Caradoc House Residential Care Home

Caradoc House Residential Care Home is a care home providing support with accommodation and personal care for up to 11 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection 10 people were receiving accommodation and personal care, some of whom were living with dementia.

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

People were not safe. The provider failed to ensure substances hazardous to health were safely stored, firefighting equipment was readily available or that window restrictors were in place on all windows.

The provider did not effectively analyse significant incidents to learn from them and to make changes to improve people’s safety. The provider’s infection prevention and control procedures were not effectively followed.

People were not always treated with dignity or respect. Confidential information was not secured and was accessible to those without authority. People’s personal property was not safely or appropriately stored.

The registered manager did not model a positive example of interaction and engagement with people and did not value people’s personal space. People were not protected from ill-treatment or abuse as the provider did not have robust systems in place to safeguard people.

People’s medicines were not safely stored, and the provider did not have checks in place to ensure people received their medicines as prescribed.

The provider failed to ensure there were enough suitably qualified staff deployed at all times.

The provider failed to notify the CQC of all significant events as required.

The provider did not have effective quality monitoring procedures in place to drive improvements in the care they provided. The management team did not have clearly defined roles and responsibilities.

Staff members knew what to do if they suspected something was wrong. People were complementary about the staff who supported them on a day to day basis who they found to be kind and caring.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible or in their best interests; the application of policies and systems in the service supported best practice.

The provider followed safe recruitment practices.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 September 2021).

At that inspection improvements were needed in order to keep people safe and on how the location was managed.

Why we inspected

The inspection was prompted by concerns about the management of the location. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the safe, caring and well-led sections of this report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caradoc House Residential Care Home 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 monitor the service and will take further action if needed.

We have identified breaches in relation to keeping people safe, dignity and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The home had effective systems in place to check visiting professionals were safe to enter.

The home followed effective cleaning practices.

People were protected from the risks of harm associated with communicable illnesses as staff received up to date guidance and training regarding the safe use of personal protection equipment and effective infection prevention and control practice.

The management team received regular updates to ensure the support was in accordance with recognised best practice. They used these updates to review their policies and procedures.

Caradoc House Residential Care Home is a care home providing support with personal care needs to ten people at the time of this inspection. The home can accommodate a maximum of 11 older people. Accommodation is provided in an adapted building.

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

Systems to assess, monitor and mitigate risks to people’s safety and well-being had improved. Further time is needed to ensure improvements are embedded and can be sustained over time. People were protected by the provider’s staff recruitment procedures. Staff received the support and training they needed to meet people’s needs. People received their medicines when they needed them from staff who were trained and competent to carry out the task. People were protected from the risk of abuse. Infection, prevention, control procedures had improved and helped to protect people from the risk of infection.

Improvements had been made to ensure the service was effectively managed. Systems had been introduced to monitor the quality and safety of the service provided. The provider worked in partnership with others to achieve good outcomes for people. These included health and social care professionals and stakeholders.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update). The last rating for this service was inadequate (published 09 April 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, staffing, person-centred care and good governance.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caradoc House Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Caradoc House Residential Care Home is a care home providing support with personal care needs to a maximum of 12 older people. Accommodation is provided in an adapted building and at the time of the inspection, nine people were using the service.

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

Risks to people's safety and well-being were not always considered and plans to mitigate risks were not in place or had not been reviewed. People were not consistently protected from the risk of abuse. People were not protected by the provider's staff recruitment procedures. The provider failed to ensure staff received the required support to enable them to meet people's needs safely. Infection prevention and control procedures did not ensure people would be protected from the risk of infection. Accidents and incidents were not investigated to identify measures to prevent re-occurrences.

The service was not effectively managed and there were no systems in place to monitor the quality and safety of the service provided. The provider had failed to act on the breaches of regulations identified at our last inspection.

People received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available.

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 ratings for this service was requires improvement (report published September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focussed inspection due to concerns we had received that Caradoc House Residential Care Home did not have appropriate management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to inadequate.

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.

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 coronavirus and other infection outbreaks effectively.

Ratings from the previous comprehensive inspection for those key questions we did not look at were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Caradoc House Residential Care Home 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 safe care and treatment, premises and equipment, good governance and safe employment of staff at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the 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.

About the service

Caradoc House is a residential home providing personal care and support for up to eleven people over 65. At the time of inspection there were ten people living in the home, three rooms had en-suite facilities. Some extension work was being carried out with the intention of increasing the number of people in the home. The home was a converted house, there was a stair lift for people to access the upper two floors.

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

People had not been protected from the risks associated with fire as some exits had been blocked and the fire evacuation plan had not been updated to reflect this. Some routine health and safety checks had not been carried out as regularly as required. Hazardous chemicals had been left in a bathroom which was used by people who might not recognise the risk. Not all bathrooms had hand washing materials available. People we spoke with said they felt safe in the home and had enough support when they needed it.

People's needs had been assessed and plans of care developed to ensure their needs were met. People's capacity to make decisions had not been assessed; there was a risk that people may have been deprived of their liberty without appropriate authorisation. Staff training was inconsistent. Two of the three staff spoken with said training was limited, but they understood how to support people and people confirmed this.

People said staff were kind and caring. Staff understood the importance of supporting people in ways that upheld their dignity. People were supported to maintain their independence. We saw a lot of positive interactions between people in the home and the staff.

People received person-centred care which reflected their needs and preferences. Activities were available including trips to museums and local beauty spots. Some people attended a day centre to keep in touch with people and engage in activities.

Staff were committed to providing high-quality person-centred care. People said they were happy with the quality of care they received. Some auditing and governance of the service had not been completed as required. There was a lack of oversight of some health and safety concerns which could have placed people at risk.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good, (published January 2017). At this inspection the overall rating for this service has deteriorated to requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. We have made recommendations in relation to staff support and supervision and mental capacity assessments. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Please see the action we have told the provider to take at the end of this report.

Caradoc House Residential Care Home is registered to provide accommodation and personal care for up to 11 people. At this inspection 11 people were living there.

A registered manager in post who was present during day one of the inspection. 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.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risks of harm and staff followed safe practice when assisting people. Any incidents or accidents were monitored by the registered manager and deputy manager to minimise reoccurrence.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. The provider undertook checks on staff to ensure they were safe to work with people before they started their employment.

People received support with their medicines from staff who were assessed as competent and followed safe practice with medicines. The provider undertook checks to ensure staff followed safe procedures when administering medicines. The registered manager had systems in place to learn from incidents resulting from any errors and to take action to prevent reoccurrence.

People were supported by staff members who had the skills and knowledge to meet their needs. Staff members attended training that was relevant to the people they supported. Staff received support from the registered manager and deputy manager who promoted an open and transparent culture.

People were involved in decisions about their day to day care. When people were not able to make decisions for themselves they were supported by staff and advocates who understood and took steps to ensure their rights were upheld.

People received care and support which was personalised to them and reflected their personal preferences. People’s care and support was adapted with people’s changing preferences and needs. People took part in activities they liked and found interesting and fun.

People were supported by staff who knew them well and had good relationships with them. People were involved in their own care and information was given to them in a way they could understand.

People had their privacy and dignity respected by staff who also encouraged them to do as much as they could to maintain independence. Staff understood how to keep information confidential and shared information only when needed and with the individuals permission.

People had a choice of food to eat and were prompted to maintain a healthy balanced diet. People’s routine health needs were looked after and people had access to healthcare when they needed it.

People and staff felt able to express their views and felt their opinions mattered. People were involved in the day to day running of their home and were involved in any changes.