Archived: Casarita

Casarita is a care home without nursing. It supports up to seven people with a learning disability or autism. At the time of the inspection there were seven people living at the service. The service comprises of two annexes which are self-contained flats; a further two flats with ensuite bathroom facilities and three bedrooms in the main building, a communal shower room, kitchen and lounge area. Outside there is a separate laundry room, a staff sleep in room and managers office. In addition, a grassed area is at the front and rear of the property with a small courtyard area located at the side entrance to the home.

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

People’s care and support was not always provided in a clean environment. This was addressed by the supporting manager following the inspection who reviewed processes in place.

There was not evidence of effective systems in place to support provider governance and oversight to drive change and sustain improvement.

People and relatives spoke positively about the service and provided feedback which included., “I am happy with the service and where [relative] is. My mind is settled knowing [relative] is happy and safe.” Another relative told us, “We are pleased with the staff and care and are thrilled with the service.”

Relatives told us they found the staff team to be polite and professional. Staff undertook a robust induction process and were confident in their role. The staff skills and knowledge was checked by the registered manager to ensure they were safe in their practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service provided a small homely environment for people to live. Staff were skilled and knowledgeable of people’s needs and provided care that was person centred.

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 03 August 2018).

Why we inspected

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.

We received concerns about the provider’s governance systems and oversight of the service. As a result, we undertook a focussed 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full 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 Casarita on our website at www.cqc.org.uk.

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 breaches in relation to the providers quality and assurance systems at this inspection.

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.

We found the following examples of good practice;

Staff were observed to be wearing Personal Protective Equipment (PPE) in line with current government guidelines. Sufficient supply of PPE was also available.

The people who used the service displayed a strong awareness of COVID-19 and to ensure face masks were worn and social distancing was maintained. This enabled the people who use the service to keep themselves safe at all times.

All staff and people who used the service were receiving COVID-19 testing as per government guidelines.

Temperatures were checked twice a day for all people who used the service. This ensured their well being was monitored on a daily basis and the staff team could support responsively where required.

Care plans and risk assessments were in place for all people who used the service, in relation to COVID-19. These documents had been reviewed throughout the pandemic ensuring all people using the service remain safe at all times.

Clear signage was on display on the exterior entrance to the service. This ensured all visitors were aware of precautions to be taken prior to entering the service.

Casarita is a residential care home for seven people with learning difficulties. At the time of our inspection there were seven people living in the home.

There was a registered manager in the home. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

We found some concerns relating to the management of the water temperatures, this was raised with the manager who has taken action in relation to this. Other quality monitoring checks were effective and remedial action was taken where concerns were found.

Whilst no formal audits were carried out in relation to people’s medicines, the registered manager told us that they carried out checks and we found that people’s medicines were stored and administered in a safe way.

People’s safety was maintained and known risks were identified and managed. Staff knew how to keep people safe and understood their responsibilities in relation to safeguarding.

There were consistently enough staff to support people safely and staffing numbers were adjusted according to people’s needs. There were robust recruitment procedures in place to recruit suitable staff.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were involved in the planning of their care and were supported to be as independent as possible. People could make their own meals and risks relating to people’s nutritional intake were mitigated. Prompt referrals to relevant healthcare professionals were made to ensure people’s health and wellbeing.

Staff worked collaboratively with other agencies and professionals to provide coordinated and consisted care for people.

People’s dignity and privacy was upheld and staff were caring and attentive towards people. People’s care was personalised and their care records were reviewed and updated regularly.

There was a clear management structure in place and staff were supported to carry out their role.

Further information is in the detailed findings below.

Is it effective?

This inspection established that improvements had been made. Whilst there were a few gaps in training provision, we were satisfied that significant progress had been made. All staff were undergoing regular supervisions. We spoke with three staff members, each of whom confirmed they were receiving regular supervisions. Consequently, the service was effective in ensuring that people were supported by staff who had received suitable training and support.

We observed other people who used the service being offered individual support by the staff in a caring and thoughtful manner and being spoken with respectfully. We observed staff successfully communicating using non verbal methods with people who experienced difficulties communicating verbally.

We saw evidence that people who used the service were involved in making choices about how they were supported and were engaged in ways that enabled their voices to be heard.

People who used the service were protected from the unsafe use of medicines. Appropriate arrangements had been made for the safe handling, usage and administration of medicines.

We saw evidence that sufficient numbers of staff were rostered to be on duty throughout a four week period and we observed satisfactory staffing levels on the day of our visit.

We noted that regular staff supervision had not been offered during a period of several months and that some mandatory staff training was not up to date.We were informed that the manager had been overseeing two other services during the preceding year.

We looked at care plans for three people and found the information comprehensive, clear in what care support was required and saw that risks had been identified and assessed.

The meals planned and offered were chosen and purchased by the people who lived in the home. Healthy options were available as well as the 'odd treats'.

The home was very clean and tidy on our arrival. Good practice was being adhered to to ensure correct infection control was in place.

The staff told us they were well supported by the company with suitable training and supervision and that the team of staff within the home were supportive on a day to day basis.

The home had not had any complaints but had various methods of ensuring the people who lived in the home were listened to. The manager and staff told us that they knew the people well and would recognise if and when something was troubling them.