Archived: Carrwood House

Carrwood House is registered to provide accommodation and personal care for up to 16 people with learning disabilities and mental health needs. The home is situated in the Grimesthorpe area of Sheffield and is close to local amenities. The home has a communal lounge and dining room, access to a garden and a small car park. There were 10 people living at the service on the days of our inspection.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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. There had not been a registered manager at the service since 2011. There was a manager present during both days of our inspection who told us they were going to apply for registration with the Care Quality Commission.

At the last inspection on 9 and 12 October 2015 the service was rated inadequate and placed into special measures by CQC. This inspection found that there were not enough improvements to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

The service did not properly follow safeguarding vulnerable adult procedures which meant that people living at Carrwood House may not have been protected from abuse.

Not all medicines were stored safely. We found gaps in medication administration records which meant people may not have always have been given their medicines at the right time. Medication administration records were not regularly audited to check that medicines were given to people as prescribed.

We saw that safe recruitment procedures were not always followed to ensure that all the required information and documents were in place before staff commenced employment. These procedures were required to verify people employed by the service were suitable to work with vulnerable adults.

Care records were not complete or up to date. There was no evidence that people’s views and aspirations were taken into account when care records were reviewed.

People living at Carrwood House told us that staff were caring.

People were offered a limited selection of food and drinks.

There was an activity advertised as being available every day.

People were not encouraged to maintain their independence or supported to improve their health and wellbeing.

We found staff had not received all the appropriate training relevant for their role and responsibilities.

All staff had received supervision in the last month, but prior to this supervision and appraisals had not been undertaken to support staff to undertake their jobs effectively.

There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required. The manager told us they were in the process of developing quality assurance systems.

We found incidents had not been reported to CQC as required by regulations 17 and 18 of the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Carrwood House is registered to provide accommodation and personal care for up to 16 people with learning disabilities and mental health needs. The home is situated in the Grimesthorpe area of Sheffield and is close to local amenities. The home has a communal lounge and dining room, access to a garden and a small car park. There were eight people living at the service on the days of the inspection.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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. There had not been a registered manager at the service since 2011. We met with the manager during the first day of our inspection who told us they were in the process of applying for registration with the Care Quality Commission.

At the last inspection on 27 and 29 April 2016 the service was rated inadequate and placed in special measures. This inspection was undertaken to check the registered provider now met all of the legal requirements. At this inspection we found that there were not enough improvements to take the service out of special measures. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found.

Staff did not fully understand what it meant to protect people from abuse. There were no effective systems in place to monitor allegations of abuse and any action subsequently taken. This would have enabled to service to identify any trends and lessons learnt.

There were not enough staff to meet the needs of people living at Carrwood House, particularly at night when only one member of staff was employed.

We found there were not appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

Safe staff recruitment procedures were adhered to.

People were offered a limited amount of options to meet their nutritional and hydration needs. Food and drink was not always stored correctly which meant it may not have been safe to consume. People told us they liked the food provided at Carrwood House.

Care records did not fully reflect whether a person had capacity to make decisions about their care and treatment. Staff did not fully understand the Mental Capacity Act and its implications on their practice.

Staff did not receive regular supervision, annual appraisals, or appropriate training to support them to carry out their jobs effectively.

There were few activities available to people living at Carrwood House. No activities were advertised to be taking place.

People’s care records contained gaps in information and were not regularly reviewed. This meant the information as how to best support people to meet their needs was incomplete and may have changed. There was no evidence that people’s views and aspirations were taken into account when care records were reviewed.

The views of people living at the service and their relatives were not regularly obtained, and were not recorded

There were no policies and procedures available to view. These should be available to people living at Carrwood House to give them information about the service. For staff they can provide good practice guidance and information about the service’s expectations of them.

We found the service did not have processes in place to enable them to respond to people and/or their relative’s concerns or complaints.

There was no evidence of regular quality audits being undertaken to ensure safe practice and identify any improvements required.

During this inspection we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 15, Premises and equipment, Regulation 18, Staffing; Regulation 9, Person-centred care; Regulation 11, Need for consent; Regulation 17, Good governance; Regulation 12, Safe care and treatment; Regulation 16, Receiving and acting on complaints; and Regulation 13, Safeguarding service users from abuse and improper treatment.

We found omissions in the reporting of incidents to CQC as required by regulations which was a breach of Regulation 15 and 18 of the Care Quality Commission (Registration) Regulations 2009 .

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

On Thursday 29 May 2014 two adult social care inspectors carried out this inspection. We spoke with seven people, four staff, the manager and the provider. We checked records relating to people and staff. We considered all the evidence we collated against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of this inspection. Their name appears because they were still a Registered Manager on our register. We have advised the manager currently in post that they are required to apply to the commission to become a registered manager.

Below is a summary which describes what people using the service and the staff told us, what we observed and what we found from the records we looked on the day. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care was planned and delivered in a way to ensure people were safe and protected from unlawful discrimination. Care workers had a good understanding of equality and diversity. People told us that they felt safe and care workers respected them and helped them with their daily living activities. One person said, 'This home is like a community. We all get on. Sometimes arguments break out between us or sometimes with staff. We sort it out.' Two more people told us that staff treated them well and made sure other people who lived at the home respected and helped each other. This meant staff promoted a safe environment for people to live in.

People were cared for in a clean and homely environment. Staff said they had attended training on infection prevention and control. One staff said, 'Washing hands properly is the most important thing. I also make sure people wash their hands.'

During the tour of the premise we noted a dedicated member of staff carrying out cleaning duties throughout the home. We observed staff using personal protective equipment (PPE) such as gloves and apron appropriately.

The environment was in need of repair, renovation and maintenance to become safe and suitable for the people who lived and worked at the home. The provider had not taken appropriate measures in relation to the up keep of the premises and did not have a planned programme of work.

Day to day maintenance work was unsatisfactory. Maintenance records evidenced that most of the work had not been carried out in a timely manner. This was due to the maintenance person having to carry out the upkeep of two properties as well as complete the necessary building work, refurbishments and renovation of the properties. This meant work was completed only when it became the top priority.

During our feedback on the day of the inspection the provider agreed to forward us an action plan with dates for completion by Tuesday 3 June 2014. They agreed to keep us up to date with progress. By Thursday 5 June 2014 we have not received the action plan.

Recruitment and selection processes in place were satisfactory. Appropriate procedures were undertaken, such as face to face interview, Disclosure and Barring Service (DBS) clearance and obtaining references from previous employers. We spoke with two staff who confirmed they had followed the process as mentioned above before they started their employment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, the manager was aware of the proper policies and procedures to follow. The manager had made arrangements for all staff to attend training on the above topic to achieve better understanding of when an application should be made, and how to submit one.

Is the service effective?

Care was delivered with people's consent and where people did not have the capacity to consent, the provider acted in accordance with legal requirements. People told us that care workers asked them for consent before assisting them. One person said, 'Staff let me know what is planned for the day. I can decide what I want to do or do nothing.'

There were arrangements in place to deal with foreseeable emergencies. Staff were knowledgeable about the procedures to follow if a person required immediate medical attention. The manager and the senior staff said they had a policy in place to deal with emergencies and staff were reminded of this at staff meetings.

People were given a choice of nutritious food which met their preferences. People told us that they often discussed menus during residents' meetings. We were informed by staff and two people who lived at the home that they had themed meals such as Indian, Italian, and if the weather permitted a barbecue.

A list of people's likes and dislikes and a four week menu was displayed in the kitchen. There was ample stock of fresh fruit and vegetables. The fridges and freezer were well stocked. Meal times were flexible and people were able to get snacks between meals if they wanted.

Is the service caring?

Staff supported the people in a caring and compassionate way. Staff were attentive and they encouraged people when supporting them.

Three people told us they had care plans and staff took time to tell them about what was written in the plans. They said they could change the plan if they wanted to. One person said, 'I know what is in my files. My key worker tells me if I want to know anything.' Another person told us, 'I know all that is in my care plan. X (the manager) is always reminding me about things I had agreed to do. Can't get away from it. They look after me I am much better in here.' This meant staff cared about the people and took steps to promote their wellbeing.

Is the service responsive?

Initial assessments of people were carried out by the manager to ensure the service was able to meet the needs of people.

With the help of regular reviews by the manager and senior staff appropriate care was delivered by staff. Once people's care needs were identified, they were followed up by risk assessments to make sure the plan of care minimised the risk to people.

Care and support was provided taking into account people's preferences, interests, aspirations and diverse needs.

The manager informed us that they were recruiting more staff to meet the needs of people.

Is the service well-led?

The manager ensured people's needs were reviewed and care was delivered in a way that promoted independence. There were arrangements in place for monitoring care and consulting people about their experiences and their changing needs. This meant the manager had taken action to ensure people were in receipt of appropriate care.

People who used the service were asked for their views about their care and treatment at residents' meetings. Although the provider visited the home regularly and spoke with people there was limited evidence that changes had been implemented due to information gained by the provider. We shared our findings with the provider and they agreed to formalise such visits in the future and produce a report with an action plan if required.

We saw audits carried out by the Sheffield Council Commissioning and Contracting staff. They have made regular visits to the home to help the manager make progress. The manager had introduced checks to monitor the activities at the home. This work was in progress. On the day of the inspection we informed the provider that the manager required sufficient support from them to ensure effective running and achievement of improvement of the home. The provider agreed to it.

People using the service told us that they felt safe living there and would know what to do if they felt unsafe. We found that people were protected from abuse as there was an appropriate system in place to safeguard people using the service from abuse.

People told us that they knew how to make a complaint. One person told us "I would tell the manager." We found that there was a system in place to ensure that people knew how to make complaints and that they would be investigated by the provider.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person living at the home told us: 'Staff here do help me. They tell me when to go in the bath and wash my clothes. They look after me alright here.'

People told us that they all felt safe living at Carrwood House and would know what to do if they felt unsafe. We found that the provider had not responded appropriately to an allegation of abuse.

Staff told us that they were supported to undertake their roles. Some comments included 'I feel supported. If we have concerns we go to (Manager)' and 'I feel supported by management'.

We found that people did not have their comments and complaints listened to and acted on. People's complaints were not fully investigated and resolved where possible to their satisfaction.

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time.