Archived: Carnarvon Care Home

Updated 22 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 inspection took place on the 17 August 2016 and was unannounced on both days.

This inspection was carried out by three inspectors, a pharmacy inspector, a specialist nurse advisor and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience had experience of providing care and support for an older person.

Prior to our inspection we had received concerning information about the service provided; these had been reported to and investigated by the local safeguarding authority. We spoke with the local safeguarding authority and reviewed information sent to us from stakeholders. The local authority kept us updated with the support that they were providing to the service to assist them to improve the care and support provided to people. During our inspection we looked to see what action had been taken as a result of these concerns.

We looked at other information we held about the service including statutory notifications. This is information providers are required to send us by law to inform us of significant events.

We spoke with nine people who were able to verbally express their views about the quality of the service they received and six people’s relatives. We observed the care and support provided to people and the interactions between staff and people throughout our inspection.

We looked at records in relation to nine people’s care. We spoke with the deputy manager, the regional director, three nurses, seven care staff, the chef, two domestic staff and two activities coordinators.

We looked at records relating to the management of medicines, staff recruitment, staff training and systems for monitoring the quality and safety of the service.

Updated 22 November 2016

This inspection took place on the 17 August 2016 and was unannounced.

Carnarvon Care Home is a care home that provides nursing and personal care to older people, people with a physical disability and younger adults. The home can accommodate up to 57 people. The home is owned by Bupa Care Homes (ANS) Limited. On the day of our inspection there were 34 people living at the service.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out this focused inspection in response to concerns raised by people’s relatives and the local safeguarding authority. We found major concerns regarding the overall clinical leadership of the service, the lack of action taken by the provider to safeguard people in the management of their medicines, monitoring to ensure people were sufficiently hydrated, pressure ulcer prevention and the lack of monitoring to ensure their complex nursing needs were being met. The provider was not meeting the requirements of the law as they did not monitor effectively the health and nursing care needs of people and identify people at risk of receiving care or treatment that was inappropriate or unsafe.

There was a lack of monitoring to ensure people received adequate support to maintain adequate nutrition and hydration to prevent ill health. People were not effectively monitored for pain or receiving adequate pain relief medicines as prescribed.

We found there to be insufficient staff at all times to support the high number of people who required two staff to assist them with their personal care and when mobilizing using a hoist. This was evident from our observations and discussions with staff and relatives.

People were not receiving appropriate monitoring which placed them at increased, serious risk of harm. For example, there was a lack of monitoring to ensure people received adequate support to maintain adequate nutrition and hydration to prevent ill health. People were not effectively assessed and monitored for pain.

Prior to our inspection we received information of concern from the local authority that the service was providing inadequate monitoring of people at risk of acquiring pressure ulcers. We found that risks associated with the use of pressure relieving equipment and the use of bedrails had not always been appropriately assessed and guidance was not provided for staff in the correct use of equipment. There was no system in place for the safety monitoring of pressure relieving equipment. Air mattresses were found to be set at incorrect air pressure settings. This increased people’s risk of acquiring a pressure ulcer.

Infection control monitoring within the service was in need of improvement. Hoist slings were not always provided for individuals and used for several people presenting a risk of cross infection. Staff did not always follow safe procedures to protect people from the risk of cross infection.

People who could not bear their weight were put at risk due to ineffective assessment of risk and a lack of appropriately assessed equipment provided. This meant action had not been taken to review their care ad ensure their safety when supported by staff to mobilise with lifting equipment such as hoists and slings.

We observed interactions with people from some staff which identified a culture of task focused care which lacked attention to providing quality care which prioritised meeting the individual needs of people.

We found at this inspection the quality and safety monitoring of the service was ineffective at identifying where the quality and the safety of the service was being compromised. We found the monitoring and auditing of people’s medicines inadequate and in need of improvement. There was insufficient clinical oversight which monitored the quality of the nursing support provided to people with complex nursing needs, ineffective assessment of risk and action taken to mitigate the risks to people of receiving unsafe care and treatment.

Immediately following this focused inspection we formally notified the provider of our concerns and placed conditions on their registration instructed them to take urgent action to mitigate the risks to people’s health, welfare and safety and a condition to stop them admitting any further people to their service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.