Archived: Caythorpe Residential Home

Caythorpe residential care home is a residential care home providing personal and nursing care to 12 people and is registered to provide care for younger and older adults at the time of the inspection. The care home can accommodate up to 14 people in one adapted and extended building.

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

People lived in a safe environment. Staff worked to reduce the risks of harm to people in their care. People were supported by enough numbers of staff who knew their needs well. Their medicines were managed safely, and staff followed government guidance to reduce the risks of the spread of infection during the COVID-19 pandemic. When incidents occurred, staff used their learning from the events to reduce the risk of reoccurrence for the people in their care.

The quality monitoring processes in place had been reviewed since our last inspection and we saw there were improvements in this area. However, more time is needed to ensure the systems in place are sustained and embedded into practice to ensure continued good standards of care for people.

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

Rating at inspection

The last rating for this service was Requires Improvement, report published 3 December 2020. The provider was in breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been sustained and the provider was no longer in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to follow up on concerns we had received, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is Good. This is based on the findings at this inspection.

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

People were not supported to reduce their risk of exposure to infection. The provider had failed to assess and mitigate risks in relation to infection control. People were not supported by staff who had knowledge of changes in government guidance around the spread of infection.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in their best interests; the policies and systems in the service did not always support this practice.

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

Rating at last inspection.

The last rating for this service was good (published 3 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about residents safety and infection control. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people's safe care and treatment and the governance of the service at this inspection.

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

Follow up

We will request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

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

Caythorpe Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It accommodates 14 people in one adapted building. There were 11 people living at the home when we inspected.

The home is owned by a single person and they have also registered as the 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 the last inspection we found that the provider was in breach of Regulation 19, fit and proper person’s employed and Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe and well led to at least good.

At this inspection we found that the provider had made the necessary improvements in care provided. They had ensured that enhanced disclosure and barring checks had been completed on all staff and had ensured that the systems to monitor the quality of care provided were effective.

At the last inspection the home was rated as requires improvement. At this inspection we found that the provider had improved the quality of care provided for people and was rated as good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were enough staff to meet people’s needs. Staff had received training which supported them to provide safe care to people. Medicines were safely administered and staff knew how to protect people from the risk of infection.

People were able to make choices about their food, clothing and how they spent their time. People’s dignity was respected and people’s abilities were recognised and encouraged to maintain their independence.

Systems were in place to monitor the quality of care provided and action was taken to resolve any concerns found. People were given the opportunity to comment about the care they received and the information was used to drive improvements in the quality of care.

The home provides residential care for up to 14 older people some of whom may be living with a dementia. Fourteen people were living at the home on the day of our inspection.

The home was owned by an individual person and they were also the registered manager for the home. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The provider was not meeting the legal requirements in two areas of care provided. They had failed to ensure that the correct checks were completed to ensure staff were safe to work with people living at the home. They had failed to ensure that the systems to monitor the quality and safety of care were effective. You can see the actions we have asked the provider to take at the back of this report.

There were enough staff in place to care for the people living at the home. Staff received training when they first started working at the home to ensure that they had the skills needed to provide safe care for people. However, the frequency of training to refresh and update their skills did not support staff to be up to date with current best practice.

Where people had been unable to make the decision to live at the home the provider had submitted appropriate applications for assessment under the Deprivation of Liberty Safeguards. However, it was not always clear who was legally entitled to make decisions for people and if decisions had been made in people's best interests.

Most staff were kind and caring and there was a pleasant relaxed atmosphere in the home. Although people did raise concerns about an individual member of staff who could be more abrupt. People’s dignity was not fully respected in the care they received and people’s independence was at times restricted by their care.

Medicines were safely stored and staff administered the medicines in a safe methodical manner to reduce the risk of errors. However, one person had not received some pain medicine due to a lack of clarity on how it should be administered. In addition, it was not clearly recorded why people had been offered medicines prescribed to be taken only when needed.

People were happy with the quality of food available to them and were supported to maintain a healthy weight. People were offered a choice of hot and cold drinks throughout the day to ensure they stayed hydrated.

Care plans recorded the risks to people while receiving care and provided information to support staff to provide safe care. However, they did not contain enough information to support staff to personalise the care to people’s individual needs. People were supported to access activities which helped them to stay mobile and to engage with and access the local community.

People were happy to raise complaints or concerns with the provider and were confident they would be resolved. Systems in place to monitor the quality of care provided were not always effective and did not support the provider to drive improvements in the care people received.

Caythorpe Residential Home can provide accommodation and personal care for 14 older people and people who live with dementia. There were 14 people living in the service at the time of our inspection.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted as both the provider of the service and the registered manager. In this report we refer to this individual as being, ‘the registered person’. The registered person has a 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 an unannounced comprehensive inspection of this service on 27 April 2016 and found that there were three breaches of legal requirements. We found that people were not consistently receiving safe care. This was because medicines were not being safely managed and, people were not fully protected from the risk of accidents. In addition, people were not consistently helped to reduce the risk of acquiring infections. A further shortfall we noted was that the system used to recruit staff was not robust. We also found that quality checks had not been completed in the right way to identify and quickly resolve problems in the running of the service.

After our inspection of 27 April 2016 the registered person wrote to us to say what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that all of the problems we noted would be addressed so that people consistently received safe care. The registered person said that all of the necessary improvements would be completed by 31 June 2016.

This report only covers our findings in relation to the action taken by the registered person to meet the breaches of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mrs Christine Lyte on our website at www.cqc.org.uk

At this inspection, we found that the registered person had introduced most of the improvements that were necessary to ensure that people safely and reliably benefited from receiving safe care. This meant that the relevant legal requirements had been met. However, a small number of further improvements still needed to be made to ensure that the service continued to reliably care for people in the right way.

Caythorpe Residential Home provides accommodation for up to 14 people who need personal care. The service provides care for older people some of whom live with dementia. There were 14 people living in the service at the time of our inspection.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted as both the provider of the service and the registered manager. In this report we refer to this person as being, ‘the registered person’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not consistently managed safely, risks to health and safety were not robustly addressed, recruitment checks had not been correctly completed and quality checks had not been effective. You can see what action we told the registered person to take at the end of the full version of this report.

There was insufficient evidence to show that there were robust arrangements to safeguard people from abuse including financial mistreatment. There were enough staff on duty. Although people had received all of the healthcare assistance they needed, the arrangements to support them to eat and drink enough were not robust.

The registered person and staff were following the Mental Capacity Act 2005 (MCA) by supporting people to make decisions for themselves and when this was not possible by ensuring that decisions were taken in their best interests. However, the Care Quality Commission is also required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this the registered person had not promptly taken all of the necessary steps to ensure that people’s legal rights were protected.

Although people were treated with kindness and compassion arrangements in the service did not fully promote people’s right to privacy. In addition, confidential information was not kept securely.

Although people had been consulted about and received most of the practical assistance they needed, the arrangements to support people who could become distressed were not sufficient. People had not been fully assisted to meet their spiritual needs and some people were not satisfied with how often they were supported to pursue their interests and hobbies. There was insufficient information to show how well the registered person would investigate and resolve complaints.

Although people had been consulted about the development of the service there was no evidence to show what had been done to implement suggested improvements. Although there was good team work and staff were supported to speak out if they had any concerns, people who lived in the service had not benefited from the registered person acting upon good practice guidance.

We found the provider had complied with the actions we set. People who used the service were protected against the risks of unsafe or unsuitable premises.

We looked at service information, records and carried out a tour of the building.

One of the people who used the service (and their spouse) told us they were happy with the care and support provided. They told us they felt safe, knew how to raise any concerns they might have and that staff treated them with respect.

Relatives we spoke with said they were consulted with regards to their relative's care. One relative told us 'Staff always keep me up to date with my family member's care and discuss things with me.'

The staff we spoke with were aware of the individual needs of people who used the service. One staff member told us, 'I always read people's care plans to read about their life history and their interests.'

People told us they felt safe in the building. One relative told us, 'It's a nice building, they (provider) do the best they can with it.' However we saw that toilet facilities within some bedrooms did not ensure people's right to privacy and dignity.

The records we looked at were accurate and relevant to the management of the service.