Caraston Hall

Updated 20 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

The inspection was undertaken by one adult social care inspector on the 06 October 2018. We gave the service 24 hours’ notice of the inspection visit because it is small and people often go out during the day and we needed to be sure the registered manager would be available.

Prior to the inspection we looked at other information we held about the service such as notifications. A notification is information about specific events, which the service is required to send us by law.

During the inspection we met and spoke to people who were receiving a regulated activity of personal care as well as other people who lived at the service. Some people living at the service had limited ability to communicate and tell us about their experience of being supported by the staff team. However, we were able to observe the interacting between people and the registered manager and the staff team.

We also looked around the premises. We spoke to the registered manager and two members of staff. We also received feedback form one healthcare professional. We looked at records relating to individual’s care and the running of the home. These included care and support plans and records relating to medicine administration. We also looked at the quality monitoring of the service.

Updated 20 October 2018

This was Caraston Hall’s first inspection since registering with the Care Quality Commission. We carried out this unannounced inspection on the 06 October 2018.

The service specialises in care for people who have severe and enduring mental health needs. On the day we visited five people lived in the service.

Not everyone using Caraston Hall receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Caraston Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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 met and spoke with people living in the service during our visit. However, some people were not able to fully verbalise their views, so staff used other methods of communication, for example a translator tool if English was not people’s first language.

People were safe at Caraston Hall. Staff had completed safeguarding training and updates were provided. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff understood what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated. Staff confirmed they’d have no hesitation reporting any issues to the registered manager or provider.

People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. Staff confirmed there were sufficient staff to meet people’s needs. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff completed an induction programme when they started work and staff competency was assessed. Staff also completed training appropriate to the people they cared for, for example mental health awareness training. Staff also completed formal care qualifications which included equality and diversity training.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

All significant events and incidences were document and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess and improve the ongoing quality of the service provided was sought from people living in the home, professionals and staff.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals.

People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were engaged in different activities during our visit including some people going out independently while others enjoyed the company of the staff.

People had free access to the kitchen and where given the choice of meals, snacks and drinks they enjoyed, while trying to maintain a healthy diet. People had input as much as they were able to in preparing meals and drinks.

People’s care records were person centred, and were personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were encouraged to be fully involved with their support plans. Advocates and interpreters supported people and staff to complete and review people’s support plans, when required. People’s preferences were sought and respected. People’s cultural, religious and spiritual needs were also documented.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, some who had worked at the service for many years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved as needed, in decisions about the care and support people received.

People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People could make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. The registered manager understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

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. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

The service was well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

The registered manager and registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People lived in an environment that was clean and hygienic. The environment had been refurbished to a high standard.

People lived in a service which had been designed and adapted to meet their needs. The provider monitored the service to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.