This inspection took place on 28 and 30 November 2018. Carham Hall Residential Home 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.

Carham Hall Residential Home provides care for up to 22 people. There were 21 people living in the home at the time of the inspection, some of whom were living with dementia.

The registered provider managed the home. They had run the home for a number of years but this was the first inspection under their new registration as a sole provider.

Before the inspection, we were made aware of concerns about the management of medicines in the home. We found improvements had been made when we visited although these were yet to be fully embedded in practice. There remained areas for improvement at the time of the inspection.

The premises were clean and generally well maintained but we found not all wardrobes were secured to the wall and some maintenance issues had not been picked up during routine audits.

We were made aware of a concern about staffing in the home prior to the inspection. On the first day of the inspection we found the provider was struggling to fill gaps in staffing and staff were working extra hours to cover these. By the second day of the inspection the provider had secured the services of a care agency to support with staffing while new staff were being recruited.

Audits and checks carried out by the provider were not sufficiently robust to identify the issues identified before and during our inspection. There were gaps in records relating to staff supervision and appraisal. The provider and deputy manager told us they were keen to make any improvements necessary.

Safeguarding procedures were in place and suitable arrangements were in place for the recruitment of staff including checks on the suitability of applicants to work with vulnerable people.

People were supported with eating and drinking. Positive feedback was received about the standard of meals and where people were at risk of malnutrition, specialist advice was sought.

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.

We saw numerous examples of kind, considerate care and people told us they felt well cared for.

People’s needs were responded to in a timely manner. Care plans were in place which contained person centred details about how people preferred to be cared for.

We received mixed views about the availability of activities. We have made a recommendation about this.

A complaints procedure was in place but no formal complaints had been received by the service.

Provision was in place should people wish to stay at Carham Hall Residential Home at the end of their lives. District nurses supported with care at this time.

We found one breach of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.