Archived: Carter House

Updated 22 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection, which took place because we carry out comprehensive inspections of services rated Requires Improvement annually. The inspection took place on 17 and 19 January 2017 and was unannounced. It was carried out by an inspector and an expert by experience. Our expert by experience was a person who had personal experience of caring for someone who is living with dementia and uses this type of care service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Prior to our visit we reviewed the information we held about the service. This included reports from previous inspections, an improvement plan we had asked the provider to send us following their last CQC inspection and statutory notifications submitted to us by the provider. Statutory notifications contain information providers are required to send to us by law about significant events that take place within services.

During the inspection we spoke with ten people using the service, two relatives and three health and social care professionals, which included two physiotherapists and an occupational therapist from a local NHS Trust, a CQC registered manager of another care home for older people and a pastoral minister. We also spoke to various managers and staff who worked for the provider including the service’s registered manager, the operations manager, an area quality and compliance manager, the clinical services manager, the head of human resources, the deputy manager, four nurses, including the clinical lead nurse, three team leaders (senior carers), six health care workers and a domestic.

Throughout our two-day inspection we undertook general observations to see how staff interacted with people using the service. We also used the Short Observational Framework for Inspection (SOFI) on the nursing, dementia and residential care units. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Records we looked at included ten peoples care plans, three staff files and a range of other documents that related to the overall governance of the service.

Updated 22 February 2017

Carter House is a care home that can provide nursing and personal care to up to 45 older people. The home is built over four floors and includes a residential, nursing, dementia and intermediate care units. The intermediate care unit with support from local NHS trusts’ community healthcare professionals provides short term care and rehabilitation for up to six weeks for people discharged from hospital. The aim of the unit is to help people to maintain their independent living skills and minimise the risk of them being readmitted to hospital. At the time of our inspection 40 people were using the service of whom approximately half were living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last comprehensive inspection on 18 August 2015 the service was rated ‘Requires Improvement’ overall and for two key questions ‘Is the service caring?’ and ‘Is the service responsive?’ This was because care plans were not personalised and did not contain all the information staff required to meet people’s needs and wishes, and nor was people’s privacy and dignity always respected by staff. We asked the provider to take action to make improvements. At this inspection we found the provider had made the necessary improvements, most notably to the way staff respected the privacy and dignity of people they provided personal care to. We also found the provider had introduced a new care plan format that included more detailed and person centred information. Overall the service demonstrated they now met the regulations and fundamental standards.

However, given the layout of Carter House, we did not consider there were always enough staff suitably deployed in the home to meet people’s care and support needs. We asked the provider to review the staffing levels in relation to the current needs of people using the service as our findings showed that their needs might not have been effectively met. The provider increased the number of care staff working on the residential unit (top floor) during the day from one to two on the second day of our inspection.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Recruitment procedures were designed to prevent people from being cared for by unsuitable staff. The premises and equipment were safe for people to use because staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs. They also received the support they needed to stay healthy and to access healthcare services.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in leisure activities, pursue their social interests and to maintain relationships with people that mattered to them.

The managers provided good leadership and led by example. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

Further information is in the detailed findings below.