Carter House

About the service

Carter House is a residential care home providing personal care and support to older people. At the time of our inspection 42 people were living at the care home. Approximately a third of the people who resided there were living with dementia. The premises is divided into three separate units/floors, each of which has their own adapted facilities.

People’s experience of using this service

People living in Carter House and staff working there told us the service had improved in the last 12 months since the last CQC inspection and said the care home was now a safe, well-managed service.

Medicines were now well-organised and staff helped people take their prescribed medicines in a safe way. The service has ensured there are always sufficient numbers of suitably trained staff to support people to stay safe and meet their needs and wishes.

Staffs suitability and fitness to work in an adult social care setting have been properly assessed.

People were protected against the risk of avoidable harm and abuse. The risks people might face were assessed and their safety monitored and managed so they were supported to stay safe. This included routinely monitoring the care homes fire safety arrangements to ensure they continued to be fit for purpose.

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.

The environment was clean and staff followed current best practice guidelines regarding the prevention and control of infection (IPC), including those associated with COVID-19.

The new manager and her deputy manager were both clear about their roles and responsibilities. They understood regulatory requirements and how to ensure people received high-quality, person-centred, safe care. This was achieved by routinely monitoring and analysing the safety and quality of the care people received.

The management team also recognised the importance of learning lessons when things went wrong and was keen to continuously improve the service.

The managers promoted an open and inclusive culture and worked in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people.

People living at the care home and staff working there were complimentary about the way the management team ran the service, and how approachable they all were. In addition, staff told us they received all the support they needed from their managers and felt staff morale had significantly improved in the last 12 months.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 2 November 2021).

Why we inspected

We carried out an unannounced focused inspection of this service in October 2021 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show us what they would do and by when to improve the safe management of medicines and the effectiveness of how they operated their governance systems.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has therefore changed from requires improvement to good.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Carter House is a care home and at the time of this inspection they were providing nursing and personal care to 42 people aged 65 and over. The service can support up to 46 people across four floors, each with their own adapted facilities. One of the floors specialises in providing care to people living with dementia.

The service was in the process of changing its stated purpose and was planning not to provide care and support to people with nursing needs by the end of 2021.

People’s experience of using this service

At our last inspection we found the provider had not ensured staff always recorded the reasons why certain prescribed 'as required' medicines were administered. At this inspection we found enough improvement had been made to address this. People now had up to date ‘as required’ medicines protocols in place where necessary, which made it clear to staff when and how to safely administer these medicines.

However, we also found a number of new issues during our inspection that indicated medicines were not always safely used or managed, placing people who lived at the care home at risk of harm. This was because staff did not always follow protocols for the safe storage, administration and recording of medicines. In addition, staff did not always have access to enough information about how to safely use people’s prescribed medicines.

Furthermore, although the provider had some good governance systems in place to assess and monitor the quality and safety of the care people received; We found these processes were not always operated effectively. This was because these measures had failed to pick up a number of issues we identified during this inspection, specifically in relation to medicines not always being safely managed.

The provider had also failed to always notify the Care Quality Commission (CQC) without delay about the occurrence of safeguarding incidents that adversely affected the health, safety and well-being of people living at the care home. We discussed this issue with the area manager at the time of our inspection. They acknowledged there had been a number of failures lately where incidents that should have been reported to the CQC immediately were not. They agreed to develop an action plan with the new permanent manager to improve how they would keep us informed about such incidents in a more timely way in future.

Staff did not always respond quickly to people’s requests for assistance and most staff expressed dissatisfaction with the provider recently reducing the number of care staff working on each unit in the care home. We discussed these staffing issues with the area manager at the time of our inspection who confirmed an action plan had already been agreed by the provider to reinstate previously agreed staffing levels at Carter House.

People were protected against the risk of avoidable harm and abuse. People were cared for and supported by staff who knew how to manage risks they might face. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including those associated with COVID-19.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored and analysed by managers and nursing staff. The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives and staff. The provider worked in close partnership with various community health and social care professionals and external agencies to plan and deliver people’s packages of care and support.

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

Rating at the last inspection

The last rating for this service was good (published 16 July 2021). At this inspection we found multiple breaches of regulation and the need for this provider to make improvements.

Why we inspected

We received concerns in relation to the safe use and management of medicines and staff not always being available, in sufficient numbers, to support people to stay safe. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated from our last inspection and has been changed from good to requires improvement. This is based on the findings at this inspection.

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 two breaches at this inspection in relation the provider failing to ensure the safe management of medicines and not operating effective quality monitoring systems.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

About the service

Carter House is a care home providing nursing and personal care to 41 people aged 65 and over at the time of the inspection. The service can support up to 46 people across four floors, each with their own adapted facilities. Most people residing at the care home were living with dementia.

People’s experience of using this service

People told us they were happy with the standard of care and support provided at this care home.

People were kept safe and protected against the risk of avoidable harm and abuse. People were cared for and supported by staff who knew how to manage risks they might face. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work in an adult social care setting had been properly assessed.

The provider ensured staff had the right levels of training and support they needed to deliver effective care and support to people living at the care home. 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. People lived in a suitably adapted and recently refurbished care home that was now decorated to a very high standard. People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and access community health and social care professionals as and when required.

People were treated equally and had their human rights and diversity respected. Staff treated people with respect and dignity and upheld their right to privacy. People were supported to maintain their independent living skills. People were encouraged to make decisions about the care and support they received and had their choices respected.

Up to date, person centred, electronic care plans were in place for everyone who lived at the care home, which helped staff meet their personal, social and health care needs and wishes. Staff ensured they communicated and shared information with people in a way people could easily understand. People were supported to participate in meaningful recreational activities that reflected their social interests. People were supported to maintain relationships with family and friends. People’s concerns and complaints were listened to and investigated by the provider. Plans were in place to help people nearing the end of their life receive compassionate palliative care in accordance with their needs and wishes.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored by the services management team. The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives, community health and social care professionals and staff working there. The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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

Rating at the last inspection

This service was taken over by a new provider as a new legal entity and was reregistered with us in April 2019. This is their first comprehensive inspection. The last rating for the service under the previous provider was good (published 22 February 2017]. The overall rating for the service remains good.

Why we inspected

This was a planned comprehensive inspection based on the service being taken over by a new provider as a new legal entity and reregistering with us.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.