Archived: Carson House Care Centre

Updated 4 May 2019

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 28, 29 and 31 August 2018. The first day of the inspection was carried out by one adult social care inspector and a pharmacist specialist, the second day by one adult social care inspector and a health and safety specialist, the third day by one adult social care inspector.

Before the inspection we reviewed information that we held about the service and the service provider. This included notifications which the provider had told us about, information from other agencies such as the local authority and clinical commissioning group and information from whistle-blowers and the general public. Prior to our inspection we had received information raising concerns about the payment of staff and staffing agencies.

During the inspection we spoke with the manager of the service, the activities coordinator, seven people living in the service, four relatives of people and eleven members of staff, including nursing staff, care staff, domestic and kitchen staff.

We looked at the recruitment records of three staff, the care records of three people, supervision and training records, staff rotas and other records relating to quality and audit checks done by the home along with maintenance and servicing records. We performed checks on the temperatures of hot water.

During our inspection we used a method called Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We walked around the home and looked in communal areas, bathrooms, the kitchen, store rooms, medication rooms and the sluice. We also looked in a sample of bedrooms and the garden areas.

We also checked that the previous Care Quality Commission rating for the service was prominently displayed for people to see. The last inspection report and rating was displayed in the reception area. The service had a website which was under construction and the last inspection report and its rating were displayed.

Updated 4 May 2019

This inspection took place on 28, 29 and 31 August 2018 and the first day was unannounced.

Carson House Care Centre is a ‘care home’ situated in Stalybridge in Tameside, Greater Manchester. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Carson House accommodates up to 45 people. The home is divided into four units. Each unit consisted of a lounge, dining area and small kitchen facilities. One unit provides general nursing care, one unit provides mental health nursing for men who have behaviours that challenge and the other two units provide mental health nursing for men and women in separate units. There are two enclosed patio areas at the rear of the building which were used as smoking areas and were accessible to people who use the service.

During our inspection some people moved to other services and others were being offered alternative homes to move into. At the end of our inspection there were 25 people living in the home.

At our last inspection in December 2017 and January 2018 we rated the home inadequate overall and identified multiple breaches of the regulations. At this inspection we found limited evidence of improvements. We found improvements had been made in relation to training and supervision and the provider was meeting the requirements of this regulation. There remained ongoing breaches of regulations relating to the provision of safe care and treatment in particular; health and safety and medication, safe recruitment practices, person centred care and governance. We also found continued breaches of the Care Quality Commission (Registration) Regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the back section of reports after any representations and appeals have been concluded.

There was no registered manager in post. The service had a manager who had been in post since September 2017 and at the time of our inspection was in the process of applying to become the registered manager of the service. However following our inspection, we were informed that the manager had withdrawn their application. 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.

Following our last inspection, the registered provider had informed CQC that they were actively involved in the day to day running of the home and attended the home on a monthly basis to engage with residents and staff. We found no evidence to support this during our inspection.

We found there was little evidence that the issues relating to the maintenance and upkeep of the building identified at our previous inspection had been rectified. We continued to find defective lighting, a lack of fire signage and hot water that posed a scalding risk.

People did not always receive their medicines safely. Stocks of some creams indicated they had not been used as often as prescribed and some checks on people’s blood sugar levels had not been carried out as required.

Appropriate checks were not always completed on staff before they started working at the home. Full employment histories were not recorded and gaps in people’s employment were not explored.

The home was generally in a poor state of repair and although a few rooms had been recently re-decorated the remaining rooms were in need of decoration. The smoking areas were untidy with cigarette ends and other litter.

People living in the home and their relatives spoke highly of the care staff. Throughout our inspection we observed caring and respectful interactions between staff and people living in the home.

Relatives gave us examples of how the rapport staff had built with people enabled staff to encourage people to be more receptive to being supported. People told us the staff knew them well and understood their needs.

People told us they felt safe in the home and relatives told us they felt their relatives were safe. Staff were aware of how to identify and report concerns and where concerns had been raised by staff they had been investigated appropriately.

Staffing levels were adequate in the home and people received support in an unhurried way. A number of staffing agencies had stopped supplying staff to the service because of unpaid bills and there was concern about how the home would be staffed if care workers left.

During our inspection staff were extremely unhappy that they had not been paid fully on time but did not let this affect the level of care and support they provided to people living in the home.

Efforts had been made to record the types of activities people wanted to do and took part in but the activities available on a day to day basis were ad-hoc and did not reflect people’s preferred activities.

Staff told us the manager had made a positive difference to the home since they had started and gave us examples of improvements they had made.

We found systems in place to monitor the safety and quality of the service were ineffective.

The overall rating for this service is ‘Inadequate’ and the service remains 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. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.