Archived: Carr Gate

Carr Gate is a nursing home providing accommodation for up to 65 people, who require personal care. The service provides support to people who have physical and mental health needs and conditions such as dementia. At the time of our inspection there were 45 people using the service.

The home is set out across 2 floors, divided in to 3 units. Each unit has a lounge and dining area. One unit specialises in supporting people with dementia and another is dedicated to nursing care. The home is spacious and has a ‘homely’ environment.

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

Feedback from people, relatives and staff indicated staffing levels impacted people’s experience of care. We found no evidence of harm to people and the registered manager gave us assurances. We have made a recommendation about feedback and practices concerning staffing deployment.

People and relatives told us they felt the care provided was safe. Staff were trained and aware of their safeguarding responsibilities. Recruitment was managed safely. Infection, prevention, and control measures were followed to ensure staff protected people from the risk of infection.

We found medicines were managed safely and risks associated with people’s care were appropriately assessed. We found records associated with people’s care were person-centred. However, at times, historic information or handwritten notes made it difficult to understand the relevant support at the time. The staff had received training in care planning and the provider was monitoring this.

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.

Effective quality and governance processes were in place. Any concerns were investigated, and lessons learnt were shared with staff. The service worked with the other professionals ensure people's care was effective.

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 rating for this service was requires improvement (published 14 December 2018). At our last inspection we recommended the registered manager completed weekly audits of medicines. At this inspection we found the registered manager had actioned this and taken steps to improve their medicines management.

Why we inspected

We received concerns in relation to staffing levels, poor internal communication and management of incidents and risk. As a result, we undertook a focused inspection to review the key questions of safe 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.

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 good based on the findings of this inspection.

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

Recommendations

We have made a recommendation about the provider continuing to review feedback around staffing levels and their staff deployment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service was accessing the government testing scheme which assisted them to promptly identify an outbreak. The service worked with the local authority infection, prevention and control (IPC) team and other health professionals in managing the outbreak.

There was clear and accessible infection prevention signage throughout the home and clear communication with staff reinforced hygiene practices. There was a plentiful supply of personal protective equipment (PPE), such as disposable masks, gloves and aprons. There were PPE stations and hand sanitising points appropriately placed around the home.

People isolating in their rooms had regular contact with staff, who wore personal protective equipment (PPE) appropriately. Staff also helped people to maintain links with their family and friends by phone and on-line.

Further information is in the detailed findings below.

Carr Gate is a ‘care home’. 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. Carr Gate provides personal care and support for up to 65 people in three units, this includes people living with dementia. At the time of our inspection there were 51 people using the service.

The service had a registered manager in post 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.

We saw improvements to the care plans on all three units of the home. We spoke to the registered manager around ongoing improvements in the nursing unit. The registered manager had just recruited a clinical lead to continue with these improvements. Staff supported people in a compassionate, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. Most people we spoke with made positive comments about how staff delivered care and said they were mostly happy with the way the home was managed.

Systems were in place to safeguard people from abuse.

Care and support was planned and delivered in a way that ensured people were safe. Where possible, people had been involved in planning their care. Care plans outlined peoples’ needs and risks associated with their care, as well as their abilities and preferences. Since our last inspection the information in care plans about how to support people had improved. However, work was still needed in relation to the care plans around people’s capacity and end of life care.

We made a recommendation to the registered manager to ensure all end of life plans were in place for people in the home, if they chose this.

We looked at the medicine management in the home on all three units. We saw charts used to record when staff had applied topical creams were not always in place. We saw some topical creams did not have a used by labels in place. However, these had been picked up in the audits at the end of each month.

We made a recommendation to the registered manager to complete weekly medication audits on all three units instead of completing these monthly to ensure these were picked up and addressed earlier.

Recruitment procedures aimed to make sure staff employed were suitable to work with vulnerable people. Staff were trained and supported to develop their skills, so they could provide people with the standard of care they required. There was enough staff on duty to meet the needs of the people living at the home at the time of our inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Since the last inspection the care plans we looked at we saw decisions made in people’s best interest had been followed and the correct procedure were accurately recorded.

People received a varied and healthy diet that offered choice and met their needs. Everyone we spoke with was complementary about the meals provided.

There was a range of social activities and events available for people to take part in, if they wished to.

The service had an open culture that encouraged involvement of people using the service, their families and staff. The registered manager, supported by senior managers in the company, was visible and promoted teamwork. The registered manager had only been in post for a few months prior to the inspection.

People were encouraged to raise concerns or complaints and were asked for feedback about the service they received. We saw complaints were dealt with in accordance to the homes policy. We looked at one ongoing complaint at the time of inspection. Staff spoke positively about the registered manager and had a clear understanding of their roles and responsibilities.

Regular checks were in place to identify areas of service needed to improve and action had, or was being taken to address shortfalls found.

Carr Gate Nursing Home provides accommodation and nursing care for up to 65 people, some of whom are living with dementia. The home is on two floors and there are three units; Cherry (nursing care), Cliffe (residential care) and Holly (dementia care). At the time of the inspection 17 people were living on Holly, 14 people were living on Cliffe and 19 people were living on Cherry.

There was a registered manager, who had been registered with the Care Quality Commission to manage the service since July 2015. 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 provided with care and support in line with the principles of the Mental Capacity Act (2005). One person, who remained in bed however, had no clear recording of any best interest decision around this and the rationale for them staying in bed continuously was not evident or understood by staff around this person.

Care records we looked at contained individual risk assessments although we found some conflicting information in relation to weight checks. We spoke to the registered manager who told us this should be completed monthly unless a risk is present.

People and relatives we spoke with told us people felt safe at Carr Gate Nursing Home.

Staff had received training in relation to safeguarding people and staff were aware of relevant procedures to help keep people safe in the home. Staff received appropriate induction, training, supervision and support to enable them to perform their role.

Staff were recruited safely. Staffing numbers were determined by the use of a dependency tool. However there were mixed views about staffing levels across the service in relation to staff having quality time to interact with people in the home. Whilst we felt there were adequate staff to meet people's care needs, we observed sometimes the deployment of staff was not effective in some areas of the home. We spoke to the registered manager about this.

We saw some examples of good care practice. Staff were observed to be caring and kind in their interactions with people.

We saw accident and incident records completed across the three units. The registered manager had a good insight to these and lessons learnt were consistently addressed at team meetings. The registered manager held regular meetings with people, staff and relatives and engaged with other

agencies. Audits were in place around the governance of the home. However some areas around care plans would have been picked up sooner if these had been more robust and effective.

We made a recommendation the registered manager looks at all repositioning records to ensure these are all up to date around the frequency for the repositioning of the person.

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

This inspection found improvements had been made in each of these areas. However, there was a continued breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the registered manager had not reported a safeguarding incident in line with safeguarding procedures and a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people were not always protected from assessed risks.

Carr Gate Nursing Home provides accommodation and nursing care for up to 65 people, some of whom are living with dementia. The home is on two floors and there are three units; Cherry (nursing care), Cliffe (residential care) and Holly (dementia care). At the time of the inspection 13 people were living on Holly, 14 people were living on Cliffe and 11 people were living on Cherry.

There was a registered manager, who had been registered with the Care Quality Commission to manage the service since July 2015. 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.

Most people told us they felt safe living at Carr Gate and the family members we spoke with on the day of the inspection also told us they felt their relatives were safe. One person, however, indicated they did not feel safe.

Staff had received training in relation to safeguarding people and staff were aware of relevant procedures to help keep people safe. However, on the day of the inspection, we identified a safeguarding concern that had not been reported and investigated.

Staff were recruited safely. Staffing numbers were determined by the use of a dependency tool and staff and people told us they felt staffing levels across the home were adequate. Whilst there were enough staff to meet people’s needs, we observed sometimes the deployment of staff was not effective.

Staff received appropriate induction, training, supervision and support to enable them to perform their role effectively.

People were provided with care and support in line with the principles of the Mental Capacity Act (2005) and staff demonstrated knowledge and understanding of the relevance of this when providing effective care to people.

People across the home were supported to have their nutrition and hydration needs met. However, the lunchtime experience on the Holly unit was not as well organised as other units, resulting in people having to wait longer for assistance.

Support was provided to people by caring staff. We observed many positive, caring interactions between staff and people.

Care plans were person centred and included people’s choices and preferences, although one care plan we sampled contained contradictory information. Care plans were were reviewed regularly.

Although we observed some activities taking place, we felt there was a lack of meaningful activities. However, a new activities coordinator had been appointed and was due to start employment at the home during the week following the inspection.

The registered manager held regular meetings with people, staff and relatives and engaged with other agencies. Audits had improved since the last inspection but required further development. Strong teamwork was evident and people, staff and relatives had confidence in the registered manager.

You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we were informed the registered manager had resigned and there was an acting manager in place. The home has three units, Cherry (nursing unit), Cliff (residential unit) and Holly (dementia unit) and we visited all three during the inspection.

We spoke with the acting manager, the Quality Assurance Manager, seven staff, ten people who lived in the home and three relatives.

We found improvements had been made in the care documentation. People told us they were generally satisfied with the care they received and were positive about the staff. They described staff as "very good" and "lovely". One person said about one staff member: 'He's a nice lad'. Another person told us: 'The staff do a good job, I'm well looked after'.

We found improvements in the management of medicines. The home had changed its pharmacy supplier and staff we spoke with who were responsible for medicines told us they much preferred the new system. They said the systems and records were clearer and easier to follow.

We found staffing levels were sufficient to meet people's needs. Additional staff had been recruited and recruitment was ongoing. We observed people's needs were being met and staff responded promptly to requests for assistance.

Staff were receiving regular supervision and training updates as required.

We spoke with 11 people who lived in the home, 9 relatives, 10 staff and the registered manager.

We found people were generally well cared for but found shortfalls in the care documentation which we considered could impact on the care people received.

We found people's nutritional needs were met with a choice of meals, and snacks and drinks were available at all times.

We identified concerns with some of the medication systems and practices in place, which meant people were at risk of not receiving their medication as prescribed.

We found there were not always enough staff to meet people's needs due to the dependency levels and the layout of the building.

We found staff had access to ongoing training and development, however some staff required training updates. We found staff supervisions and appraisals were not up to date which meant systems were not in place to formally support staff in their roles.

People we spoke with said they felt well cared for and made positive comments about the staff. One person said; “It’s good here, I like it.” Another person said; ”It’s grand and the staff are lovely.” Another person told us; “The staff are nice.”

We saw a good rapport between staff and people living in the home. For example, we observed one person laughing with a staff member. This person said to us that the staff member “always makes me smile”.

People said they enjoyed the food. We saw there was a choice of food and people were offered more.

We saw staff maintained people’s privacy and dignity at all times and maintained confidentiality when speaking to people and other staff. We found that care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

We found there were enough qualified, skilled and experienced staff to meet people’s needs.

You can see our judgements on the front page of this report.

The people we spoke with told us their needs were being met and they were very positive about the staff. One person said; “I can have my hair done anytime I want.” Another person commented; “They are very kind. They know me and look after me.” Another person told us; “I like it here. They are all so kind. It makes all the difference.”

The relatives we spoke with told us they were happy with the care their family members received, and they felt involved in their care. One relative told us; “Both my parents have been in here. The staff are really good I can’t fault them. They let me know as soon as anything happens.” Another relative said; “They really look after [my relative] and they are kind and caring.”

Other comments included:

“The staff keep me updated about my dad’s care.”

“The staff are fantastic.”

We asked people if they have ever had to make a complaint. People told us that they had not had to complain but if they did they knew to speak to the manager.