Carrington Court

We found the following examples of good practice.

A robust process was in place for visitors to the home. This included a temperature check, completion of a COVID-19 lateral low test and signing of a declaration, confirming the visitor was well, not displaying symptoms or been in contact with anyone who had. Once these steps had been completed, PPE was applied before access to the home was permitted.

Contact with relatives had been maintained during the COVID-19 pandemic through window visits, video and phone calls, with extra telephones being purchased to support this. Indoor visiting had been supported prior to national and local lockdowns, with compassionate visits currently permitted for people receiving palliative care or to support metal health wellbeing. Full guidance was in place to ensure these were managed safely.

The home had implemented cohorting and zoning effectively to reduce the risk of inspection spreading. Colour coding of rooms was used, with staff allocated to these zones wearing matching coloured badges. A separate zone had been created for step down beds, with a communal lounge repurposed, to ensure visiting professionals could work safely and distance themselves appropriately.

Staff were allocated separate break times, with a break room provided on each floor reducing unnecessary footfall around the home. How staff travelled to and from work had been risk assessed with guidance provided to staff, to ensure this was done safely. The home used one specific taxi firm whose practices had been screened with staff wearing masks when travelling. Only people living in same household / support bubble could travel to work in the same vehicle.

To help in minimising the spread of infection, staff travelled to work in their own clothes, changing into their uniform on arrival before putting on PPE. Staff had all received PPE and infection prevention and control IPC training, with their competency assessed.

The home had effective cleaning procedures in place. Frequent touch points were cleaned at least four times per day, with records in place evidencing this.

Carrington Court is a residential care home providing personal and nursing care for up to 48 people. The accommodation was set in one building, across two floors.

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

People were placed at significant risk of harm because the provider had failed to adequately assess the risk of and control the spread of infection in relation to COVID-19. As a result, the provider was in breach of regulations. The home was not appropriately zoned and COVID negative and COVID positive people were not receiving care from dedicated staff. Risk assessments were not as robust as they could have been, and the laundry process was not clear.

The home was clean and appropriate Personal Protective Equipment (PPE) was in place. The service was up to date with infection prevention control training, and increased signage had been out up around the home to highlight risk.

Staff told us that they had enough PPE and that any concerns they had about infection prevention and control had been addressed.

Why we inspected We inspected the service due to an outbreak of COVID in the home. We have found evidence that the provider needs to make improvements. Please see the safe section of this report. You can see what action we have asked the provider to take at the end 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 infection prevention and control measures 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.

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. Further information is in the detailed findings below.

Carrington Court care home is owned by HC-one and is situated near the centre of Hindley, Wigan. The home can accommodate up to 48 people who need care and support. At the time of the inspection the home was fully occupied.

People’s experience of using this service:

People felt they or their relatives were safe living at Carrington Court.

There were systems and processes in place to keep people safe from the risk of abuse.

Risk assessments were completed appropriately and updated as required.

Staff were recruited safely, with all relevant checks in place and staffing levels were sufficient to meet people’s needs.

Medicines systems were safe, and staff had appropriate training.

Staff had received infection control training and wore appropriate personal protective equipment (PPE), to deliver personal care.

Care files included assessments and documented health needs and routines.

Staff had a thorough staff induction programme, on-going training and refreshers and were knowledgeable and competent.

Staff supervisions were completed regularly and there were annual appraisals.

People enjoyed the food and there were plenty of choices.

Food and fluid and positional charts were completed as required.

GPs and other professionals were contacted when required.

The building had wide corridors and doorways to help people who had restricted mobility move around.

The service worked within the legal requirements of the Mental Capacity Act (2008) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff interacted respectfully with people who used the service and spoke in a friendly manner.

Care plans clearly reflected respect for people’s diversity and equal treatment for all those who used the service.

Staff were seen to respect privacy and dignity.

Care plans were person-centred, and people were given as much choice and control over their lives as possible.

There was a range of activities and outings and people’s wishes were fulfilled where possible. There was a complaints log and the service had received a number of compliments.

End of life wishes were recorded in care files, where people had expressed them, and some staff had completed training in this area.

The registered manager and provider were aware of their responsibility regarding duty of candour.

The service had a manager in place, who was registered with the Care Quality Commission (CQC) as required.

CQC notifications of significant events that the service is required to tell us about, were sent in as required.

Safeguarding issues, accidents and incidents were reported to the relevant bodies and any incidents reviewed to look at lessons learned.

Previous ratings were displayed on the provider’s website.

Relatives felt management and staff were efficient and effective at liaising with external healthcare professionals and other external bodies.

The service analysed data for any trends and patterns to aid improvement. Working in partnership with others.

The service was involved in intergenerational project work with local college and primary school around facilitating activities.

Rating at last inspection:

At the previous inspection, published on 24 August 2016, the service was rated good.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected. As the previous inspection was Good this meant we needed to re-inspect within approximately 30 months of this date.

Follow up:

We did not identify any concerns at this inspection. Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service was last inspected on 12 August 2014, when we found the service to be compliant with all the regulations we assessed at that time.

At the time of the inspection there were 48 people living at Carrington Court. Carrington Court is a purpose built home in Hindley, which offers Nursing and Residential Care. The home is situated close to local amenities. The home had 48 bedrooms which were across two floors and could be accessed via a lift and stairs. The home is an accredited home with Gold Standards framework.

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 told us they felt safe living at the home. People had comprehensive risk assessments which were reviewed and updated in a timely way to meet people’s changing needs. People and their relatives told us they were well informed and had been involved in the assessments and planning of the care and support received.

The home had sufficient numbers of staff deployed which was formally calculated based on people’s dependency. We found staff were able to meet people’s needs efficiently and all the people spoken with confirmed their needs were met in a timely way.

The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns. People were protected against the risks of abuse because the service had a robust recruitment procedure in place.

The management of medications, promoted people’s safety. Appropriate arrangements were in place to ensure that medicines had been ordered, stored and administered appropriately.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

People were supported in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We saw staff assessed peoples’ nutritional needs and varied menu’s had been developed. People were offered choice and the dining experience was interactive and relaxed.

We observed frequent, appropriate physical contact between staff and people which were natural and symbolised the familiarity and relationships that had developed between people and staff.

People’s privacy and dignity was maintained and their independence was encouraged. People told us that staff were respectful of their wishes.

People’s care plans were reflective of their preferences and needs and reviewed regularly in conjunction with them and their relatives.

People and their relatives knew how to make a complaint. They told us they were confident in the manager and we saw complaints had been resolved in the required timeframes.

The home had a full programme of activities in place for people and their relatives were actively encouraged to attend. Relatives spoke of feeling part of a community.

The service had links with the local community and we were told some wonderful relationships had been formed between people living at the home and a local college.

A range of audits were undertaken to help monitor and improve the quality and safety of the service. We saw actions were implemented timely following any deficits identified. Management understood their legal requirements and notifications had been submitted to CQC.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people who lived in the home and a member of the management team was available on call in case of emergencies. One person said: 'I'm not frightened of anything here.' Another person said: 'I do feel she's safe here.'

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider demonstrated that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any concerns.

Is the service effective?

People told us they were happy with the care that had been delivered and we saw their care records were up to date. One relative said: 'She has put weight on and is far more independent.' Another relative said: 'She is a lot better than she was. They are very attentive'

Care records confirmed people's preferences and needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: 'I'm very pleased with it.'

We heard that information was shared effectively between staff. Several ways of sharing information included daily management team meetings, handovers, daily records, diaries and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: 'I think the staff are lovely.' One person who lived in the home said: 'All the carers are good. I wouldn't wish to be anywhere else. '

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so that care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the senior carer and they briefed care staff. One person who lived at the home said: 'They couldn't do more for you.' Another person said: 'If I've needed anything I just ask.'

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and had attended meetings for people who lived in the home which were held every month to seek suggestions for any improvements required. One relative said: 'I have made complaints about clothes but the manager sorted it out.' Staff told us they were clear about their roles and responsibilities and were well supported.

During our visit we met with eight of the people living at Carrington Court and two of their relatives. We also met with other people living there and observed the support provided to them.

In addition we spoke with the Manager and nine members of staff who held various roles within the home.

Relatives told us that in their opinion people had received the support they needed with their personal care.

People who lived in the home told us staff treated them well and with dignity and respect. One of the people living at Carrington Court told us, "I love it here, I've not been here long and I really like it, the staff are lovely, attentive and kind, they really do their very best for you."

Staff told us the manager was excellent and they felt supported in their roles and received lots of training to enable them to provide needs led services to the people who lived in the home.