Craigarran Care Home

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

The governance and management systems in the home were not fully effective in identifying and addressing some of the concerns identified during our inspection. This included concerns around the recording of people’s ability to make decisions about their care and the accessibility and accuracy of care records, People found the provider and clinical lead were approachable, knowledgeable and worked hard to ensure the service effectively met people’s needs. Staff felt the registered manager needed to be more supportive and present within the care home.

People living at the service were supported safely. Their independence was encouraged and risk

assessments were in place to support this. Staff had a good understanding of how to protect people from the risk of abuse. People's medicines had been administered safely. However, some medicine protocols needed improving. We have made a recommendation around this.

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.

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 20 February 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

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 Craigarran Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report. We have made a recommendation around protocols for ‘as required’ medicines.

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 will take further action if needed.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was only allowing essential visitors at the time of our inspection, however, systems were in place to allow safe visiting. This included screening visitors to reduce any potential infection risk, before they entered the building. Arrangements were being put in place to allow future family visits using a specially purposed room in the home with a separate entrance and a Perspex screen to avoid cross contamination.

Social distancing was encouraged, and changes had been made to communal areas to promote this.

Staff wore personal protective equipment (PPE). Training in infection prevention and control measures and the appropriate use of PPE had taken place.

Systems were in place to admit people into the home when it was safe to do so.

A regular programme of Covid-19 testing was in place for people living at the home and the staff team.

Further information is in the detailed findings below.

• The registered manager was very proactive in the early planning and preparation for COVID19. They felt they had received little guidance so they had carried out their own detailed research to inform staff what was expected of them.

• Visitors to the service were rigorously checked before they entered the premises and were taught how to use personal protective equipment (PPE).

• All staff had been trained in infection, prevention and control. Additional cleaning routines had been established. A volunteer provided additional cleaning time.

• Risks of cross contamination had been assessed and actions put in place to mitigate the risks. A separate annex to the home was set aside for anyone who tested positive.

• Regular testing of people and staff was in place using the national testing portal.

• Additional assessments were in place for staff from Black, Asian and Minority Ethnic (BAME) communities. Staff had completed surveys to say they had felt well supported during the pandemic.

• Contingency planning was in place should there be a second wave of the virus.

Further information is in the detailed findings below.

Craigarran Care Home is a residential nursing home providing personal and nursing care to older people and people living with a dementia. It can support up to 44 people across a single, purpose-built and adapted site. There were 38 people using the service when we visited.

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

People were happy at the service and spoke positively about the support they received. Staff treated people with dignity and respect.

Risk to people were assessed and addressed. Clinical risk assessment and monitoring needed improving, and the registered manager told us how this would be done. Staffing levels were monitored to ensure they were safe.

We have made a recommendation about the management of some medicines.

Care plans were personalised and regularly reviewed. Further improvement was needed in some monitoring records. People were supported to access activities they enjoyed. Clear complaints processes were in place.

Staff received regular training, supervision and appraisal. 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. People received appropriate help with eating and drinking.

The registered manager and provider carried a number of audits to monitor and improve standards. Feedback was sought and acted on. We received positive feedback on the management and leadership of 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 and update

The last rating for this service was requires improvement (published 22 November 2017) and there was a breach of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

There was also an inspection on 18 September 2018 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This was a planned re-inspection because of the issue highlighted above.

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.

Craigarran Care Home is a care home with nursing registered with CQC to provide care for up to 44 people. On the day of our inspection there were 41 people using the service. Facilities included en-suite bedrooms, several lounges, a dining room, communal bathrooms, shower rooms and toilets, a hairdressing room, a communal garden and a large, spacious reception area.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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 and their relatives were complimentary about the standard of care at Craigarran Care Home. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people using the service.

Training records were up to date and staff received supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home. Bathrooms and toilets were appropriately signed and walls were decorated to provide people with visual stimulation. Corridors were clear from obstructions, well-lit and handrails were painted a bright colour, different to the walls, which helped to aid people’s orientation around the home.

The provider was working within the principles of the Mental Capacity Act 2005.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

People who used the service had access to a range of activities in the home and in the local community.

Staff used a range of assessment tools and recorded how care was to be delivered. However we found care records were not always up to date, regularly reviewed or reflective of people’s needs.

People had access to healthcare services and received ongoing healthcare support.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had audits in place to measure the quality of the service however the audits were not used effectively and had failed to identify the deficits we found in the service.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.