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Carham Hall Residential Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 February 2019

This inspection took place on 28 and 30 November 2018. Carham Hall Residential Home 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.

Carham Hall Residential Home provides care for up to 22 people. There were 21 people living in the home at the time of the inspection, some of whom were living with dementia.

The registered provider managed the home. They had run the home for a number of years but this was the first inspection under their new registration as a sole provider.

Before the inspection, we were made aware of concerns about the management of medicines in the home. We found improvements had been made when we visited although these were yet to be fully embedded in practice. There remained areas for improvement at the time of the inspection.

The premises were clean and generally well maintained but we found not all wardrobes were secured to the wall and some maintenance issues had not been picked up during routine audits.

We were made aware of a concern about staffing in the home prior to the inspection. On the first day of the inspection we found the provider was struggling to fill gaps in staffing and staff were working extra hours to cover these. By the second day of the inspection the provider had secured the services of a care agency to support with staffing while new staff were being recruited.

Audits and checks carried out by the provider were not sufficiently robust to identify the issues identified before and during our inspection. There were gaps in records relating to staff supervision and appraisal. The provider and deputy manager told us they were keen to make any improvements necessary.

Safeguarding procedures were in place and suitable arrangements were in place for the recruitment of staff including checks on the suitability of applicants to work with vulnerable people.

People were supported with eating and drinking. Positive feedback was received about the standard of meals and where people were at risk of malnutrition, specialist advice was sought.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw numerous examples of kind, considerate care and people told us they felt well cared for.

People’s needs were responded to in a timely manner. Care plans were in place which contained person centred details about how people preferred to be cared for.

We received mixed views about the availability of activities. We have made a recommendation about this.

A complaints procedure was in place but no formal complaints had been received by the service.

Provision was in place should people wish to stay at Carham Hall Residential Home at the end of their lives. District nurses supported with care at this time.

We found one breach of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 27 February 2019

Not all aspects of the service were safe

Procedures for the safe management of medicines had not always been followed. Although improvements had been made at the time of the inspection, these were not fully embedded in practice.

Routine checks on the environment had not picked up some safety issues such as not all wardrobes were secured to walls.

The service was operating short staffed on the first day of the inspection. The services of a care agency had been secured by the second day of the inspection.

Safeguarding procedures were in place and staff knew how to follow these. Safe recruitment practices were followed.

Effective

Good

Updated 27 February 2019

Not all aspects of the service were effective

There were gaps in staff supervision and appraisals. A plan was in place to address these. The deputy manager had no formal supervision sessions recorded with the provider.

Staff received training which was updated at regular intervals.

The premises lacked dementia friendly design features. A plan was in place to address this.

People were well supported with eating and drinking and specialist advice was sought where there were concerns about people's nutrition.

Caring

Good

Updated 27 February 2019

The service was caring

People and relatives told us the care was good.

We saw numerous examples of kind and caring interactions between people and staff.

Two people were using the services of an advocate to support them to make and communicate decisions.

Responsive

Requires improvement

Updated 27 February 2019

The service was responsive

There was mixed feedback about the availability of activities. We have made a recommendation about this.

Care plans contained person-centred details about how people preferred their care. These were in the process of being further personalised.

A complaints procedure was in place. No formal complaints had been received and people and relatives knew how to complain if necessary.

Well-led

Requires improvement

Updated 27 February 2019

The service was not well-led

Routine audits and checks were not suitably robust and had not picked up all the issues identified before and during the inspection.

The deputy manager was relied upon heavily yet was also having to support with direct care during periods of short staffing. Staffing had improved by the second day of the inspection which helped alleviate this.

Staff told us they felt well supported by the deputy manager.