Archived: Carnarvon Care Home

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.

This is a summary of what we found:

Is the service safe?

When we arrived at the service the staff asked to see our identification. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The registered manager demonstrated a good knowledge of how to safeguard vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that staff were attentive to people's needs. Staff we spoke with were able to demonstrate they knew people well. We saw staff treated people with dignity and respect.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, speech and language therapist, chiropodist and district nurse. This told us that the service worked well with other professionals and that people's needs were met.

Is the service well-led

The service had a new care manager in post awaiting to be registered, who had started to put a number of quality assurance measures in place. The manager was very proactive in monitoring and looking for ways to improve the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place for the safe administration and recording of medicines.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe administration and recording of medicines.

We spoke with 10 people who used the service. One person said, 'I wouldn't go anywhere else, this home is nice." Another person said, 'It is okay, I don't have any problems.' We also spoke with four relative's of people who used the service.

We looked at the care records of five people who used the service and found that they were not protected by the service's medication procedures, their capacity to consent was not properly assessed and they did not experience care, treatment and support that met their needs and protected their rights.

We looked at the personnel records of four staff members and found that the appropriate checks had been undertaken to check that they were able to work with vulnerable people. Staff were provided with training, however staff had not been provided with the support that they needed to meet the needs of the people who used the service.

We gathered evidence of people's experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

During our visit we spoke with people who told us it was very nice and they felt comfortable. They also told us that the standards had improved at Carnarvon Nursing Home. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home.

During our inspection we saw that people received good care and that staff treated them with respect. One person told us "I can choose what I do and the staff are very helpful".

Relatives and people we spoke with told us the cleaning had improved and one person said "It is much nicer to come into a clean fresh room and not wait to get the bed made".

People told us they felt there were enough staff on duty to meet their needs and that the manager was very approachable and had "got things moving".