Caritate Nursing Home is a ‘care home’ that provides nursing care for a maximum of 24 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were 19 people living at the service. 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 who was responsible for the day-to-day running of the service. 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 carried out this unannounced inspection on 13 November 2017. At this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 17 July 2017.

In July 2017 we found there were gaps in the recording of people’s care and treatment, in the recording of best interest decisions and a lack of detail in some people’s care plans. We had other concerns about how risks in relation to people’s care were managed and the system for monitoring the quality of the service was not entirely effective.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people and their relatives included, “[Person] is well looked after”, “Staff are good”, “No problems at all”, “I am happy living here” and “I have nothing to complain about.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People’s behaviour and body language showed that they felt cared for by staff.

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time. One relative told us, “I have always felt really comfortable visiting. Staff tell me it is my home as well.”

The environment was clean, well maintained and there were no unpleasant odours. Bedrooms were personalised to reflect people’s individual tastes.

While safe arrangements were in place for the storing and administration of people’s medicines, there were some gaps in Medicine Administration Records (MARS). There were some missing signatures where two staff had not signed to confirm the accuracy of handwritten entries for prescribed medicines. Topical creams had not been dated on opening and there were missing records of when staff applied creams for people. We found some creams that were out of date. There were discrepancies between records of medicines given and the stock held for some people. We have made a recommendation about medicines recording.

Staff were supported by a system of induction training, one-to-one supervision and appraisals. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Caritate. Staff supported people to access hea

Caritate Nursing Home provides nursing care for up to 24 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were 19 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection on 17 July 2017. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection of 13 and 14 February 2017.

In February 2017 we found that people’s consent to their care was not always appropriately recorded and informal consent was not consistently sought by staff before providing care to people. We had concerns relating to gaps in the recording of how people’s health care needs were being monitored. Medicines were not safely managed and there was a lack of effective quality monitoring systems.

At this inspection we found improvements had been made to the management of medicines, how people’s consent was sought and to the recording of people’s consent. However, we still had concerns in relation to gaps in the recording of people’s care and treatment and the system for monitoring the quality of the service.

Safe arrangements were in place for the storing and administration of medicines. There were some missing signatures where two staff had not signed to confirm the accuracy of handwritten entries for prescribed medicines. Some people had been prescribed creams and these had not been dated upon opening. We found some creams that were out of date. However, the registered manager told us systems in relation to this would be improved and we judged that this had not had an impact on the safety of how people received their medicines.

People, or their advocate’s, consent to their care and treatment was appropriately recorded. We observed that staff asked for people’s consent before assisting them with any care or support.

Food and fluid intake charts for some people were not completed thoroughly enough to be able to check exactly how much food and fluid the person had taken. Where some people’s care plans stated they should be re-positioned, and their skin checked at particular intervals during the day, there were no records to say that these checks had taken place. Although, we found no evidence that people’s skin integrity and food and fluid intake needs were not being met. While a new system of audits, to monitor the quality of the service provided, had been developed audits in relation to the care provided had not been implemented at the time of the inspection.

At this inspection we had other concerns about how risks in relation to people’s care were managed, the lack of detail in some people’s care plans and gaps in the recording of best interest decisions.

Where some people had lost weight and there were no risk assessments in place to give guidance for staff about how to minimise the risk of further weight loss. Concerns raised by staff about the accuracy of the weighing scales had not been investigated. Where people had been assessed as being at risk from developing skin damage, pressure relieving mattresses were in place. We found mattresses were not set at the correct setting for individual people’s weight and there was no system in operation to check if mattresses were set at the correct level. For another person, the risks associated with them not having timely access to anti-biotics, due to their complex respiratory disease, had not been identified.

Care plans lacked detailed guidance for staff to follow and some had not been updated to reflect the care be

This inspection took place on 13 and 14 February 2017 and was unannounced.

Caritate Nursing Home provides nursing care for up to 24 people with a range of health care needs and physical disabilities. At the time of the inspection, there were 19 people living at the service.

The service was managed by two registered managers. 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 carried out a focused inspection on 2 October and 17 November 2016. During that inspection, we found breaches in regulations. We found that there was not an established, effective accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons. In addition at the previous inspection, we found that the service was not meeting the requirements of the Mental Capacity Act (2005), including the Deprivation of Liberty Safeguards (DoLS).

At this inspection, we found improvements had been made in these areas. People’s rights were protected as the principles of the Mental Capacity Act 2005 (MCA) were followed by staff. Applications had been made to the supervisory body when necessary to authorise people’s care and treatment under the Deprivation of Liberty Safeguards (DoLS). However, we noted that people’s consent was not always appropriately recorded. The registered manager took action to address this issue. We also observed occasions where staff did not seek consent before assisting people with aspects of their care or before accessing their bedroom.

We found some concerns relating to the coordination and documentation of people’s health care needs. In particular in relation to one person who had a number of complex health concerns. We also found one person’s nutritional needs were not being effectively monitored due to inconsistent completion of charts by some staff.

We found some issues relating to medicines management. There was no system to report or record errors or omissions and medicines audits were not being undertaken at the service. We observed an excess of some stock and some staff signing medicine as being administered before the person had taken it.

As part of the service’s quality assurance procedures senior staff submitted monthly reports to the registered managers, for example, the lead nurse, maintenance person and the head chef. These reports were reviewed in order to identify concerns that might require action. However, this process had not identified the concerns with medicines management, consent and the recording and coordination of some health care needs.

Feedback on the service was sought through the distribution of quality assurance surveys and via a comments book which was accessible to people and their relatives. However, there were no staff meetings or residents’ meetings to provide people and staff the opportunity to raise concerns or share ideas collectively. Some staff felt they were not listened to or respected by senior and nursing staff.

Staff had received training in order to carry out their roles effectively, however a number of staff had lapsed in their mandatory training. We were told this was being actively addressed by the registered manager.

Feedback from staff, people and their relatives about the registered managers was generally positive. Relatives we spoke with felt involved in their family members care and this was reflected in people’s care records. Complaints were investigated and responded to in a timely manner and learning was used to assist learning and drive improvements. One person told us they had not been supported to make a complaint and this was reported to the registered manager who said they would look into this allegation.

People and their rel

This inspection took place on the 2 October and 17 November 2015. The inspection was unannounced. This was a focussed inspection due to concerns received by the commission . This report only covers our findings in relation to these concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Caritate Nursing Home on our website at www.cqc.org.uk

Caritate Nursing Home is a care home which provides nursing care and accommodation for up to 24 people. Caritate Nursing Home provides short term and longer term care for people, including younger adults, who are living with physical disability and people who may have physical and mental health needs.

The service had two registered managers 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 found the service was not meeting the requirements of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards. This is a legal framework that protects the rights of people who are unable to make certain decisions. Where people were deemed as lacking capacity, assessments had not been completed to ensure that staff were appropriately supporting people to make decisions and choices. The staff had a good understanding of how to support people to make day to day decisions but they did not have a good understanding of their legal obligations with regard to the Mental Capacity Act for more complex decisions.

We saw at least one example where potentially a person was deprived of their liberty. There was no documentation to demonstrate that this deprivation was made in the best interests of the person and the registered person had not submitted an application to the local authority for authorisation in relation to this deprivation as required by the Act. CQC is responsible for monitoring Deprivation of Liberty Safeguards. If such a Safeguard is authorised the provider is required to notify CQC, at the time of the inspection we had not received any notifications with regard to this.

Whilst the majority of feedback we received was positive there were at least three occasions where the staff and providers did not work with families and/or other social care professionals in the best interests of the people they were caring for. The Registered managers did not show an understanding of their roles and responsibilities particularly when things had gone wrong. The actions taken by the provider, when there were issues raised with them, did not foster continued and good working relationships. There was not a culture of learning from events and of being open and transparent.

There were breaches of Regulation 11: Need for Consent and Regulation 16 Receiving and acting on complaints of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition we have made a recommendation that the provider consider how they work with families and carers. You can see what action we told the provider to take at the back of the full version of the report.

Caritate Nursing Home provided care and support to a maximum of 24 people. There were 21 people using the service at the time of our inspection.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed. However some risk assessments had not been reviewed regularly. We saw the care plans were developed and reviewed with the person using the service and /or their relatives where appropriate.

We saw the home was clean and tidy. There was information about infection control readily available throughout the home although the infection control policy had not been updated since 2008.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were properly supported to deliver care and treatment safely and to an appropriate standard.

We saw evidence of ongoing audit in areas including complaints, falls and health and safety. Results of satisfaction surveys were shared with people who used the service and their representatives.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective). We visited the home on 3 October 2012.

People who lived at Caritate told us that they were happy living at the home. We were told that “everybody is easy to get on with”.

During the inspection we saw people treated with dignity and respect and included in day to day decisions about their care and support.

People told us the “meals are lovely” and “if you don’t like what is on the menu they always offer you something else”.

We saw that people’s wishes were taken into account when the menus were compiled. We saw that a number of specialist diets were well managed and met people’s dietary and nutritional needs.

People who used the service told us that they felt they were living in a safe environment. One person said “I could speak to the staff about anything”.

We saw that training and systems in place enabled staff or people who used the service to report any suspected abuse to the appropriate people.

Two people we spoke with told us that they thought there were enough staff. They said that they did not have to wait for long if they rang their call bell for assistance. One person told us “they [the staff] always have time for a little chat”.

We saw that there were enough staff to help people with their meals in a professional and unhurried way.

We saw that records were accessible to staff as required but were also stored securely. They contained appropriate information and were very well organised.

The inspection took place on 6 and 7 May 2015 and was unannounced.

Caritate Nursing Home provides care and accommodation for up to 22 people. On the day of the inspection 20 people were using the service. Caritate Nursing Home provides short term and longer term care for people, including younger adults, who are living with physical disability and people who may have physical and mental health needs.

The service had two registered managers 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.

People and staff were relaxed throughout our inspection. There was a busy but pleasant atmosphere. We saw kind, patient interactions between people and staff but sometimes staff did not explain to people where they were moving them or what they were doing or why. For example we observed some people being moved from one room to another without an explanation. People and their relatives said the care was good at the home and people enjoyed living in the home.

People’s risks were managed well and monitored. People were promoted to live full and active lives where possible and were supported to be independent where able.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers and dieticians.

We observed people receiving safe, compassionate care. People and their relatives told us they felt safe with the care provided by the service. People’s safety and liberty were promoted. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People’s human and legal rights were respected. Staff had received appropriate training in the Mental Capacity Act and the associated Deprivation of Liberty Safeguards. Staff displayed a good understanding of the requirements of the act, which had been followed in practice.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People and those who mattered to them knew how to raise concerns and make complaints. People and relatives during the inspection told us they had no concerns. The registered managers informed us any complaints made would be thoroughly investigated and recorded in line with the complaints policy.

Staff described the management to be supportive and approachable. Staff talked positively about their jobs and the registered managers. Comments included “I love my job”. Staff felt any issues they raised were always listened to and solutions/ improvements discussed.

Staff received a comprehensive induction programme which included shadowing more experienced staff. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. We observed staff using the correct techniques to transfer people and staff demonstrated good communication skills and good knowledge of the people they cared for.

People received a healthy balanced diet and meals were a social occasion but the dining room was overcrowded at lunch. This affected some people’s experience and enjoyment. For example some people were so close their shoulders were touching and one person was not able to join others at a table as there was no room at any of the tables. Improvements were required to the presentation of meals for those receiving a pureed diet.

Activities were meaningful, individualised and reflected people’s interests and individual preferences and hobbies. People enjoyed the activities on offer but they told us they would like more external outings as the weather improved. Pamper sessions, board games and music entertainers were enjoyed by people. One health professional told us this area could be expanded upon even further so people were able to lead as active and meaningful lives as possible.

There were effective quality assurance systems in place. The registered managers had set values that were respected by staff to ensure the quality of care remained high.

Staff felt listened to and able to contribute ideas to the development of the service and to drive improvement. Incidents and accidents were thoroughly investigated and action taken to reduce the likelihood of a reoccurrence. Learning from incidents and concerns raised was used to help service improvement and ensure positive progress was made in the delivery of care and support provided by the staff.