This unannounced comprehensive inspection was carried out on 16 and 17 August 2018.

Carrington House Limited 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. The care home accommodates up to 60 people in one adapted building.

There was a no registered manager in post because they left the service in July 2018. A new manager had started at the service two weeks prior to the inspection. They had not yet registered with the Care Quality Commission. 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.

At the previous inspection in October 2017, we gave the service an overall rating of ‘good’. This inspection was prompted by concerns we received about the care of some people using the service. These including two incidents where people had suffered harm. At this inspection, we found there were areas that required improvement across the five key questions. There were also breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We therefore, gave the service an overall rating of 'Requires Improvement'. You can see what action we told the provider to take at the back of the full version of the report.

People's care plans and individual risk assessments were not always robust enough to help staff mitigate known risks. This had resulted in unsafe care for two people and had the potential to put other people at risk too. The daily records were not detailed enough to evidence what care had been provided to people. This made it difficult to monitor if people were consistently receiving the care they needed. The service had not always worked closely with other professionals to explore more effective ways of supporting people who regularly refused support with their personal care.

The provider systems to assess and monitor the quality of the service had not been used effectively to ensure that people received consistently safe, effective and good quality care. There was no effective oversight of the service by the nominated individual (registered person). There was no evidence of a coordinated system to support learning across the three services they were involved with. The provider had a system to handle complaints and concerns. However, they needed to explore how to better manage the concerns of a relative who complained regularly.

The service needed to improve the amount and quality of activities provided to occupy people during the day. More work was necessary to explore people’s hobbies and interests to ensure that activities provided would be interesting for people to take part in. The manager told us of their improvement plans to make the service more caring and person centred.

Positively, we saw that local safeguarding protocols were being followed by staff and people were not concerned about potential abuse. People’s medicines were managed safely. There were systems in place to ensure that people were protected from the risk of acquired infections.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were supported by caring, friendly and respectful staff. People found staff to be responsive and sensitive to their needs. People had been given the opportunity to discuss their wishes

This unannounced comprehensive inspection took place on 12 and 13 October 2017.

At the last inspection in October 2016, we asked the provider to take action to make improvements to the cleanliness and safety of the service; staff deployment; quality of people’s care records; how people’s medicines were managed; quality of staff training records; and how they assessed and monitored the quality of the service. During this inspection, we checked if improvements had been made and we found they now met the regulations.

Carrington House provides care and support to people with a range of care needs including those with chronic health conditions, physical disabilities, dementia, and mental health conditions. At the time of the inspection, 59 people were being supported by the service and one person was on trial leave before moving to a Supported Living Service.

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.

People were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and accurate records were now kept. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely. The service was now clean and safe for people to live in.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The requirements of the Mental Capacity Act 2005 were now being met because people’s ability to make decisions about their care and support was appropriately assessed. People were supported to have enough to eat and drink, and they now had their meals quickly. They had access to various health services when required.

Staff were kind and caring towards people they supported. They treated people with respect and as much as possible, they supported people to maintain their independence. People were happy with how their care was provided and they valued staff’s support. People made decisions and choices about how they wanted to be supported and staff respected this.

People’s needs had been assessed and they had care plans that took account of their individual needs and preferences. Care plans now contained personalised information that enabled staff to provide person-centred care. Staff were responsive to people’s needs and where required, they sought appropriate support from healthcare professionals. The provider had an effective system to manage people’s complaints and concerns.

There was stable leadership of the service because the registered manager now only managed this service. Staff felt well supported and their contributions recognised. The provider had made significant improvements to all areas where we had previously identified shortfalls. On-going audits were also carried out. However, improvements were required in the quality of staff recruitment records. Further work was needed to improve people and relatives’ experiences of the service.

This inspection took place on 18 and 20 October 2016, and was unannounced. At the last inspection in October 2015, we asked the provider to take action to make improvements to the deployment of staff across the service and the way in which staff appraisals were undertaken. We received a provider action plan which stated the service had addressed the issues and would meet the regulations on 16 May 2016.

Carrington House Limited provides accommodation, care and support for up to 60 people with a variety of care needs, including health conditions and physical disabilities. Many people may also be living with dementia. At the time of our inspection there were 56 people living at the service, one person having recently been admitted to hospital.

The service has a registered manager. 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 service was not always safe. An appropriate level of cleanliness was not maintained throughout the service. Communal areas had broken equipment stored within them and some items of furniture in use were damaged or showed signs of deterioration. This exposed people to the risk of acquired infection and injury from damaged equipment and furniture.

People told us they felt safe and there were sufficient numbers of staff on duty. However we observed delays in the serving, and provision of assistance to people, during the lunchtime meal. Staff were visibly under pressure during this time and were unable to provide support to people in an unhurried way.

Medicines were not managed safely and gaps were found within medicine records. Monitoring tools and audits of medicine stocks were completed regularly by a coordinator however it was not clear who was delegated their responsibilities during periods of absence.

People’s capacity to make and understand the implication of decisions about their care were not consistently assessed or documented within their care records. There was no evidence that, where people lacked capacity to make or understand decisions, those made on their behalf had been made in accordance with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. However, people’s consent was gained before any care was provided.

Training records for staff were incomplete and gaps were evident on the training matrix for staff. However, staff felt that they were trained and had the skills and knowledge to provide the care and support required by people. New members of staff received an induction.

There were mixed opinions with regards to the meals provided at the service. People were supported to make choices in relation to their food and drink and a varied menu was offered.

People's needs had been assessed and care plans took account of their care needs but lacked detail with regards to their preferences, choices and individuality. Care plans and risk assessments had been regularly reviewed by senior staff to ensure that they were reflective of people's current needs. However it was not evident how people, and their relatives, had been involved in the process and their views included in the reviews of their care.

Quality assurance processes were ineffective. The registered manager completed quality monitoring audits however the audits completed had failed to identify the concerns found during our inspection and it was not clear how any identified actions to be taken were recorded. There was no evidence as to how audits were used to drive improvements in the service. The quality assurance survey, and resulting action plan, did not take into account the full views of the respondents and two negative responses were omitted.

The arrangements for the management and storage of personal corres

When we visited Carrington House on 14 May 2013 we spoke with four people who used the service and three relatives. We also spoke to eight staff members, the manager and the proprietor. We found that people were satisfied with the care and support they received. They said staff respected their privacy and dignity. People were enabled to pursue activities outside the home. A relative of a person who used the service said, “I am happy that …is able to go out for therapy”.

We found people were provided with sufficient food and drink to meet their needs. A person who used the service said, “The food is very good”. Another person said, “I think the food here is marvellous”.

We found that the home had a system in place to reduce the risk and spread of infection however, we observed clean laundry was left outsied people's bedrooms on the floor. This could pose a risk of cross contamination. We found handwritten entries on the MAR sheets were not countersigned by a second person. This could pose a risk of errors occurring when transcribing.

Staff told us they felt supported in their roles and were provided with regular supervision. We found there was not a planned schedule with supervision dates available. This meant staff may not always be aware when supervision would be taking place. Some amendments to the home's complaints policy were needed to ensure information was current.

We visited Carrington House Limited on 19 October 2012 to follow up on the areas we had found the service to be non-compliant with during our inspection in June 2012.

We observed a relaxed atmosphere with good interactions between staff and residents, and people being engaged in activities within the areas we visited.

We spoke with five people living in the home, who told us they felt “well cared for” and enjoyed living there. We also spoke with six members of staff who told us they were happy working in the home and felt supported to do their work.

We visited Carrington House Limited on 20th June 2012 having received information of concern regarding the care provided for people living there, the management of the home, and also to follow up on the previous concerns raised at our last visit.

During our visit people told us they were “generally happy” with the care, but that “the staff were always busy and there weren’t enough on duty”. We had received anonymous information that residents were rushed when care was provided, not allowing them time to encourage independence where possible, or attend to basic needs including washing their hands. One person told us they “would like to go home, but they look after me well”. Another person told us “staff stop and chat when they can, but they are busy”. We spoke with six people and three relatives who told us they were happy with the care provided. One person told us “they look after me well” and they enjoyed living at the home. Another person told us the “care was OK but the management was sloppy”.

People told us the staff were kind but “didn’t have enough time to spend with people and were always busy”. People also said they felt staff treated them with respect and dignity and involved them in decisions about their care.

We observed staff speaking respectfully with people and offering them choices about what to do and also choices at meal times.

The reason for our inspection of Carrington House Limited on 26 March 2012 was because we had received some information of concern, from two separate, anonymous, sources. One caller was concerned that there were insufficient staff on duty at night. The second caller alleged that people were being woken up and got up at 5 am, which was not what they wanted to do. We also checked whether the provider had made the improvements we had asked them to make, following our inspection on 01 November 2011.

During our visit to on 26 March 2012 we spoke at some length with three of the people who were living there. One person told us that “at times it’s very very good”. However, they said that when there was a shortage of staff, it could be “rough”. We asked a few people who were up early whether that was their choice and they told us it was. A number of people were not able, due to health reasons, to tell us whether this was their choice.

We observed some of the care that was being provided. Staff were patient, caring and professional and dealt with personal care issues discreetly.

Following the inspection on 26 March 2012, we received further information, from a third anonymous source, which gave us some concerns about the way the service was managing medicines. We carried out a further inspection, to look at medicine management, on 13 April 2012. During this visit we did not speak with people living at the home about the service being provided.

People we spoke with told us they enjoyed living at Carrington House, the staff are kind and caring. One person told us they go out to the local shops and very much enjoy this. People told us they were given choices about their meals, but could also change their minds if they wanted to.

This inspection took place on 20 and 21 October 2015 and it was unannounced. When we inspected the service in May 2013 we found that the provider was meeting all their legal requirements in the areas that we looked at.

The service provides accommodation and care for up to 60 people with a variety of social and physical needs. Some people may be living with dementia. At the time of our inspection there were 56 people living at the home.

The home has a registered manager. 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 felt safe in the home, although not always secure. Risks to people had been assessed, reviewed and managed appropriately. Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

Robust recruitment procedures were in place. Sufficient staff were on duty but were not always deployed effectively in all areas of the home. Staff were competent in their roles and received support and supervision from management, although appraisals had not been completed.

People had been involved in planning their care and deciding in which way their care was provided. Each person had a detailed care plan which reflected their preferences and included personalised risk assessments. People's health care needs were being met and they were supported to receive support from healthcare professionals when required. Medicines were managed safely and audits completed.

Some areas of the home were not cleaned to an appropriate standard and maintenance tasks had not been completed. There were items inappropriately stored in communal bathrooms and cleaning materials had been left unattended by domestic staff.

There were a number of communal areas for people to spend time and enjoy the company of others should they wish. A wide range of activities were on offer in the home and people were encouraged to participate. The activities did not always meet the needs of everyone living in the home.

People were supported to make choices in relation to their food and drink and a balanced, nutritious menu was offered. Additional assistance was provided to people at meal times in an unhurried, relaxed way.

Staff were kind and caring. They provided care in a relaxed and pleasant manner, treating people with respect. Staff promoted and maintained people’s dignity and provided encouragement to people throughout their support.

There was a clear management structure within the home and people, their relatives and staff knew who to raise concerns with. There was an open culture and senior members of staff were approachable. Quality assurance processes were not always effectively used to improve the service being provided.

During this inspection we found that there were two breaches of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was concerning the deployment of staff within the home and the appraisals of staff.

We also found there was a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. This was concerning notifying the Commission of incidents that occur within a service and the authorisation of applications to deprive people of their liberty being granted.

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