CQC report explained · a nursing home
What the CQC found at Carter House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found medicines were safely administered, records were complete, staffing levels were sufficient, and risks and infection control were managed.
- Effective?
- Good
- This area was not covered by this focused inspection. Its rating was carried over from the previous inspection.
- Caring?
- Good
- This area was not covered by this focused inspection. Its rating was carried over from the previous inspection.
- Responsive?
- Good
- This area was not covered by this focused inspection. Its rating was carried over from the previous inspection.
- Well-led?
- Good
- Inspectors found better quality checks, clearer management responsibilities, an open culture and evidence that lessons from previous problems had been acted on.
What inspectors found, October 2022
Rated Good; inspectors found the home had improved its medicines, staffing and management systems since the previous inspection.
This was an unannounced, focused inspection on 10 October 2022. The inspector spoke with four people living in the home and several staff. They checked care plans, medicines records and management records, and requested further evidence after the visit.
The home was rated Good for Safe and Well-led. Inspectors found medicines were organised and safely given, staffing levels were sufficient, risks were assessed, and infection control arrangements were in place. They also found stronger checks on quality and safety, with managers learning from previous mistakes.
The previous overall rating was Requires Improvement, published in November 2021. The home had breached rules then about safe medicines management and good governance. Inspectors found enough improvement had been made and said the home was no longer in breach.
This inspection did not assess Caring, Effective or Responsive. Those ratings were carried over from the previous inspection when calculating the overall Good rating.
Safer medicines
Medicines were organised, securely stored and safely administered. Inspectors found no recording errors or omissions in the records they checked.
“The service's medicines systems were now well-organised, and people received their prescribed medicines safely.” from the report
Enough staff
Inspectors found enough staff to meet people's needs. The home had introduced regular reviews of people's needs and call-bell response times to help plan staffing.
“There were enough staff to meet people's needs and wishes.” from the report
Improved oversight
Managers had increased checks on medicines, staffing and call-bell response times. They also carried out daily walkabouts and used audits and feedback to identify improvements.
“How the provider monitored and analysed the quality and safety of the service had improved in the last 12 months.” from the report
Open management
People and staff spoke positively about the new management team. Inspectors found the managers promoted an open and inclusive culture and worked with health and social care professionals.
“The managers promoted an open and inclusive culture which sought the views of people receiving a service, their relatives, and staff.” from the report
Manager registration pending
minorThere was no registered manager in post at the time of the inspection. A new permanent manager had applied to register with the CQC, and the application was still being reviewed.
“At the time of our inspection there was not a registered manager in post.” from the report
- 01Has the new permanent manager's application to register with the CQC now been completed?
- 02How are daily, weekly and monthly medicines checks carried out, and what happens if a problem is found?
- 03How often is staffing reviewed when people's needs change, and what were the results of recent call-bell response checks?
- 04What changes were made after the medicines problems and governance shortfalls found at the previous inspection?
- 05What were the previous ratings for Effective, Caring and Responsive, and when will these areas next be reviewed?
This was an unannounced focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous inspection. This explanation was written from the published report of 28 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2021
Carter House is rated Requires Improvement; inspectors found risks in medicines management, staffing response times and quality checks.
This was an unannounced, focused inspection on 2 November 2021. Inspectors looked only at Safe and Well-led because concerns had been raised about medicines and staffing. They spoke with people, relatives and staff, and checked care plans, medicines records, staff rotas and management audits.
The home had improved its records for medicines given when needed. However, medicines were still not always stored, given or recorded safely. Inspectors found medicines errors, an unlocked medicines fridge and gaps in records. Staff also did not always respond quickly to call bells, although staffing levels were due to be restored.
People were protected from abuse, risks were assessed, and the home was clean. Staff followed infection control guidance, including measures relating to COVID-19. The home also gathered views from people, relatives and staff and worked with health and social care professionals.
The overall rating fell from Good to Requires Improvement. The Safe and Well-led ratings were Requires Improvement. The other three areas were not inspected during this visit, so their previous ratings were used.
Risk management
Care plans contained current, personalised risk assessments. Staff could explain how they helped reduce risks such as falls.
“People's electronic care plans contained up to date person-centred risk assessments and management plans.” from the report
Infection control
The home followed infection control guidance, used protective equipment correctly and kept the premises clean.
“Staff used personal protective equipment (PPE) correctly and in accordance with current IPC guidance.” from the report
Protection from abuse
People were protected from avoidable harm and abuse. Staff had current safeguarding training and knew how to report concerns.
“Staff had received up to date safeguarding adults training and knew how to recognise and report abuse or neglect.” from the report
Listening to people
The provider used meetings and surveys to gather views from people, relatives and staff, and had acted on staffing concerns.
“The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives and staff.” from the report
Medicines safety
seriousStaff did not always follow safe procedures. Inspectors saw a tablet picked up from the floor and found medicines records with gaps and unclear instructions.
“Medicines were not always handled safely.” from the report
Medicines storage
seriousAn unlocked fridge containing medicines was left in an office with the door open and no staff visibly nearby. This created a risk of unauthorised access.
“Medicines were not always stored safely.” from the report
Staff response times
needs fixingStaff did not always answer requests quickly. Inspectors saw two call bells take more than five minutes to receive a response, against the home's three-minute expectation.
“Staff were not always available to respond quickly to people's requests for assistance.” from the report
Quality monitoring
seriousManagement checks did not identify or correct the medicines problems found during the inspection. This meant people remained at risk of unsafe care.
“The provider did not always operate their governance systems effectively.” from the report
Late notifications
needs fixingThe former registered manager did not always tell CQC promptly about safeguarding incidents that affected people's health, safety or wellbeing.
“The provider was not always clear about their regulatory responsibilities to notify the CQC without delay” from the report
- 01What changes have been made to make sure medicines are stored securely and given and recorded correctly every time?
- 02How are you checking that medicines administration records have no gaps and that covert medicines are properly documented?
- 03Have the previously agreed minimum staffing levels of two care workers on each unit during the day been restored?
- 04How quickly are call bells now answered, and how do you monitor this?
- 05What action has been taken to make sure safeguarding incidents are reported to CQC without delay?
This was a focused inspection of Safe and Well-led only; the other three key question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 16 November 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Carter House
5 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- October 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- July 2021Goodstayed GoodSafe: GoodWell-led: Good
- February 2017Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2015Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- April 2019
Registered with the Care Quality Commission on 4 April 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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