Carrington House Limited

We found the following areas of good practice:

The home had purchased adequate amounts of personal protective equipment (PPE) to ensure that staff could protect themselves and people living in the home. Staff had received training with regard to donning and doffing PPE and were able to explain how they used PPE to protect themselves and to keep people living at Carrington House safe. Used PPE was disposed of as clinical waste and was collected regularly by the contractor.

Visitors were able to meet with people using the service in a socially distanced way in either the family room or the reception area and PPE was provided. Where people were unable to visit in person, alternative ways had been found to keep in touch and this included by phone, tablet and window visits.

A contractor was in place to provide a cleaning service for the home and cleaning schedules had been updated in light of COVID-19 risks. Frequent cleaning of high touch areas was undertaken, both day and night. The home had a large stock of cleaning detergents which had been checked for their efficacy in preventing the spread of COVID-19. Oversight of laundry was comprehensive and housekeeping staff demonstrated a good knowledge of the guidelines in place for washing people's clothing should someone test positive for COVID-19.

All staff undertook both PCR and lateral flow tests in order to protect the people they cared for. Where staff tested positive, they were supported to isolate at home and the appropriate authorities informed. Where staff needed to isolate following guidance from 'Track and Trace', the care home supported people to do so and ensured that they continued to be paid. Staff spoke highly about the leadership approach of managers. Staff who had tested positive for COVID-19 told us that they had been well supported by managers whilst they made a full recovery. All staff had received the first dose of a COVID-19 vaccine.

Carrington House is a residential care home providing personal care to 52 people at the time of the inspection. The service can support up to 60 people. The home is split across three floors with shared bathrooms. Each bedroom has its own ensuite toilet and washing room. The home has a number of lounges and dining areas, a garden and conservatory areas for people to meet up and socialise.

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

People said they felt safe because the home was secure and there was enough staff to support them with what they needed. Staff ensured people were safe as they completed detailed risk assessments and care plans and had training for their role. Staff had a good understanding of safeguarding and were confident about reporting any concerns. People received their medicines correctly and on time and in line with their preferred methods of taking them.

People and relatives told us staff were caring and polite and treated them well and with respect. People were pleased with the improvements over the last year and the changes in the staff team. One relative told us, “This is a vibrant care home. There is a good energy around with new young team. They work well together as a team and put residents and their needs first. I would gladly recommend it.” People and their relatives felt involved in decision making and in control of their care.

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 were encouraged to choose the décor and get involved in making changes to the environment. People told us they enjoyed the food and had plenty of choice. People were confident the staff knew what they were doing and were well trained. People had support to access a variety of healthcare professionals both in the home and in the community.

People received personalised care and felt treated as individuals. People were encouraged to maintain and develop social links, hobbies and interests and were pleased about how the activities had improved over the last year. People had a choice of activities and when and to what degree they got involved. People made suggestions for changes and new activities, as well as complaints which were listened to and agreed actions implemented. People and relatives experienced sensitive and responsive care at the end of their life.

People and relatives and visitors agreed the home was well managed and felt involved in how the home was managed. People knew who the registered manager was and were happy to approach them and they thought communication was good.

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 23 November 2018) and there were multiple breaches 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 enough improvement had been made and the provider was no longer in breach of regulations.

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.

Carrington House Limited 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. The care home accommodates up to 60 people in one adapted building.

There was a no registered manager in post because they left the service in July 2018. A new manager had started at the service two weeks prior to the inspection. They had not yet registered with the Care Quality Commission. 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 previous inspection in October 2017, we gave the service an overall rating of ‘good’. This inspection was prompted by concerns we received about the care of some people using the service. These including two incidents where people had suffered harm. At this inspection, we found there were areas that required improvement across the five key questions. There were also breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We therefore, gave the service an overall rating of 'Requires Improvement'. You can see what action we told the provider to take at the back of the full version of the report.

People's care plans and individual risk assessments were not always robust enough to help staff mitigate known risks. This had resulted in unsafe care for two people and had the potential to put other people at risk too. The daily records were not detailed enough to evidence what care had been provided to people. This made it difficult to monitor if people were consistently receiving the care they needed. The service had not always worked closely with other professionals to explore more effective ways of supporting people who regularly refused support with their personal care.

The provider systems to assess and monitor the quality of the service had not been used effectively to ensure that people received consistently safe, effective and good quality care. There was no effective oversight of the service by the nominated individual (registered person). There was no evidence of a coordinated system to support learning across the three services they were involved with. The provider had a system to handle complaints and concerns. However, they needed to explore how to better manage the concerns of a relative who complained regularly.

The service needed to improve the amount and quality of activities provided to occupy people during the day. More work was necessary to explore people’s hobbies and interests to ensure that activities provided would be interesting for people to take part in. The manager told us of their improvement plans to make the service more caring and person centred.

Positively, we saw that local safeguarding protocols were being followed by staff and people were not concerned about potential abuse. People’s medicines were managed safely. There were systems in place to ensure that people were protected from the risk of acquired infections.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were supported by caring, friendly and respectful staff. People found staff to be responsive and sensitive to their needs. People had been given the opportunity to discuss their wishes about the kind of care they would like at the end of their lives.

At the last inspection in October 2016, we asked the provider to take action to make improvements to the cleanliness and safety of the service; staff deployment; quality of people’s care records; how people’s medicines were managed; quality of staff training records; and how they assessed and monitored the quality of the service. During this inspection, we checked if improvements had been made and we found they now met the regulations.

Carrington House provides care and support to people with a range of care needs including those with chronic health conditions, physical disabilities, dementia, and mental health conditions. At the time of the inspection, 59 people were being supported by the service and one person was on trial leave before moving to a Supported Living Service.

There was 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 were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and accurate records were now kept. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely. The service was now clean and safe for people to live in.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The requirements of the Mental Capacity Act 2005 were now being met because people’s ability to make decisions about their care and support was appropriately assessed. People were supported to have enough to eat and drink, and they now had their meals quickly. They had access to various health services when required.

Staff were kind and caring towards people they supported. They treated people with respect and as much as possible, they supported people to maintain their independence. People were happy with how their care was provided and they valued staff’s support. People made decisions and choices about how they wanted to be supported and staff respected this.

People’s needs had been assessed and they had care plans that took account of their individual needs and preferences. Care plans now contained personalised information that enabled staff to provide person-centred care. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. The provider had an effective system to manage people’s complaints and concerns.

There was stable leadership of the service because the registered manager now only managed this service. Staff felt well supported and their contributions recognised. The provider had made significant improvements to all areas where we had previously identified shortfalls. On-going audits were also carried out. However, improvements were required in the quality of staff recruitment records. Further work was needed to improve people and relatives’ experiences of the service.

Carrington House Limited provides accommodation, care and support for up to 60 people with a variety of care needs, including health conditions and physical disabilities. Many people may also be living with dementia. At the time of our inspection there were 56 people living at the service, one person having recently been admitted to hospital.

The service has 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.

The service was not always safe. An appropriate level of cleanliness was not maintained throughout the service. Communal areas had broken equipment stored within them and some items of furniture in use were damaged or showed signs of deterioration. This exposed people to the risk of acquired infection and injury from damaged equipment and furniture.

People told us they felt safe and there were sufficient numbers of staff on duty. However we observed delays in the serving, and provision of assistance to people, during the lunchtime meal. Staff were visibly under pressure during this time and were unable to provide support to people in an unhurried way.

Medicines were not managed safely and gaps were found within medicine records. Monitoring tools and audits of medicine stocks were completed regularly by a coordinator however it was not clear who was delegated their responsibilities during periods of absence.

People’s capacity to make and understand the implication of decisions about their care were not consistently assessed or documented within their care records. There was no evidence that, where people lacked capacity to make or understand decisions, those made on their behalf had been made in accordance with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. However, people’s consent was gained before any care was provided.

Training records for staff were incomplete and gaps were evident on the training matrix for staff. However, staff felt that they were trained and had the skills and knowledge to provide the care and support required by people. New members of staff received an induction.

There were mixed opinions with regards to the meals provided at the service. People were supported to make choices in relation to their food and drink and a varied menu was offered.

People's needs had been assessed and care plans took account of their care needs but lacked detail with regards to their preferences, choices and individuality. Care plans and risk assessments had been regularly reviewed by senior staff to ensure that they were reflective of people's current needs. However it was not evident how people, and their relatives, had been involved in the process and their views included in the reviews of their care.

Quality assurance processes were ineffective. The registered manager completed quality monitoring audits however the audits completed had failed to identify the concerns found during our inspection and it was not clear how any identified actions to be taken were recorded. There was no evidence as to how audits were used to drive improvements in the service. The quality assurance survey, and resulting action plan, did not take into account the full views of the respondents and two negative responses were omitted.

The arrangements for the management and storage of personal correspondence for people living at the service and their documents was not robust.

Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

Safe recruitment processes were in place and had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

People's health care needs were being met and they received support from health and medical professionals when required.

Staff were kind and respectful. People's privacy and dignity was promoted throughout their care. People were provided with information regarding the services available.

A range of activities was provided at the service. We observed staff engage people in social conversation and activities outside of times where there was a high demand for their assistance.

There was a complaints procedure and policy. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff. There was an open culture and the management team were approachable.

During this inspection we found the service to be in 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.

We found people were provided with sufficient food and drink to meet their needs. A person who used the service said, 'The food is very good'. Another person said, 'I think the food here is marvellous'.

We found that the home had a system in place to reduce the risk and spread of infection however, we observed clean laundry was left outsied people's bedrooms on the floor. This could pose a risk of cross contamination. We found handwritten entries on the MAR sheets were not countersigned by a second person. This could pose a risk of errors occurring when transcribing.

Staff told us they felt supported in their roles and were provided with regular supervision. We found there was not a planned schedule with supervision dates available. This meant staff may not always be aware when supervision would be taking place. Some amendments to the home's complaints policy were needed to ensure information was current.

We observed a relaxed atmosphere with good interactions between staff and residents, and people being engaged in activities within the areas we visited.

We spoke with five people living in the home, who told us they felt 'well cared for' and enjoyed living there. We also spoke with six members of staff who told us they were happy working in the home and felt supported to do their work.