Archived: Carson House Care Centre

Carson House Care Centre is a ‘care home’ situated in Stalybridge in Tameside, Greater Manchester. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Carson House accommodates up to 45 people. The home is divided into four units. Each unit consisted of a lounge, dining area and small kitchen facilities. One unit provides general nursing care, one unit provides mental health nursing for men who have behaviours that challenge and the other two units provide mental health nursing for men and women in separate units. There are two enclosed patio areas at the rear of the building which were used as smoking areas and were accessible to people who use the service.

During our inspection some people moved to other services and others were being offered alternative homes to move into. At the end of our inspection there were 25 people living in the home.

At our last inspection in December 2017 and January 2018 we rated the home inadequate overall and identified multiple breaches of the regulations. At this inspection we found limited evidence of improvements. We found improvements had been made in relation to training and supervision and the provider was meeting the requirements of this regulation. There remained ongoing breaches of regulations relating to the provision of safe care and treatment in particular; health and safety and medication, safe recruitment practices, person centred care and governance. We also found continued breaches of the Care Quality Commission (Registration) Regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the back section of reports after any representations and appeals have been concluded.

There was no registered manager in post. The service had a manager who had been in post since September 2017 and at the time of our inspection was in the process of applying to become the registered manager of the service. However following our inspection, we were informed that the manager had withdrawn their application. 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.

Following our last inspection, the registered provider had informed CQC that they were actively involved in the day to day running of the home and attended the home on a monthly basis to engage with residents and staff. We found no evidence to support this during our inspection.

We found there was little evidence that the issues relating to the maintenance and upkeep of the building identified at our previous inspection had been rectified. We continued to find defective lighting, a lack of fire signage and hot water that posed a scalding risk.

People did not always receive their medicines safely. Stocks of some creams indicated they had not been used as often as prescribed and some checks on people’s blood sugar levels had not been carried out as required.

Appropriate checks were not always completed on staff before they started working at the home. Full employment histories were not recorded and gaps in people’s employment were not explored.

The home was generally in a poor state of repair and although a few rooms had been recently re-decorated the remaining rooms were in need of decoration. The smoking areas were untidy with cigarette ends and other litter.

People living in the home and their relatives spoke highly of the care staff. Throughout our inspection we observed caring and respectful interactions between staff and people living in the home.

Relatives gave us examples of how the rapport staff had built with people enabled staff to encourage people to be more receptive to being supported. People told us the staff knew them well and understood their needs.

People told us they felt safe in the home and relatives told us they felt their relatives were safe. Staff were aware of how to identify and report concerns and where concerns had been raised by staff they had been investigated appropriately.

Staffing levels were adequate in the home and people received support in an unhurried way. A number of staffing agencies had stopped supplying staff to the service because of unpaid bills and there was concern about how the home would be staffed if care workers left.

During our inspection staff were extremely unhappy that they had not been paid fully on time but did not let this affect the level of care and support they provided to people living in the home.

Efforts had been made to record the types of activities people wanted to do and took part in but the activities available on a day to day basis were ad-hoc and did not reflect people’s preferred activities.

Staff told us the manager had made a positive difference to the home since they had started and gave us examples of improvements they had made.

We found systems in place to monitor the safety and quality of the service were ineffective.

The overall rating for this service is ‘Inadequate’ and the service remains 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 providers 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.

This 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 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.

This inspection was to check satisfactory improvements had been made and to review the ratings.

Although some improvements had been made to the service we found the service was not meeting the requirements of multiple regulations and have rated the service as ‘Inadequate.’ Breaches were identified in relation to fit and proper persons checks, lack of social support and meaningful activities, staff training ,supervision and induction, lack of accurate information in the statement of purpose, concerns regarding the financial position of the registered provider, environmental risk assessments, systems to monitor the safety and quality of the service and governance systems that lack robustness. We are currently considering our options in relation to enforcement in response to some of the breaches of regulations identified.

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 providers 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. This 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 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 registration.

For adult social 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.

Carson House Care Centre is situated in the Stalybridge area of Tameside Manchester and provides accommodation for up to 45 people who require nursing and personal care. All rooms provide single accommodation and 43 rooms have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or a passenger lift. Communal bathrooms and toilet facilities were available throughout the home. The home is divided into four units, two on the ground floor and two on the upper floor; each unit consisted of a lounge, dining area and small kitchen facilities. One unit is dedicated to providing general nursing care, one unit known as (CBU) the challenging behaviour unit provides specialist mental health nursing for men who have behaviours that challenge and the other two units provide mental health nursing for men and women in separate units. The laundry and main kitchen are located on the lower ground floor. There are two enclosed patio areas at the rear of the building that were also accessible to people who use the service.

At the time of our inspection there were 36 people living at Carson House.

The service had employed a new manager following the previous inspection. The manager was not registered with the Care Quality omission (CQC) although they told us they were due to submit their application to register as manager with CQC. 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 received positive comments from people who live at the service, relatives and staff. All of the people living at Carson House that we spoke with told us they felt safe and well cared for. However some people living at Carson House felt they did not have enough to do and that they wanted to have trips out and have daily access to social activities. We also received mixed comments about the food and menus on offer. We found improvements had been made in relation to people having their hydration and nutritional needs met. The chef had a good understanding of people's dietary needs and made improvements to the kitchen facilities and cleaning schedules. We have made a recommendation that the service review the current dining areas and source ways of improving the environment and dining areas to a more home like environment.

Following the last inspection, we wrote to the registered provider requesting specific information and clarification on the current registration, ownership and management of Carson House. The service’s current statement of purpose had no details regarding Mr David Hetherington Messenger the current registered provider. The registered provider had no written records to show any quality assurance and governance processes carried out by them.

We found that robust governance systems had not yet been fully implemented to monitor all aspects of the quality and safety of the service being provided. Evidence showed the provider had not always mitigated risks appropriately to reduce the likelihood of identified health and safety risks occurring. This meant people were at risk of potential harm.

Some routine safety checks of the premises had been undertaken. However these had not identified the risks we found during inspection, as detailed in the safe domain of this report.

We saw improvements had been made to medicines administration to provide a safe system in supporting people with their medications. However the oxygen cylinders were free standing and had no safety straps to prevent the risk of them falling over and causing potential risks of igniting.

We found that safe and appropriate recruitment and selection practices had not been carried out by management to satisfy themselves that only suitable staff were employed to care for vulnerable people. This was also the finding at the last inspection.

From examining the staff training matrix (record) we found there had been improvements but there were still gaps in the training staff had received. This meant some staff may not be appropriately trained and skilled to meet all the needs of the people living at the home. This was also the finding at the last inspection.

Since the last inspection staff had started to receive supervision from senior staff and the new home manager had plans to eventually implement appraisals for the staff team. Although some improvements had been implemented, further work was needed to show sustained support to the whole staff team to ensure they were appropriately guided and supported to fulfil their job role effectively.

Peoples' support plans contained up to date, detailed information about their care and support, including risk assessments and action plans. However handover summaries completed by nursing staff were inappropriate and some were not signed or dated and were illegible.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

The service was clean and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection for example disposal gloves and aprons. However the environment was in need of redecoration and refurbishment in various areas of the building.

Staff understood how to recognise and report abuse which helped make sure people were protected. People living at Carson House, visiting relatives and staff spoken with said they thought safe care and treatment was provided.

We have made a recommendation that the service should review their policies and procedures to ensure staff had the most updated information relevant to the service.

We have made a recommendation that the service review storage of confidential information of people’s confidential records.

We last inspected Carson House Care Centre in January 2017. At that inspection we assessed the service as inadequate in safe, effective, responsive and well-led and requires improvement in caring. At that inspection we identified multiple regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to dignity and respect, the need for consent, safe care and treatment, meeting nutritional and hydration needs, good governance, staffing, and fit and proper persons employed.

The overall rating for this service was Inadequate and the service was therefore placed in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key domain over two consecutive comprehensive inspections. The purpose of special measures is to ensure the provider makes significant improvement to become compliant with the Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At the time of the last inspection a receivership company had been appointed to sell the home and an external care management organisation had been appointed to oversee the day to day management and care delivery at the home. The receivership company had been appointed from 26 September 2016 to 5 June 2017. This meant at this inspection the receivership company were no longer managing the service and that the original registered provider had been reinstated to manage the service again on 6 June 2017.

This inspection was to check if improvements had been made and to review the ratings

Carson House Care Centre is situated in the Stalybridge area of Tameside and provides accommodation for up to 45 people who require nursing and personal care. All rooms provide single accommodation and 43 rooms have en-suite facilities.

Bedrooms are located over two floors and can be accessed by stairs or a passenger lift. Communal bathrooms and toilet facilities were available throughout the home. The home is divided into four units, two on the ground floor and two on the upper floor; each unit consisted of a lounge, dining area and small kitchen facilities. One unit is dedicated to providing general nursing care, one unit (CBU) provides specialist mental health nursing for men who have behaviour that challenge and the other two units provide mental health nursing for men and women in separate units.

The laundry and main kitchen are located on the lower ground floor. There are two enclosed patio areas at the rear of the building that were also accessible to people who use the service.

At the time of our inspection there were 39 people living at Carson House.

At the time of this inspection the service did not have a registered manager in place. The previous registered manager left the organisation in December 2016. 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 this inspection, we saw that some improvements had been made. However we identified multiple continued breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to person-centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance of the service, staffing and ensuring fit and proper persons are employed. We are currently considering our options in relation to enforcement in response to some of the breaches of regulations identified. We have issued requirement notices for all breaches identified at this inspection. Please see the section at the back of the inspection report to explain the actions taken.

Some people living at Carson House Care Centre, their relatives, and staff spoke highly of the service. For example one person said “I’ve lived in a few homes and this is the best one, the staff know my needs. Sometimes there are agency staff but on here we have people who’ve been here a long time.” However some comments from relatives were not so positive about the care their relative received and the decor of the home.

As found at the last inspection there were enough staff available to meet people’s needs. However, we observed that some staff did not positively engage with people or provide individualised personal care.

As at the last inspection we found that safe and appropriate recruitment and selection practices had not been carried out by management to satisfy themselves that only suitable staff were employed to care for vulnerable people.

We had on- going concerns in relation to staff supervision because staff were not receiving supervision on a regular, ongoing basis and there was no evidence that staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

From examining the staff training matrix (record) we found there were continued gaps in the training staff had received. This meant some staff may not be appropriately trained and skilled to meet all the needs of the people living at the home.

We found that not all staff had received training relating to safeguarding adults and clear and accurate records were not being kept of any safeguarding investigations carried out, including the outcomes of those investigations.

During this inspection we found some improvements had taken place regarding the management and administration of medicines. For example a ‘medication count sheet’ had been implemented for boxed medication and we conducted a count of the contents of three boxed medications and the balances were all accurate. However we found that stocks of medication carried over from the previous month had not been recorded on the medication administration records (MAR’s). This meant there was not an accurate record of medication in the home and therefore accurate audits of medication administration could not be undertaken.

We found that some risk assessments relating to keeping people safe had not been reviewed on a regular basis and some care files contained out of date information. This meant people were at risk of potential harm.

Some of the routine safety checks of the premises had not been undertaken, for example checks of water temperature delivery, window restrictors and nurse call bells. This meant the provider could not be sure people using the service were kept as safe as possible at all times.

As at the last inspection we found some people’s documentation to consent to care and treatment had been signed by family members who did not always have the legal right to provide this consent. The home had not checked with relatives to ascertain whether these legal safeguards were in place.

At this inspection, we saw that improvements had been made to the general cleanliness of the home and an external company had undertaken deep cleaning throughout the whole home. However, we found that clear and accurate records were not being kept of the cleaning that was being undertaken by domestic and care staff and no records had been kept of any cleaning that had been undertaken in the kitchen since the end of 2016.

We found that robust systems had not been implemented to monitor the quality and safety of the service people received.

At the time of the inspection the Clinical Commission Group (CCG) had suspended admissions to the home due to the concerns identified at our last inspection of the service. The CCG told us they were currently working with the service to try and improve standards of care.

We found improvements had been made in relation to people having their hydration and nutritional needs met. The chef and cook had a good understanding of people’s dietary needs and people had a choice of meals.

As found at the last inspection we saw a continued use of plastic plates, dishes ad cups which was not person centred. We made a recommendation that people only used plastic crockery if they had been individually assessed as requiring them with the reason clearly identified in the care plan.

We found that when staff interacted with people they treated people with respect and dignity. However we recommended that staff should provide people with consistent and positive interaction.

This inspection was carried out over five days between 16 and 20 January 2017. Our visit on 16 January was unannounced.

We last inspected Carson House on 31 May 2016. At that inspection we assessed the service as requires improvement in safe and well-led and good in effective, caring and responsive domains. We also identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to infection control, cleanliness, safety of the environment, medication and good governance. We also made one recommendation to ensure the information and legibility of handover notes were improved.

Carson House is situated in the Stalybridge area of Tameside and provides accommodation for up to 45 people who require nursing and personal care. All rooms provide single accommodation and 43 rooms have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or a passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into four units, two on the ground floor and two on the upper floor; each unit consists of a lounge, dining area and small kitchen facilities. One unit is dedicated to providing general nursing care, one unit provides specialist mental health nursing for men who have challenging behaviour (CBU) and the other two units provide mental health nursing for men and women in separate units.

The laundry and main kitchen are located on the lower ground floor. There is an enclosed patio area at the rear of the building that is accessible to people who use the service.

At the time of our inspection there were 41 people living at Carson House.

The service did not have a registered manager in place as they had left the organisation in December 2016. 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 carried out this inspection in response to information of concern we received regarding the safety of people at the home due to the unavailability of a hoist on the ground floor. At the time of the inspection a receivership company had been appointed to sell the home and an external care management organisation had been appointed to oversee the day to day management and care delivery at the home.

We identified multiple breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to person-centred care, dignity and respect, consent, safe care and treatment, safeguarding, meeting people’s hydration needs, premises and equipment, good governance of the service, staffing and ensuring fit and proper persons are employed. You can see what action we told the provider to take at the back of the full report. We are currently considering our options in relation to enforcement in response to some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

Some people, their relatives, and staff spoke highly of the service; one person’s relative told us, “I can honestly say in the past three years I’ve never had anything to complain about.” However, not all relatives were happy with the service and the home was dealing with a complaint during our inspection.

During this inspection we found that there were enough staff available to meet people’s needs. However, the use of agency staff meant that people were not always being cared for by people who knew them or were fully aware of their individual care needs.

People were supported by staff who were mostly kind and caring. However, we found during our inspection that people were not always treated with dignity because staff did not always ensure people were left in a dignified state.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had not been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, we found that not all staff had received training at the home on safeguarding adults and staff had not identified and reported the safeguarding issues we raised during the inspection.

Documentation at the home showed that people sometimes received input from other health care professionals, such as dentists and podiatrists. However, we found that people had not always received the necessary care and support when they needed it.

We found concerns regarding the management and administration of medicines during our inspection.

Care files we looked at showed plans and risk assessments documenting people’s specific care and support needs. These were detailed plans outlining how people needed to be cared for in an effective and safe way. However, they did not always accurately reflect people’s current care needs as they had not always been kept up to date.

We found that although care and monitoring documentation was in place, these were not always accurate, effective and followed by staff; this placed people at risk of harm.

During our initial tour of Carson House on the first morning of our inspection, we saw that some areas of the home were not clean and several bedrooms had a strong malodour. We found a number of concerns with the general home environment, such as stained carpets, broken sinks and cracked window panes. These concerns had previously been reported on and an action plan put in place from the last inspection in May 2016, but had not been rectified. The enclosed outdoor area was dirty, unkempt and strewn with cigarette ends.

We found people’s documentation to consent to care and treatment had been signed by family members who did not always have the legal right to provide this consent. The home had not checked with relatives to ascertain whether these legal safeguards were in place.

During our inspection we raised multiple safeguarding alerts with the local authority. These pertained to our concerns relating to people’s current care and support. We also reported our initial findings to the local authority commissioning team who arranged subsequent visits to the home by social work teams to conduct safe and well checks.

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 providers 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.

This 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 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.

Due to our findings during our inspection the provider invoked a temporary, voluntary suspension on new admissions to the home until the issues we had identified had been resolved.

We last inspected Carson House on 4 February 2014. At that inspection we found the service was meeting the regulations we assessed.

Carson House is situated in the Stalybridge area of Tameside and is registered to provide accommodation for up to 45 people who require nursing and personal care. All rooms provide single accommodation and 43 rooms have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into four units, two on the ground floor and two on the upper floor; each unit consists of a lounge, dining area and small kitchen facilities. One unit is dedicated to providing general nursing care, one unit provides specialist mental health nursing for men who have challenging behaviour and the other two units provide mental health nursing for men and women in separate units.

The laundry and main kitchen are located in the lower ground floor. There is an enclosed patio area at the rear of the building that is accessible to people who use the service.

At the time of our inspection there were 43 people living at Carson House.

The service had 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.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to infection control, cleanliness, safety of the environment, medication and good governance. You can see what action we told the provider to take at the back of the full report.

We have made one recommendation for the registered manager to ensure handover notes are improved around information and legibility.

People, their relatives, and staff spoke highly of the service; one person’s relative told us, “This is a good place. Visiting professionals were also complimentary of the service and one professional told us, “They are very committed staff”.

During this inspection we found that there were enough staff available to meet people’s needs and the registered manager had worked closely with local health services to formulate safe staffing and nursing levels.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been used to ensure that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

Documentation at the home showed that people received appropriate input from other health care professionals, such as dentists and podiatrists, to ensure they received the care and support they needed from community healthcare services.

People looked well cared for and content during our visit and we saw that people were given choices and consent was sought before care was given.

Care files we looked at showed comprehensive plans and risk assessments documenting people’s specific care and support needs. These were detailed plans outlining how people needed to be cared for in an effective, safe and personalised way. The plans included a photograph of the person and detailed information around their preferences. Additionally, we saw that these care files were regularly reviewed in a comprehensive way; meaning that information in the files was current and up-to-date to ensure people received the correct care and support.

During our initial tour of Carson House on the first morning of our inspection, we saw that some areas of the home were not clean and we identified issues with infection control; there were no paper towels available to dry hands after washing and we evidenced unsafe practices around storage of laundry. We found a number of concerns with the general home environment, such as stained carpets, broken sinks and cracked window panes.

A number of periodic safety checks carried out by external companies had been allowed to run past their recheck date for example, checks on mechanical equipment such as bath lifts and riser beds The registered manager was fully aware of the shortfalls in the environment and safety rechecks and had reported these issues to the provider. The registered manager and director told us the provider had been experiencing some difficulties with finances, but the home was transferring to a new provider and financial issues were being addressed. We saw evidence that new equipment and furnishings had been ordered and equipment safety checks arranged.

We met several people living in Carson House during the course of our visit, but the purpose of this visit did not require us to seek their views.

We looked at a particular safeguarding incident which had been investigated in December 2013 but had not been reported to the Care Quality Commission. We were satisfied that the incident had been handled correctly and that the welfare of the person concerned had been protected.

We also looked at staffing levels within the home. We learnt that sometimes nurses had been asked to work a double shift. Also there had recently been fewer staff than required, in particular on night shifts.

The manager told us about the measures that had already been taken to improve the availability of nurses and care workers. We found that the service was therefore compliant with the standard relating to staff numbers.

At our previous visit in July 2012 we found that five essential standards were not being met. We asked Carson House Care Centre to take action to improve in those areas. On this visit in September 2013 we found improvements in all these areas and that Carson House was now meeting those five essential standards and two others that we chose to look at.

We found that people were treated with respect and that, so far as they were able, they and their relatives were involved in decisions about the running of the home. We found that care records were well maintained and up to date, which would help ensure high standards of care. We found that staff were trained in safeguarding and people were adequately protected from harm.

We saw that the premises were being developed but that they were safe for the people currently living there. We found that the process for recruiting staff was adequate and that the necessary documentation was available. We found that there were systems to monitor, assess and improve the quality of care being delivered. We found that the standard of record keeping had improved since the last inspection.