Carrick House is a care home registered to provide nursing care for up to 24 older people. We were informed that, at the time of our visit, 24 people were accommodated. This inspection was carried out by one inspector.
We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with ten people using the service, two visiting relatives, ten staff supporting them including the registered manager and the operations manager. We also looked at a selection of records. If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The communal areas and bedrooms that we looked at within the home were clean and tidy and maintained by domestic staff. A survey completed by a relative said 'Good atmosphere, smaller unit size, not too institutionalised.'
Staff training included subjects specifically related to the safety of people, such as safeguarding, moving and handling, food hygiene, fire safety, first aid and infection control.
Care plans reviewed showed people had risk assessments in place for staff to follow. This ensured people were supported appropriately with their physical and mental health well-being.
Medicines were administered by appropriately trained staff. The provider had made suitable arrangements in relation to the obtaining, storing and disposing of medicines.
During our observations we found some people were unable to access their call bells which meant people could not summon help if they needed it. We found seven calls bells were placed out of reach and one call bell was unplugged. The manager informed us that in these cases the people would not be able to use the call bell system, however this was not clear in people's care plans. The manager and operations manager told us it 'was not acceptable' and it would be addressed 'promptly' with the night staff. They also informed us that care plans and risk assessments would be updated to reflect this.
There were procedures in place to protect people from abuse and keep them free from harm. Referral procedures to external agencies were in place and staff spoken with were aware of whom to contact, both internally and externally, should they suspect someone had been the victim of abuse.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were advised no DoLS applications had been made. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty.
Is the service effective?
From speaking with staff and our observations we found that there was a good understanding of people's care and support needs. Staff we spoke with were clear about how best to support people while maintaining their independence and dignity. One person who used the service told us "They go over the top to help you.'
Care plans we examined included assessments and reviews of people's health and care needs. Care plans also included detailed information to ensure staff delivered care consistently to meet people's needs. All care and nursing staff we observed demonstrated they understood the care needs of people and how best to support them.
Is the service caring?
We observed staff interacting with people at different times during the day and saw breakfast and lunch being served as well as medicines being administered. People were supported by staff who displayed patience and kindness. The environment was relaxed and staff were calm. One person who used the service told us 'I like it here very much, the staff are very caring.'
There was a celebration taking place on the day of our inspection and the chef had baked a cake for the occasion. The atmosphere was sociable and people told us they enjoyed the cake which was served. One person told us, 'The food is good, it looks appetizing, and there is a good choice and plenty of it.' The same person told us 'You can always ask for more as well.' We noticed at lunch time people were given time and were supported to enjoy their meal.
Is the service responsive?
We saw people's health and social care needs were reviewed frequently with other professionals. We spoke with four people who used the service. They all told us they could speak to staff or family if they had any worries or concerns. One relative told us (referring to the manager) 'X is very good, you can approach X about anything and be assured it will be dealt with.' A person who used the service said 'It's fine here, they look after you well.'
People were confident they would receive the support they needed quickly should their health needs change. Care staff and the manager were able to tell us how they would be able to recognise changes in people who were at risk of physical health deterioration. In such cases people were monitored closely and medical or emergency help arranged as necessary.
Is the service well led?
The registered manager was a health care professional and had been in post for over fifteen years. We spoke with the registered manager and operations manager who showed a good understanding of what was required to ensure staff were led by an effective management team.
The manager held regular staff meetings and used this to communicate issues related to the day to day running of the nursing home. Staff we spoke with felt supported by the manager and understood the philosophy of the home. One staff member told us 'The best thing is we all work as a team here to support and look after people.'
Systems were in place to ensure that people were happy with the service they received. A relative commented in a survey 'X, the home manager and nurse is the life blood and pulse of Carrick.' The same person also said 'Continuity of staff and smooth running from day to day' was one of the best things about the home.