Archived: Carter House

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.

We spoke with some people at the service. Most people did not have the capacity to share their views regarding their care so we carried out a structured observation in order to make judgements about the care that individuals received. We observed interactions with staff and the care provided. We saw people were treated with respect and that staff were responsive to people's needs.

We spoke afterwards to three relatives of people who used the service who visit regularly. They spoke positively of the service. One of them said 'It has been fantastic for (my relative), I am always kept well informed.' Another told us "I cannot fault the care given."

At the last inspection we had found that care records were not always up to date and did not contain enough detailed information on how to deliver care. We found that this time the records were up to date and, although some were not personalised, most contained details of people's preferences and the care to be provided.

People said they felt safe and well cared for. Staff were knowledgeable about safeguarding procedures and how to raise any concerns if needed. We saw that the service worked co-operatively with a range of other health professionals.

We saw evidence that regular checks were made of equipment at the service and that there was an adequate supply of hoists and wheelchairs.

At the last inspection we found that there were not enough qualified skilled and experienced staff on some floors at all times to meet people's needs. Since our last inspection the service had carried out an assessment of people's needs and introduced additional staff on most of the floors. Staff told us they felt better able to respond to people's needs than previously. While some people told us there were enough staff, three people said that staff were sometimes too busy to help them with small tasks of daily living.

Most people we spoke to were happy with the care they received. They felt the staff looked after them well. One person said 'the staff are very good you just have to ask if you want anything' another said 'the staff are wonderful.' Most people felt they were consulted about their care and offered choices. We saw from records that their views about the home were sought through a variety of methods. Staff said they were trained and supported to do their work and we saw from records that regular induction and refresher training was being undertaken.

However we were concerned about the lack of daily activities for people who used the service and that their care records were not always updated or reviewed.

We observed the staff busy with the daily routine and noted that the staffing levels on some floors at some times were not always adequate to meet the variety of needs of the people who used the service.