Callands Care Home

Updated 18 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 6 inspectors, a medicines inspector, a specialist nurse advisor and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Callands Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Callands is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for 4 months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed all the information we had received since the previous inspection. We sought feedback from the Local Authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke to 12 people who lived at the service and 4 family members. We spoke with 17 members of staff including, area director, clinical lead, deputy manager, nurses, nursing assistants and carers, to gain their views and experience of the service.

We spoke to external professionals. We reviewed 15 care records, multiple medication administration records, and 3 staff personnel files and 4 agency profiles in relation to recruitment. We also viewed various records, policies, and procedures in relation to the governance of the service and management.

Updated 18 November 2023

About the service

Callands is a 'care home' providing accommodation, nursing and personal care for up to 120 younger and older adults; some of whom live with dementia or physical disabilities. At the time of the inspection 109 people were living at the home across four separate units.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

People were not involved in their care planning. Care plans were not reflective of people’s needs and lacked person centred details. Risks were not always assessed. There was only 1 activity coordinator available to provide support to 109 people, there was limited activities available. The environment was not supportive of people living with dementia there was limited signage to promote independence.

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; the policies and systems in the service did not support this practice.

Right Care:

The service had an inconsistent staff team and high agency use. This meant staff were not always aware of people needs. People's communications needs were not always recorded and there was a lack of awareness of how to apply national best practice supporting people with a learning disability and autistic people. Some inappropriate language was used when referring to people who used the service.

Although some people had individual ways of communicating, using body language, Makaton (a form of sign language), pictures and symbols, this was not documented which meant staff were not aware of how best to communicate with people to provide effective support and encourage independence.

Right Culture:

Staffing levels and shift patterns were insufficient to enable all people to access the community to pursue their leisure interests and form meaningful relationships within their local community.

Staff did not always have the training and skill needed to support people effectively.

Some staff had poor relationships with each other and management. Staff did not always feel management were approachable and supportive.

Governance processes were not always effective in the monitoring of the service. Whilst some of the concerns were identified through the service’s own provider audits, they had failed to rectify the concerns raised.

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 service has been rated requires improvement for the previous 4 inspections, the last inspection was published on 21 March 2021. 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of the service, medication, and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions safe and well-led only. During the inspection other concerns were identified and as a result we opened the inspection to include the responsive domain. 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 requires improvement to inadequate based on the findings of this inspection.

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

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

Enforcement and Recommendations

We have identified continued breaches in relation to lack of risk assessment, medicines management and governance systems in managing and monitoring the service. There were also breaches identified in relation to the lack of person-centred care, safeguarding people from abuse, clinical practice and staffing, 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

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.

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.