Archived: Carrick

Carrick is a residential care home providing personal care and accommodation for up to five people with learning disabilities or who are autistic. Five people lived at the service at the time of this inspection. One person had their own self-contained accommodation and the remaining four people lived in the main house. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

The service was not able to demonstrate how they were meeting all of the underpinning principles of the statutory guidance Right Support, Right Care, Right Culture.

Right support

One person’s support needs had significantly increased, and this had impacted on other people’s safety and well-being. Prior to the new manager’s arrival in the week prior to the inspection, staff had not received appropriate support and guidance to help them meet this person’s needs.

The numbers of staff on duty each day had increased since the last inspection and in the month prior to the inspection the staffing numbers had been safe. However, staffing arrangements at Carrick remained challenging. The service had significant numbers of staff vacancies and had been unable to recruit additional staff. The service had become dependent on a small group of agency staff to achieve the required staffing levels. These agency staff continued to be permitted to work excessive hours each week and had regularly worked over 84 hours per week with limited opportunities for rest. These working practices exposed people and the staff to ongoing risk of harm.

The provider had not made sure that necessary, pre employment checks had been completed for agency staff working in the service.

People were protected from abuse. Appropriate referrals had been made to the local authority when significant incidents occurred. The new manager had a good understanding of local safeguarding procedures.

Right care

Medicines were not manged safely. Records were incomplete and it was not possible to establish if people had received their medicines as prescribed. Staff skills in relation to medicine had not been regularly assessed.

Additional training had not been provided to staff on how to meet people’s communication needs. This continued to limit opportunities for people to participate in decision making.

Access to the community had improved for people since the last inspection. People had been offered regular opportunities to go out and people were being supported to engage in more activities. Sensory items were available to people in the lounge and plans were being developed to improve access to the garden.

Right culture

The culture of the service remains of concern. There was no registered manager in post and limited leadership support had been provided prior to the new manager’s arrival in the week prior to our inspection. This, in combination with the small number of agency staff regularly working excessive hours, meant there was a risk of a closed culture developing. This had not been identified and there were no plans in place to mitigate the risk.

The provider has again failed to demonstrate to the commission that there were appropriate systems in place to ensure people were protected from financial abuse. We have shared our concerns in relation to this issue with the local authority.

The provider’s quality assurance systems had failed to ensure the service achieved compliance with the requirement of the regulations.

The new manager had impacted positively on staff morale. Staff were complimentary of the new manager’s approach and told us, “I have been really impressed with the manager, she is really nice and is a good manager. I know they are looking for a full-time manager and I hope we get someone like that.”

The new manager had a good understanding of the Mental capacity act and appropriate applications had been made to the local authority for the authorisation of potentially restrictive care plans.

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 Inadequate. (Report published 17 May 2022). Breaches of the regulations were identified. At this inspection we found not enough improvements had been made and the provider was still in breach of the regulations.

Why we inspected

We received concerns in relation to a significant increase in the number of incidents occurring in the service. A decision was made for us to inspect and examine those risks and the performance of the service. We also undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have again found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this report.

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 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 Person centred care, Safe care and treatment, Safeguarding, Staffing, Governance and the Fitness of staff to work at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Carrick is a residential care home providing personal care and accommodation for up to five people with learning disabilities or who were autistic. Five people were living at the service at the time of this inspection. One person had their own self-contained accommodation and the remaining four people lived in the main house. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

The service was regularly short staffed and frequently operated at minimum safe staffing levels which impacted on people’s freedoms. One staff member routinely worked in excess of 84 hours per week, contrary to documented risk assessments. This exposed people to a risk of harm and poor quality of life, and had resulted in the service being unsafely staffed on one occasion.

Safeguarding incidents had not always been shared with the local authority and the provider had not worked collaboratively with partners to ensure people’s safety.

The provider’s quality assurance systems were ineffective and action plans developed to address issues identified at our last inspection had failed to drive improvements in the service’s performance.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Staffing levels were insufficient to enable people to go out when they wanted to. Some staff were working excessive hours which impacted on their performance and exposed people to increased risk of harm. People were not treated equally and their needs were not met.

Right care:

People did not consistently receive person centred care appropriate to their needs. People were excluded from routine decision making and available communication tools were not used.

Right culture:

There was a lack of effective oversight of the service. In combination with low staffing levels, long working hours had led to unplanned restrictions on people being used within the service. The acting manager had limited leadership experience and had received minimal support from the provider.

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 Requires Improvement. (Report published 14 September 2021) Breaches of the regulations were identified . The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider was still in breach of a number of regulations.

Why we inspected

We received concerns in relation to staffing levels and staffing working hours from a whistle-blower. A decision was made for us to inspect and examine those risks and the overall performance of the service. We also undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

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 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 Person centred care, Dignity and respect, Safe care and treatment, Safeguarding, Staffing and Governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Carrick is a residential care home providing personal care and accommodation for up to five people with learning disabilities or autistic people. At the time of the inspection five people were living at the service. One person had their own self-contained accommodation. The remaining four people lived in the main house and shared a living/dining area and small kitchen. The service is part of the Spectrum group who run similar services throughout Cornwall.

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

There were not always enough staff available to support people. In order to maintain safe staffing levels some staff were working excessive hours. This meant that, should they be off work for any reason, it would be difficult to find alternative cover.

Systems to monitor the service and make any improvements in a timely manner had not been effective.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, responsive and well-led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Although people’s communication needs and preferences had been identified staff had not received the relevant training to meet these needs.

Right care:

One person’s actions sometimes impacted on others putting them at risk of harm and causing them anxiety. In order to mitigate this risk staff were required to closely monitor where people were in the service and where they chose to sit. This affected people’s autonomy to move around freely and make day to day choices.

Right culture:

The registered manager had been working remotely and there was a lack of management presence in the service. This increases the risk of closed cultures developing. The registered manager told us about changes to the lay out of the office they were planning which would enable them to work in the service.

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. (Report published 16 January 2020).

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. 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.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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 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 safeguarding, staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider 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.

Carrick provides care and accommodation for up to five people who have autistic spectrum disorders and/or a learning disability. At the time of the inspection five people were living at the service. One person lived in a self-contained flat, with the remaining four people sharing the main house. Each had their own bedroom and shared a lounge/dining area and small kitchen. The service is part of the Spectrum group who run several similar services throughout Cornwall.

The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were safe. Staff had received safeguarding training and were aware of processes to follow if they had any concerns. Risk assessments guided staff on how to support people when they were distressed. Staff were able to describe how they kept people safe when there were risks to their health.

There were enough staff to meet people’s needs. Most of the staff team had been in post for a long time and they knew people well. New staff were well supported, they completed an induction and period of shadowing before starting to work independently.

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People were supported to access the local community and use local facilities.

People received their medicines as prescribed. Staff identified when people might benefit from additional healthcare support and made referrals appropriately. If people required additional support to attend appointments this was organised on their behalf.

Staff were familiar with people’s preferred method of communication and were quick to respond to requests or offer reassurance.

People were involved in light household tasks. The service was based in a rural setting and people enjoyed local walks and using local facilities. Opportunities for meaningful engagement in the service were limited and we have made a recommendation about this in the report.

The service was being overseen by an acting manager at the time of the inspection. The registered manager was working at a different Spectrum location. A meeting with senior management was due to be held to discuss future arrangements for the management of the service.

The acting manager had carried out a whole service audit and identified areas for improvement. An action plan had been developed with timescales for when improvements would be made.

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. (report published 23 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected Carrick on 31 May 2017, the inspection was unannounced. The service was last inspected in June 2015, we had no concerns at that time and the service was rated Good. At this inspection we found the service remained Good.

The service is required to have a 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. There was no registered manager in post at the time of the inspection. The acting manager was in the process of making an application for the position.

We arrived at the service shortly before 10:00 am. There were two members of staff on duty at this time. The identified required number of staff at this time of day was three. Staff told us one member of staff had not turned up for their shift. They had contacted another employee to support them and they arrived at the service at 10:30. Records showed there were several occasions in the days preceding the inspection when staffing levels identified as necessary had not been met. We have made a recommendation about staffing levels in the report.

Daily records showed people were going out regularly. People had access to a range of activities both within the service and in the local community.

Recruitment practices helped ensure staff were suitable to work in the care sector. Staff had received training in how to recognise and report abuse. The service held money for people and kept receipts to evidence any expenditures. We checked the amount of cash held for people against the records and found there were some discrepancies. Although these were minor it is important accurate records are kept to protect people from the risk of financial abuse.

Risks were clearly identified and appropriate action taken to minimise risks and protect people from avoidable harm. Staff knew how to minimise risks and manage identified hazards in order to help keep people safe from harm or injury. People received their medicines as prescribed. Action was taken when a medicine error occurred and the systems in place improved to help ensure the errors did not re-occur.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. 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.

Staff communicated effectively with people. They adapted their approach to communication according to people’s individual needs. One person was occasionally agitated during the day and staff were understanding and worked with the person to alleviate their anxiety.

Care plans were well organised and up to date. The plans contained information about what was important to people as well as information regarding their health needs. Personal histories were recorded to help staff get a picture of the events and circumstances which may have impacted on who people were today.

Roles and responsibilities were well-defined and understood by the staff team. The acting manager was supported by a development support worker (DSW). Spectrum employ DSW’s at several of their services to act as a link between the service and the organisations behavioural team. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual. Staff told us morale was good and were positive about the new manager. Regular supervisions and staff meetings were an opportunity for staff to voice any concerns or make suggestions on how to improve the delivery of care.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We also spoke to two relatives and an advocate. All the people we spoke with told us they were 'very impressed' with the care and support that people received at Carrick. No concerns were raised.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed. We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for in a clean, hygienic environment.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their care.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and college attendance. The records showed they saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were in place. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.