Archived: Callands Care Home

Callands is a 'care home' providing accommodation, nursing and personal care for up to 120 younger and older adults; some of whom live with dementia or physical disabilities. At the time of the inspection 109 people were living at the home across four separate units.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

People were not involved in their care planning. Care plans were not reflective of people’s needs and lacked person centred details. Risks were not always assessed. There was only 1 activity coordinator available to provide support to 109 people, there was limited activities available. The environment was not supportive of people living with dementia there was limited signage to promote independence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

The service had an inconsistent staff team and high agency use. This meant staff were not always aware of people needs. People's communications needs were not always recorded and there was a lack of awareness of how to apply national best practice supporting people with a learning disability and autistic people. Some inappropriate language was used when referring to people who used the service.

Although some people had individual ways of communicating, using body language, Makaton (a form of sign language), pictures and symbols, this was not documented which meant staff were not aware of how best to communicate with people to provide effective support and encourage independence.

Right Culture:

Staffing levels and shift patterns were insufficient to enable all people to access the community to pursue their leisure interests and form meaningful relationships within their local community.

Staff did not always have the training and skill needed to support people effectively.

Some staff had poor relationships with each other and management. Staff did not always feel management were approachable and supportive.

Governance processes were not always effective in the monitoring of the service. Whilst some of the concerns were identified through the service’s own provider audits, they had failed to rectify the concerns raised.

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 service has been rated requires improvement for the previous 4 inspections, the last inspection was published on 21 March 2021. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of the service, medication, and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions safe and well-led only. During the inspection other concerns were identified and as a result we opened the inspection to include the responsive domain. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well led sections of this full report.

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

Enforcement and Recommendations

We have identified continued breaches in relation to lack of risk assessment, medicines management and governance systems in managing and monitoring the service. There were also breaches identified in relation to the lack of person-centred care, safeguarding people from abuse, clinical practice and staffing, 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 6 months to check for significant improvements.

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.

Callands is a ‘care home’ providing accommodation, nursing and / or personal care for up to 120 younger and older adults; some of whom lived with dementia and physical disabilities. At the time of the inspection 104 people were living at the home across five separate units.

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

The provider did not always have effective governance and quality assurance measures in place; systems and processes were not effectively monitoring, reviewing or helping to improve the quality and safety of care being delivered. Inconsistent leadership and oversight have meant that there has been repeated breaches of regulation and mitigation of risk has not always been effectively managed.

The provider did not always ensure that quality performance and risk management procedures were effectively providing high-quality, safe care. Audit tools and home improvement plans were not sufficiently supporting areas of improvement, and in some cases had not identified the areas and concerns we identified during the inspection.

People’s areas of risk were appropriately identified and recorded within their care records however, we found that not all risks were safely managed. Clinical risk management tools were not regularly completed or being checked, and monthly risk reviews did not always contain the appropriate information in relation to risks that had been identified.

Not all care records contained the relevant guidance and information in relation to specific support needs people required. Risk management plans did not contain the relevant information staff needed to ensure people received safe care and treatment.

Medication systems and procedures were reviewed. People received their medicines as prescribed, by trained and competent members of staff and regular audits and checks were regularly taking place. However, some areas of medicine management need to be further reviewed and strengthened. We have made a recommendation regarding this.

Staff told us they felt valued, involved in the care being provided and believed the new interim manager was making a positive difference. Feedback from relatives suggested that they were happy with the provision of care their loved ones received but communication and visiting arrangements during the pandemic could have been better.

We were assured that infection prevention and control (IPC) measures were appropriately followed. The home itself was clean, hygienic and well-maintained, although some areas such as clinic rooms and medication dispensing trolleys required attention. Regulatory health and safety compliance checks and certificates were in place.

We observed safe staffing levels during the inspection and people told us they received prompt care when it was required. However, we did receive some mixed feedback from relatives who expressed that the home appeared under-staffed especially during the pandemic. Recruitment processes were safely in place and people received safe care and support by staff who had been appropriately recruited.

Rating at last inspection and update

The last rating for this service was ‘requires improvement’ (published 08 July 2019). We found breaches of regulation in relation to staffing and good governance. 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. We found the provider was still in breach of regulation.

Why we inspected

We carried out an announced inspection to follow up on concerns we had received following a safeguarding referral to the Local Authority. The information The Care Quality Commission (CQC) received indicated that there were concerns around safe care and treatment and governance procedures. 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.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were not looked at during this visit. 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 to calculate 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

The overall rating for the service has remained ‘requires improvement’. This is based on the findings at this inspection. We found evidence that the provider still needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Callands 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 identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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.

Callands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. Callands care home is a two-storey building that accommodates up to 120 people across five separate units. At the time of the inspection 109 people were receiving support.

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

At our last inspection in February 2018, we found the home was in breach of regulations in relation to ‘need for consent’ and ‘good governance’. During this inspection we found the service was no longer in breach of ‘need for consent’, however the provider remained in breach of ‘good governance’ and we identified a new breach of regulation in relation to ‘staffing’.

The overall quality and safety of care people received had not improved since the last inspection.

Quality assurance measures were not effectively in place. Processes and systems to assess and monitor the provision of care being delivered were not routinely completed, audits and checks were not identifying areas of improvement and the overall governance of care being delivered was inconsistent.

Sufficient numbers of 'maintenance' staff were not deployed across the home. The home had been without two maintenance co-ordinators for a substantial period of time; this was impacting the provision of care people received.

Staff were not supported with effective training, learning and/or development opportunities. At the time of the inspection organisational training compliance was not being met.

Assessment of staffing levels and recruitment procedures were in place although we identified that this area of ‘safe care’ needed to be strengthened. We have made a recommendation in relation to this.

Aspects of the environment were not well maintained. Both internal and external areas of the home were not appropriately managed and required attention. We have made a recommendation regarding refurbishment work that is required.

Confidential information was not always securely stored and protected in line with General Data Protection Regulations (GDPR). People’s sensitive and confidential information was accessible to others.

Care plans and risk assessments were in place and generally contained the correct level of information in relation to the support people needed. Some areas of risk management needed to be reviewed and strengthened.

Staff were familiar with people’s likes, preferences and wishes and positive relationships had developed between staff and people receiving care. However, it was identified that the absence of specific staff members was having a negative impact on the tailored level of care being provided.

Safeguarding and whistleblowing procedures were in place; although we did identify that safeguarding training was not meeting organisational compliance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we did identify that people’s consent was not always reflected in the care records we checked.

People and relatives told us that dignified and respectful care was provided. We observed kind and compassionate interactions between staff and people receiving support.

The registered provider had a complaints procedure in place. Complaints were reviewed, discussed and responded to in line with organisational policy.

Medicine management procedures were safely in place. Staff received medication administration training, regularly had their competency levels checked and were familiar with the medication administration policy.

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 30 May 2018); there were two 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 sufficient improvements had not been made and the provider was still in breach of regulations.

The service remains rated ‘requires improvement’. This service has been rated 'requires improvement' for the last three comprehensive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to 'staffing' and 'good governance' at this inspection.

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

Follow up

We will meet with the provider 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.

We will request an action plan from 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.

Callands care home was previously inspected in March 2017. During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered person had failed to ensure that people consistently received safe care and treatment and the management of medicines was not completely safe.

Furthermore, we found that the registered person had failed to ensure that sufficient numbers of suitably qualified, competent, skilled and experienced persons were not being deployed effectively and effective systems were not in place to assess, monitor and improve the quality and safety of the service.

At this inspection we found that the registered provider had taken action to address breaches identified at the last inspection.

However, during our inspection, we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to good governance and the need for consent.

We found that accurate, complete and contemporaneous records were not always being maintained in respect of each service user. Furthermore, we found that the registered person had not always acted in accordance with the principles of the Mental Capacity Act. You can see what action we told the provider to take at the back of the full version of this report.

Callands care home is a 'care home' run by HC-One Ltd. 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.

The care home is a two storey building that accommodates up to 120 people across five separate units, each of which have individual lounges and dining areas with adapted facilities. The units include: Coniston (which accommodates 30 older people with nursing care needs); Windermere (for 10 people living with dementia); Grasmere (for 30 people living with dementia who also have nursing needs); Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults). At the time of our inspection, the service was accommodating 100 older people with a diverse range of needs.

Callands care home is set in its own grounds within the Callands area of Warrington. A range of shops and other local facilities are within walking distance of the care home and the area is supported by good public transport services. There is a car park provided for visitors at the front of the building.

The care home did not have a registered manager at the time of our 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.

During our three day inspection, we spoke with people living in the care home, relatives and staff. We also undertook observations of the standard of care provided. We saw that staff took time to talk and interact with people throughout the day and were helpful and supportive when people asked for help. We also noted that staff interactions were positive and that people living in the care home had access to activities and were treated with respect and dignity.

People had access to a range of health care professionals to help maintain their health and wellbeing and medication was ordered, stored, administered, recorded and disposed of safely. People using the service were also provided with a range of wholesome and nutritious meals and alternative and vegetarian choices were available upon request.

Staff had access to induction, mandatory and service specific training to help them understand their roles and responsibilities.

Systems had also been established to ensure that staff working in the care home had been correctly recruited and to ensure people were protected from abuse. A complaints process was also in place to ensure concerns and complaints were listened to and acted upon. Furthermore, a range of quality assurance and auditing processes were in place to ensure key areas were monitored. This involved seeking the views of people using the service periodically.

Some staff spoken with raised concerns about the effectiveness of the current dependency tool in place. Likewise, prior to our inspection the local authority advised us that this was an area that the provider needed to review to ensure that consideration was also given to people’s medication needs, the support people needed to engage in activities and the layout of the home. At the time of our inspection this was still an outstanding action.

We have recommended that the registered provider undertakes a review of the current dependency tool to ensure it includes a holistic overview of the dependency needs of people using the service.

Callands Care Home was previously inspected in March 2016 when it was found to be meeting all the regulatory requirements which were inspected at that time. We also undertook a focussed inspection on the 20th July 2016 to review action taken since our last inspection and to check that people were receiving appropriate care and support as we had received information of concern. During that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and safe care and treatment. We found that people using the service had not always had their needs adequately assessed and planned for. Furthermore we found that people did not always receive care that was person centred and responsive to their needs.

During this inspection we found that the provider had taken action to address one of the breaches identified at the last inspection in respect of person centred care. We found that improvements had been made in regard to the breaches however further work was needed in both areas.

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our inspection the service was accommodating 110 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

The units include: Coniston (which accommodates 30 older people with nursing care needs); Windermere (for 10 people living with dementia); Grasmere (for 30 people living with dementia who also have nursing needs); Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was no registered manager at Callands Care 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.

The deputy manager had been assigned to oversee the management of Callands Care Home pending a newly appointed manager commencing in post and was present during the two days of the inspection.

Whilst many of the people spoken with and their representatives told us that they were well cared for and happy in Callands Care Home, we observed and identified breaches of the relevant regulations in respect of staffing, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Systems were in place to safeguard people from abuse and to respond to complaints. Staff spoken with confirmed they had received training in this key area and were confident that any allegations of abuse made would be reported and fully investigated to safeguard people’s welfare.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. There were systems in place to protect people who could not make decisions which followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff also had access to training in this protective legislation.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were had access to induction, regular on-going training and periodic supervision to develop the necessary skills and competence for their roles.

People using the service had access to a choice of menu and received wholesome and nutritious meals that were well presented and took into consideration each person’s dietary needs.

Records showed that people also had access to a range of health care professionals (subject to individual need).

The home employed three activity coordinators who supported people to take part in activities either individually or in groups, which included going out to places of interest. Since our last inspection changes had been made to how activities were planned and organised, however we identified areas where there was still scope for further improvement.

This was because a number of people highlighted concerns regarding the range of activities available in the home. People told us that they felt there were insufficient activities on offer to meet their diverse needs and the number of people living in the home.

Since our last inspection in March 2016, we have received information of concern regarding the standard of care provided to people with complex support needs.

We therefore undertook a focussed inspection on the 20th July 2016 to review action taken since our last inspection and to check that people were receiving appropriate care and support.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Callands Care home’ on our website at www.cqc.org.uk

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our focussed inspection the service was accommodating 114 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

The units include: Coniston (which accommodates 30 older people with nursing care needs), Windermere (for 10 people living with dementia), Grasmere (for 30 people living with dementia who also have nursing needs), Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was no registered manager at Callands Care 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.

A peripatetic manager had been assigned to oversee the management of Callands Care Home and was present during the day of the inspection. We were informed that a new manager had been appointed and that this person intended to apply to register with CQC.

During this inspection we found 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 the report. We found that people had not always received care that was person centred and responsive to their individual needs and that some call bells were not operating and / or being responded to effectively.

Since our last inspection the provider had increased activity coordinator hours by ten additional hours per week to enable the provision of activities over a seven day period. A sensory garden had also been developed for the Grasmere unit to include an arbour area and sensory items and a newsletter produced. Despite this action, people spoken with were still of the view that the range of activities on offer was limited and that this issue remained in need of review.

Systems were in place to record and respond to complaints.

Callands Care Home was previously inspected in April 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our inspection the service was accommodating 105 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

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The units include: Coniston (which accommodates 30 older people with nursing care needs), Windermere (for 10 people living with dementia), Grasmere (for 30 people living with dementia who also have nursing needs), Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was a registered manager at Callands Care 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.

The registered manager was not in day to day charge of the service when we inspected Callands Care Home. A peripatetic manager had been assigned to oversee the management of Callands Care Home and was present during the three days of the inspection.

During the inspection we found Callands Care Home to have a pleasant and homely atmosphere. We observed people's choices and preferred routines were respected and that staff communicated and engaged with people in a compassionate and caring manner.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training and supervision to develop the necessary skills and competence for their roles.

Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a choice of menu. The provider’s hospitality manager was due to visit the home to undertake a review of catering and people’s dining experience in order to improve standards following feedback received from people using the service.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff understood their duty of care in relation to this protective legislation.

Systems were in place to safeguard people from abuse and to respond to complaints.

People spoken with highlighted concern regarding the range of activities available in the home and felt that there were insufficient on offer to meet their diverse needs and the number of people living at Callands Care Home. We have made a recommendation relating to this matter.

We spoke with management and staff and reviewed a sample of records which included staffing rotas, dependency tools and care plan documentation as part of this follow up inspection. Records viewed contained evidence that systems were in place to monitor the changing needs of people using the service and for the effective deployment of staff.

People using the service and their representatives reported that they were happy with the standard of care provided. They gave overall positive comments about their support and made various comments such as: 'It couldn't be any better here. I'm not one for company. I like to stay in my own room. I suppose I could go to activities if I wanted'; 'Nothing bothers me'; 'I'm very happy. I have no complaints'; 'I'd like to raise some things with staff but we've not had any meetings recently. I'm not sure if I have a keyworker but if I did have one I'd like to always be able to talk to them.'

Likewise, relatives were positive about the service and made various comments such as: 'We are very happy. Our relative doesn't like to get involved in activities but the staff always give personalised care, especially for meals'; 'My sister looks better and the rest is doing her good' and 'I'm happy with the care. I can visit any time and make myself a cup of tea and have a biscuit or have a drink at the bar. You are always made to feel welcome.'