Archived: Carisbrooke Nursing Home

Carisbrooke Nursing home provides accommodation and nursing care for up to 20 people and on the day of our inspection there were 16 people using the service. The service had 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.

People who used the service were safe as the provider managed the risks to their safety and provided staff with training and support to recognise and act on any potential abuse. People were supported with adequate numbers of staff and felt their needs were met. Their medicines were managed safely by appropriately trained nurses.

Staff had received appropriate training for their roles, and had also been supported with regular supervision from the management team. People’s rights to make decisions about their care was respected and those people who lacked capacity to make their own decisions, had been appropriately supported under the principles of the Mental Capacity Act 2005 to ensure any decisions made on their behalf were made in their best interest.

People were supported to maintain a healthy diet and fluid intake and staff showed good awareness of peoples differing dietary needs. People’s health needs were managed by staff who ensured they followed the advice of the health professionals who supported them.

People received kind and compassionate care from staff who had a good knowledge of their needs and people or their relatives were supported to be involved in the planning of their care. Staff caring for people enjoyed working at the service and were respectful towards the people in their care. They showed good awareness of supporting people to maintain their privacy and dignity.

People received individualised care and majority of the care records we viewed were up to date and pertinent to their needs. They were supported to undertake social activities that reflected their interests on a regular basis.

People felt able to raise concerns to the staff who cared for them and felt they would be taken seriously. The management team were visible and we saw there were regular quality audit systems in place that ensured the management team maintained the quality of the service.

The service had a registered manager in place at the time of our inspection. 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.

People felt safe in the service and staff understood their responsibility to protect people from the risk of abuse.

Medicines were not always stored, managed or administered safely. Risks in relation to people’s care and support were not always managed appropriately. People were supported by staff who had not always received adequate training.

There were sufficient numbers of staff available to meet people’s needs. Safe recruitment practices were followed and staff were provided with regular supervision and support. People were supported to eat and drink enough. People had access to healthcare and people’s health needs were monitored and responded to.

People’s rights under the Mental Capacity Act (2005) were not always respected and people were not always involved in making decisions about their care and support. People were not provided with kind and compassionate support at all times and people’s rights to privacy and dignity were not always respected.

People did not always receive consistent support as staff were not aware of the content of care plans and did not always have a knowledge of people’s preferences. People were provided with the opportunity to get involved in activities.

There were systems in place to monitor and improve the quality of the service however these were not effective in identifying areas for improvement. The registered manager had not notified us of incidents as required.

The management team were approachable. People were supported to raise issues, concerns and complaints, however, people could not always be assured that these would be dealt with appropriately. People were given the opportunity to get involved in giving their views on how the service was run.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although the service had currently no applications to be submitted for a DoLS order, we saw proper policies and procedures were in place, and the appropriate staff understood when an application should be made, and how to submit one.

We saw training records showing staff had participated in recent training in both Safeguarding Adults and Deprivation of Liberty Safeguards training, and had regular training updates and staff meeting discussions on those subjects. We saw records which were for the most part accurate and up to date records of the care people received.

Is the service effective?

We spoke with people who used the service and some relatives. The relatives we spoke with told us that it was a caring service which provided the right kind of care for their family members.

One relative we spoke with told us, 'Yes staff do a good job in difficult circumstances. My relative has very high levels of need but they manage that very well. Staff try their best and try to 'go the extra mile' to make sure that they are well cared for.'

We looked at six care files and found the service identified individual needs and based care and support programmes upon those needs. The service respected the equality and diversity of the people who used its services by customising the experience of their care and support to that person's assessed needs, making sure the care, facilities and nutrition were provided individually to that person's requirements.

People who used the service told us the staff provided effective care that met their needs.

Is the service caring?

Staff showed a good knowledge of the needs of people who used the service. This was supported by detailed and up to date care plans. One person told us, 'If you have a problem the staff will help you. Two nurses are always there to help me to have a shower.' Another person told us, 'Carers are good and the staff are all very good to me, I never have anything to worry about. I have nothing to complain about, if I had I would tell you.'

Staff supported people in a caring manner. They responded to people's individual needs in a patient and dignified way. We saw members of staff talking to people in a simple and reassuring way asking them how they would like their care provided.

Is the service responsive?

The managers and staff of the home held regular review meetings for each person. This involved each person and their family members to make sure the care provided continued to meet the person's needs. Records showed regular involvement of other professionals such as doctors and community nurses to plan the best way of delivering a service to the person.

A relative of a person who used the service told us they and their family member thought Carisbrooke Nursing Home was a very good home. They told us the provider had worked with occupational therapists to prepare a communication book which included photographs and information of their relative's life which helped them to remember more of themselves.

Is the service well-led?

The staff were trained in essential areas of care provision such as safeguarding, manual handling and management of medicines.

The provider had policies and systems in place which indicated the service was efficiently and professionally led. We saw a statement of purpose document for the service which outlined the way the service was run. One member of staff told us, 'We get assistance from colleagues and management in our work. The manager is very supportive of the staff, and the owner visits regularly.'

We were concerned that consent to care and treatment was not always sought from people who used the service. We were concerned that people's individual needs were not always assessed and appropriately planned.

We found improvements had been made in the safe handling of medicines and in ensuring there were sufficient numbers of staff who were competent in speaking English employed by the service.

We found improvements with the confidential storage of records. However, we were concerned that care records did not always reflect people's identified needs, were contradictory and difficult to read.