Archived: Carrick Lodge

Updated 7 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

We undertook an announced focused inspection on 10 December 2015. This inspection was completed to check that improvement had been made to meet legal requirements after our comprehensive inspection on 21 July 2015. We inspected the service against two of the five questions we ask about services; is the service safe? Is the service Well Led? This is because the previous concerns were in relation to these questions.

The inspection was carried out by two inspectors. Before our inspection we reviewed the information we held about the home. This included the information from the service regarding what steps they would take to meet the legal requirements.

We spoke to the registered manager, the deputy manager, the provider, four staff, three people who lived at the service, one family member of a person who lived at the service, three external health and social care professionals and an external safety professional.

Updated 7 January 2016

We carried out a comprehensive inspection on 21 July 2015. Four breaches of the legal requirements were found. This was because the arrangements in place for the administration and management of medicines at the service were not robust. Staff had transcribed medicines for five people, on to the Medicine Administration Record (MAR) following advice from medical staff. These handwritten entries were not signed and had not been witnessed by a second member of staff. Prescribed creams had not been dated when opened. There were gaps in the daily recording of the temperature of the medicine fridge, and the temperature readings recorded were above the recommended safe cold storage for medicines of between 2 and 8 degrees. The pharmacist recommendation that the temperature of the room in which the medicine fridge was stored should be recorded, had not been actioned.

The service did not have robust infection control procedures in place. Toiletries were used communally and there were no paper towels available. People were using communal hand towels which did not protect people from the risk of cross infection.

The provider and deputy manager were not clear on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Legislative guidance had not been followed appropriately.

There was lack of systems or processes which effectively assessed, monitored and mitigated the risks relating to the health, safety and welfare of people and those that work at the service. One fire door was not closing on activation of the fire alarm as it was hooked open to obstruct access for some people to a staircase. Policies and procedures held at the service required review, some were not dated and some held incorrect information. Records held by the registered manager regarding training and supervision was not comprehensive and did not enable the effective monitoring of staff needs. The Care Certificate was not being used by the service for the induction of new staff. Staff recorded food and fluid taken by people and these records were monitored by the registered manager. There was no evidence of monitoring of these records and it was not clear what action had been taken when gaps were found in these records. Care plan reviews were not always carried out regularly and consistently.

Providers have a responsibility to comply with the Health and Social Care Act 2008 regulations and submit statutory notifications to the Care Quality Commission (CQC) when any event which may impact on their service provision occurs, such as death of a service user or any concerns of abuse that may be raised. The CQC had not received any notifications from the service.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. Prior to this inspection CQC had received some information of concern which mainly related to issues identified at the last inspection. As a result we undertook a focused inspection on the 10 December 2015 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carrick lodge on our website at www.cqc.org.uk

Carrick Lodge is a care home offering nursing care for up to 38 older people who are living with dementia. At the time of the focused inspection on 10 December 2015 there were 23 people living at the service.

There was 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.

At this focused inspection we found the registered provider had taken action to help ensure all handwritten entries on to the MAR were signed by two staff. This helped ensure the risk of any errors would be reduced. Some prescribed creams had been dated upon opening however, many remained undated. This meant staff were not aware of the date after which the cream would not be safe to use. The temperature of the medicine fridge was being recorded daily, including the temperature of the room where the fridge was stored. However, the temperature of the fridge had been recorded between 0.4 degrees and 6 degrees centigrade between the 3 November 2015 and 9 December 2015. This did not ensure the safe cold storage of the medicines held in the fridge as the minimum temperature had been below the recommended 2 degrees centigrade for over a month.

The service had taken action to replace communally used hand towels and provided soap and paper towel dispensers in all bathrooms and toilets for people to use. However, the staff toilet and the nurses station/office continued to provide a communally used hand towel for all staff to use when washing their hands. This did not protect staff and people from the risks associated with cross infection.

The registered manager and the deputy manager had applied to undertake training in the Mental Capacity Act 2005 but this had not yet taken place. However, the registered manager was aware of the legal requirements and had arranged for healthcare professionals to review people living at the service with regard to this legislation. Some people required to have applications made for potentially restrictive care plans to be authorised, had been refered to appropriate health and social care professionals.

The fire door which was previously held open with a hook and prevented from closing in a fire was now closing automatically when necessary. The services policies and procedures had not been updated and reviewed at the time of this inspection. However, the service had applied to obtain an electronic system to keep their policies and procedures up to date and was waiting for this to be installed. There had been a considerable delay in this taking place and the registered manager assured us it would be chased up.

Records held by the registered manager regarding staff training did not enable the effective monitoring of staff needs. The training matrix held a ‘YES’ next to the subject undertaken with no detail of when this took place and when it would require updating. Supervision was being provided to staff regularly.

The action plan provided by the service stated three staff were undertaking the Care Certificate. The registered manager told us new staff were informed of the need for them to complete the Care Certificate as part of their induction. However, there was no evidence of new staff having completed any part of the Care Certificate. Some staff had been employed for several months and their progress had not been monitored at the time of this inspection. The guidance for completing the Care Certificate is 12 weeks.

Two of the three care plans we looked at had been reviewed and updated recently. However, one care plan had not been updated since 6 October 2015 and did not accurately reflect the person’s current needs. Staff recorded some people’s food intake due to concerns with their nutritional needs, however there were some gaps seen in these records. There was no evidence that the registered manager monitored these records.

The service had sent in statutory notifications to CQC since the last inspection regarding any event which may impact on their service provision occurs, such as death of a service user or any concerns of abuse.