ medicines. These are medicines administered to people on an as required basis. This helped ensure people received their medicines safely.

People who lived at the home spoke highly of the manager. They told us they considered the home had improved. Staff we spoke with also gave positive feedback. They told us they found the manager to be approachable and supportive. Relatives we spoke with also told us they found the manager to be approachable.

Catterall House is located of the main road to the outskirts of Garstang in Lancashire. The home and is within easy reach of the cities of Preston and Lancaster. Accommodation is provided for up to 24 people who need help with personal care. At the time of the inspection there were nine people living in the home. There are communal lounges and a dining room and the kitchen and laundry are on the ground floor. The home has a small lift to access the first floor.

The home was last inspected on 23 February where five breaches of the regulations were found. The home was rated as requires improvement overall with the key question of safe being rated as inadequate. The key questions of effective, responsive and well led were rated as requires improvement and the caring key question was rated as good. At this inspection we found the safe key question was now rated as requires improvement.

At this inspection we found some improvements had been made but in other areas work was still required to bring the home up to a suitable standard of quality. At this inspection we identified three breaches to the regulations. Within the main body of this report you can read the details of both the improvements and the identified breaches. We also made 10 recommendations within the report. Recommendations are made where regulations are not breached but steps should be taken to ensure quality and standards are maintained.

At the time of the inspection the previous manager had become the deputy and a new manager was in place. The home did not have a current 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.

At this inspection we found breaches to the regulation associated with the risk assessment and risk management of the environment. Almost as a consequence of the absence of these risk assessments a breach was also found with how the building was managed and maintained. This included the safe storage of cleaning materials and damp in some areas of the home.

At the inspection in February we identified a breach in how the home managed complaints. A recent complaint to the home had no record of a response within the complaints file. We were subsequently told the response was on the computer and would be added to the file. There had been no further complaints since this time. Other areas of concern were continued from the last inspection and included the lack of a comprehensive and implemented set of policies and procedures and also the lack of a quality audit system for all aspects of provision.

Recommendations at this inspection were varied and included prompts for action to be taken around recording, testing of equipment, staff training and specific audit and monitoring.

We did find things had improved in relation to the cleanliness of the environment. Cleaning schedules were now in place and a dedicated domestic staff member was about to start employment.

Concerns around consent and the implementation of the mental Capacity Act had been rectified with all people in the home having received a capacity assessment. Steps had been taken to act on the results of these assessments including applications for deprivation of Liberty safeguards and the recording of appropriate best interest decisions.

Safeguarding procedures had much improved and a new policy had been written. Staff had all agreed the contents of the policy and procedures were available within the home. Some staff had received specific training and safeguarding champion was on site to support staff as required.

Medicines management had improved with a new policy being written and again staff signing to say they understood it. Procedures were implemented for the safe management of medicines and audits were completed to continually improve this process.

The people in the home were very complimentary about the food in the home and we saw a number of options being offered to people in the home. The chef and staff we spoke with were aware of people’s dietary needs and where risks of malnutrition increased to people we saw appropriate action was taken.

Staff morale was much improved and it was clear there were now enough staff to meet people’s needs. It must be noted however that there were only nine people currently living in the home and staff contracted hours were being honoured. We have recommended a comprehensive dependency tool is developed so if numbers and needs increase the home can ensure the staffing remains reflective.

Care records were accurate and reflected the people’s needs living in the home. Work had been undertaken to complete thorough assessment of people’s needs and new care plans had been developed which were regularly reviewed.

People we spoke with told us their views were sought on how the home was run and we saw surveys had recently been completed which had led to change. This included changes to the menu following an updated survey on people’s thoughts and preferences for food.

The overall rating for this service was ‘Inadequate’ in November 2015, when it was put into ‘Special measures’. We re-inspected the home in February 2016 and found some improvements had been made and the overall rating had reduced to Requires Improvement with one key question rated as good and another rated as inadequate. At this inspection we can again see improvement. Whilst the overall rating remains at Requires Improvement the service now has two key questions rated as good and none rated as inadequate.

As the service has demonstrated improvements during this inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Catterall House is located on the outskirts of Garstang and is within easy reach of the cities of Preston and Lancaster. Accommodation is provided for up to 24 people who need help with personal care. Most bedrooms are of single occupancy. Bathrooms are located throughout the home. A variety of sitting rooms are accessible and a separate dining room is provided. A range of amenities are available within Garstang village centre and public transport links are nearby. There are ample car parking spaces available adjacent to the premises.

The last inspection of the service took place on 3 November 2015. During that inspection we found the provider was in breach of a number of regulations. The breaches were in relation to safe care and treatment, premises and equipment, need for consent, staffing, good governance and notification of other incidents. At that time the domains of effective, caring and responsive were rated as 'Requires Improvement' and the areas of safe and well led were rated as 'Inadequate', which resulted in an overall rating of 'Inadequate'.

We found improvements had been made across some areas of the service during this inspection. However, we identified areas where further improvements needed to be made and we still had concerns about the way risks to the health, safety and wellbeing of people were managed. These are detailed within each relevant section of the report. We have judged that the service still remains Inadequate for the key question of safe and the home will therefore remain in special measures.

On our arrival to the home on this occasion the inspection team waited approximately ten minutes for the door to be answered. We were greeted by a senior care worker, who told us she was leading the shift for the day, as the manager of the home was on a training course. However, the manager arrived shortly afterwards, having left the training course to attend to the inspection team. The manager of Catterall House was in the process of applying for registration with the Care Quality Commission. We were told that the provider was aware that the front door bell was faulty and was in the process of getting this repaired.

We found that the cleanliness of the premises had improved in some areas, but further improvements were still needed. Some areas were also in need of modernising and updating.

We looked at medication practices adopted by the home and found some improvements had been made, although several shortfalls were still evident in this area, which meant that people were not protected against the risk of receiving inappropriate or unsafe care and treatment, because medicines were not being well managed.

Systems and equipment within the home had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use.

Areas of risk had not been managed appropriately. Therefore, people were not consistently safe.

Formal consent had not always been obtained before care was provided. Legal authority had not been sought for those whose liberty was potentially being deprived.

New staff were, in general appropriately recruited and therefore deemed fit to work with this vulnerable client group.

The three care staff on duty each day were responsible for laundry duties as well as the provision of activities. An additional cook had been employed since our last inspection and the provider was in the process of appointing a cleaner, which will help to ease the workload for the care staff.

Induction programmes for new employees were formally recorded. Supervision and appraisal meetings for staff were regular and structured. This meant the staff team were supported to gain confidence and the ability to deliver the care people needed. A wide range of training programmes were provided, in line with the nationally recognised care certificate, although the training matrix could have been more detailed. We made a recommendation about this.

Evidence was available to show that surveys and meetings for those who lived at the home were conducted. Information was readily available about the use of local advocacy services. An advocate is an independent person who can support people through the decision making process. We found that people’s privacy and dignity was respected.

Guidance from community health care professionals had been consistently followed. The planning of people’s care was, in general detailed and person centred. However, some records did not contain all the information about a person's needs and conflicting information was sometimes provided.

We made a recommendation around the provision of fresh vegetables, fresh meat and homemade dishes being served at meal times and these being displayed on picture menus, which would be beneficial for those who lived at the home. We also recommended that the provider consults The National Institute for Health and Care Excellence (NICE) guidance and Alzheimer Society guidelines related to dementia care environments.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and receiving and acting on complaints.

As one domain remains inadequate in accordance with our guidance the service will remain in special measures. We have placed a restriction on admissions. Where we have identified more serious breaches of regulation we will ensure that action is taken to keep people safe.

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

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

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

Is the service safe?

People told us they felt safe living at the home. Safeguarding procedures were in place and staff were fully aware of actions they needed to take, should they be concerned about someone's safety. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the possibility of risks to people and helped the service to continually improve.

Plans of care and risk management plans were in place. However, the provider may wish to note that these could have been more detailed in places and more specific to individual needs. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

The registered manager compiled the staff rotas, which took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met. Policies and procedures were in place to make sure that unsafe practices were identified and people were protected from harm. Records, in general were well maintained in line with current legislation and guidelines in relation to confidentiality and data protection.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People said their current needs were being fully met by a kind and considerate staff team. We established that a range of external professionals were involved in the provision of care. This helped to ensure people received the correct health care to meet their needs.

Those working at the home told us they received plenty of training and gave us some good examples of courses they had completed. We established that the manager responded effectively to staff requests for additional specialised training.

Is the service caring?

We spoke with five people living at Catterall House. We asked them for their opinions about the staff that supported them. Feedback from people was consistently positive. For example, one person commented, "The staff are lovely and very helpful. You would have difficulty in finding one that is unpleasant. They are all very nice." Another told us, "We are being well looked after. I am not just saying that I really mean it. The staff are smashing."

When speaking with staff it was clear that they genuinely cared for the people they supported. People using the service and their relatives, completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with. People's preferences, interests and goals had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

We noted that staff were responding to the needs of people in a timely fashion and were anticipating their needs well. This was because staff members were familiar with the needs of those in their care and had developed a good understanding of those living at Catterall House.

People knew how to make a complaint if they were unhappy and felt they would be listened to, should they wish to make a complaint or raise any concerns. The home worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The manager of the home had been in post for nearly a year. It was clear he led the team by example and staff spoke highly of his skills and style of management. People were well aware of the lines of accountability within the home and it was evident that those living at Catterall House trusted the manager and his staff team.

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. We noted that significant improvements had been made since the last inspection, which was pleasing to see.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of Catterall House and were eager to make sure the home continued to improve. Complaints were well managed and records were maintained in a confidential manner.

Systems had been implemented to ensure thorough checks were conducted before new staff were appointed and the quality of service provided was regularly assessed and monitored. This helped to ensure people received the care and support they needed. A detailed assessment of the environment had been produced and a clear action plan developed. The provider was working through actions needed in order to enhance the environment for those living at Catterall House, which was pleasing to see.

Comments from those living at the home included:

"They (the staff) look after us really good. I have no complaints whatsoever."

"I like sitting here in this chair to watch TV, so I can see the main road and people coming and going. It makes life a bit more interesting."

"We are always asked what we would like from the menu. I had hotpot today. It was really tasty."

During our inspection we assessed a wide range of outcome areas. We found compliance in areas related to respecting and involving people, consent to care and treatment, meeting nutritional needs, cleanliness and infection control and management of medication. However, there was non compliance in several areas. For example, the care planning and risk assessment processes could have been better, the maintenance of the premises was poor, recruitment practices were not thorough enough, the quality of service was not effectively assessed and monitored and some records were not accessible, upto date or sufficiently detailed. Some outcome areas were incorporated into the inspection process because of concerns raised.

During our visit we were able to speak with three people living at the home, who all provided us with positive comments. They told us they felt safe living at Catterall House, with their needs being met by a kind and caring staff team. They were happy with the environment in which they were living and felt their dietary needs were being appropriately met.

Comments received included:

"It is lovely here. I am content with this home."

"The staff should get a medal. They are marvellous."

"Everywhere is so clean. It is spotless."