Carnalea Residential Home

Updated 10 February 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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors, and an Expert by Experience who spoke with people. 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

Carnalea Residential 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. Carnalea Residential Home is a care home without 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. The registered manager had recently left, and the provider was in the process of recruiting a new registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We also sought feedback from the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with eleven people who used the service about their experience of the care provided. We observed the care provided within the communal areas. We spoke with eight members of staff including the provider, the deputy manager, senior care workers, care workers and the chef.

We reviewed a range of records. This included eight people's care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 10 February 2023

About the service

Carnalea Residential Home is a care home providing personal care to up to 55 people. The service provides support to older people with varying care needs including, dementia, diabetes, Parkinson’s disease, epilepsy and mental health needs. At the time of our inspection there were 42 people using the service.

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

The provider had ineffective systems in place to monitor people’s safety and well-being. Risks were not always identified and mitigated against. Accidents and incidents were not effectively reviewed and monitored to learn lessons and minimise the risk of them happening again. Medicines were not always managed well. Systems to monitor people’s medicines were not robust to pick up issues, which meant people may not receive their medicines as prescribed and required.

New staff were not always recruited safely as there were gaps in their employment history and references were not robustly followed up.

Although there appeared to be sufficient staff on shift, some people told us they had to wait when they needed assistance. The provider did not have a system for measuring people’s assessed needs against the numbers of staff required to meet those needs. We have made a recommendation about staff deployment.

Systems to monitor the safety and quality of the service people received were not effective. Most audit systems were not completed and those that were, were not robust and did not identify concerns. Care plans did not provide the detail and guidance necessary to provide consistent care. Most people said staff were attentive and friendly, but some people felt they did not get the attention they needed. The provider did not have adequate management and oversight of the service.

The provider held meetings with people to hear their views and with staff to update information. The provider had not undertaken any surveys to gain feedback from people, relatives or others involved in the service.

People told us they felt safe and secure in Carnalea Residential Home. Staff understood how to protect people from abuse and knew how to raise concerns. The service was clean and safe infection control procedures were followed.

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.

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

Rating at last inspection

The last rating for this service was good (published 27 March 2021).

Why we inspected

We received concerns in relation to leadership and governance and staff culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, medicines safety, staff recruitment and the monitoring of quality and safety at this inspection.

We have also made a recommendation in relation to staff deployment.

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