Inspection Report on Carr Holm

11 February 2019

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Description of the service

Carr Holm is located in Prestatyn and has easy access to local amenities and transport links.

The service is registered with Care Inspectorate Wales (CIW), to provide personal care for up to twenty adults. The home was full on the day of inspection. The service is now registered under the Regulation and Inspection of Social Care Act (Wales), 2016, (RISCA).

The registered providers of the service are Mr and Mrs Mallows, Mr Mallows is the responsible individual, (RI). The home has a manager who is registered with Social Care Wales (SCW).

Summary of our findings

1. Overall assessment

Carr Holm offers a warm and caring environment, care is given by a stable staff group who are familiar with people’s needs. People’s independence is maintained and encouraged where ever possible. The environment is comfortable and clean and is well maintained.

People benefit from a service that provides good support to their staff and is committed to continual improvement.

2. Improvements

A new lift has been installed in the home, people gave favourable views regarding its use. People have been involved in choosing new décor and carpet for the dining room. A projector and screen have been purchased for people to have “movie nights”. New signage has been placed on toilet doors following recommendations from the previous inspection in July, 2017. A new disabled toilet has been installed for people’s convenience.

3. Requirements and recommendations

Section five of this report sets out our recommendations to improve the service. The care home is meeting legal requirements. Recommendations include:

  • Protection of personal data.
  • Check for correct window restrictors.
  • Wardrobes to be fixed to walls.
  • Responsible Individual to provide reports as per RISCA requirements.

1. Well-being


People living in the home are treated with warmth and respect by staff who are familiar to them. There are varied activities on offer to stimulate, and keep people as active as they wish to be. People praised the food offered in the home and were supported to maintain adequate nutrition and hydration. The service is compliant to legislation as regards well- being.

Our findings

People are treated with dignity and respect. We noted a family atmosphere in the home. Staff and people living in the home had a warm, familiar, yet respectful rapport. We observed staff conversing and laughing with people, staff knew people well and talked to them about interests and their families. People praised the home and staff. One person told us, “I can have a laugh with staff, the manager is nice and gives you hugs.” Another person told us, “Staff are good to me.” We spoke with people’s relatives, they were happy with the care given and said that communication with families was good. A person’s relative told us, “Amazing place. Very good care. I’m happy with the staff, room, and food. If I needed care myself I’d come here!” People can be assured of empathetic care and support.

People are offered varied activities. The Responsible Individual told us they had a mini bus and were able to take people on outings. They had recently taken people to a local pub where they enjoyed karaoke and bingo, people had been out Christmas shopping and had been to the cinema. A projector and screen had recently been purchased for movie nights in the home. A pianist was entertaining people on the day of inspection, we were told that a singer and a comedian also perform on a regular basis. A person told us that they valued their privacy, and we saw they watched films in their own room on a laptop, they told us they were supported in choices on how to spend the day. Christmas decorations were up and people told us they had enjoyed the festive period. A person told us they enjoyed gardening and had prepared pots ready to plant parsnips. The service provider’s dogs visited, people were happy to see them and took turns to pet them. The Responsible Individual assured us that the dogs had received their anti-flea and worming treatments and no one residing in the home had a dog allergy. We saw that people had their own TV, radio and phones in their room if they wanted. People are supported to maintain their interests and hobbies.

People receive good nutrition and hydration. We saw people were offered a four week rolling menu of home cooked foods, a full hot meal at lunch time, and lighter fare in the evening. People told us they could have an alternative if they did not like the meal, two choices were offered at meal times. We saw that drinks and snacks were offered throughout the day. We were shown staff have access to snacks and drinks for people at night if they require. People and their families praised the food with comments such as, “lovely chef, never had anything I didn’t like!”, “the food is good, I get what I ask for”, and “lovely food here.” Families told us that they were able to have Christmas dinner with their relative which they appreciated. The chef told us they were supported by the local health board and had training from the speech and language therapist regarding special texture diets for people with swallowing difficulties, other special diets such as for diabetes, were also catered for. People are happy with the food provided.

2. Care and Development


People benefit from person centred care and have daily choices. Care is appropriate and timely. The service is mindful of people’s health and safety needs through regular risk assessments. People’s liberty and rights are protected. The service is compliant to legislation as regards care and development.

Our findings

Care is person centred. We saw that care plans were personalised to each person living in the home. People’s history, likes, dislikes and preferred day and night time routines were detailed in care files. Care plans were updated as people’s needs changed and were reviewed monthly. Care plans demonstrated staff knowledge of the person cared for, further detail as to the process of care to instruct colleagues would be of benefit in some care plans. Where able, we saw that people with capacity signed their plans of care to demonstrate partnership in care and good communication. People told us they had daily choices and could influence their care. People benefit from care which is central to their individual needs.

Care is appropriate and delivered in a timely manner. People and their families told us the staff were quick to pick up on adverse signs and symptoms and call the doctor. We saw evidence in care files regarding health care professionals visiting people as required, advice given was carefully documented. We spoke with a district nurse in the home, they told us, “no problems here, good care, quick to call us if there are any problems.” People’s health needs are closely monitored.

People are risk assessed to enable their safety. We saw care files contained risk assessments for moving and handling and people who were at risk of falls. Assessments were reviewed regularly and updated if the person’s needs changed. The service is mindful of people’s safety needs.

People’s liberty is protected. We saw that people who were unable to leave the premises unaided due to a lack of capacity were assessed. We saw referrals were made to the Deprivation of Liberty panel to review the person and notes were kept regarding outcomes and effects on care plans. We saw that families were informed regarding the process. People deprived of liberty were treated sensitively, reassurance methods were contained in people’s care files. People can be assured the service will endeavour to protect their rights.

3. Environment


People can be assured of a homely environment which is fit for purpose. The home is clean and well maintained. People are able to personalise their rooms and influence the décor of the home. We made some recommendations regarding health and safety and data protection. The home is compliant to legislation as regards environment.

Our findings

The home is well maintained. We were shown the new disabled toilet which was compliant to infection control guidelines with washable floors and walls. A new lift had been installed as the old one had broken. People told us they liked the new lift and showed us how well it worked. New décor was in place in the dining room and a new carpet, providers told us that people living in the home chose the carpet and wall paper. New double glazing windows had been invested in for people’s comfort and warmth. We recommended the Responsible Individual look at Health and Safety Executive (HSE) guidance regarding safe window restrictors to care home windows (first floor and above) as they did not appear to be the ones recommended. We recommended that all wardrobes should be attached to the walls to prevent injury to people should they pull them down; we noted some had been attached, but others had not.

People were able to personalise their rooms with furniture and personal possessions of importance to them. Providers told us the laundry provision had improved and people’s clothes were labelled and placed in baskets with their names on. We saw the laundry was compliant to the regulations, we recommended that a dedicated sink should be used for hand-washing to enable good infection control practices. People and families told us that they were happy with the level of cleanliness in the home. The RI told us of further maintenance and re-decoration plans. We recommended that a written maintenance plan be devised and progress noted in the quarterly reports as this would further demonstrate compliance to the regulations. The home is homely and compliant to legislation.

The service is mindful of security issues. The front door was locked, visitors had to sign in and out of the home in a dedicated book. We were asked to show our identification badge on admission to the home. We saw that people and staff files were kept in a locked office to maintain confidentiality. Files containing personal details were easily accessible in people’s rooms and we recommended they be kept in a more secure location to ensure privacy and comply with data protection laws. Providers are committed to continually improving safety processes.

4. Leadership and Management


Staff receive sufficient support, training and supervision. The home is now registered under the Regulation and Inspection of Social Care Act (Wales) 2016, (RISCA). Providers wish to continually improve the service and ensure its quality. The service is compliant to leadership and management regulations.

Our findings

Staff are enabled to perform their role. Staff training and supervision records are up to date. We read the minutes of staff meetings and saw that managers communicated any changes with staff and shared/discussed ideas and changes. Staff told us their voice was heard and they were able to contribute to future plans for the service. Staff told us they were well supported by approachable managers and considered they were well supervised and trained. A staff member told us, “I love it here, good support, approachable managers and plenty of training and support to do further education.” Other staff members said, “We have high standards here. Staff have good supervision, senior carers work with carers and give formal and informal supervision. We have a good level of support and training from the owners. “People can be confident of being cared for by staff who feel well supported in the home.

Staff checks are in place. We selected a sample of staff files and saw that sufficient checks were in place to ensure staff were appropriate to work with vulnerable adults. Disclosure and Barring Service (DBS), checks seen were up to date. Staff had two references including one from a previous employer as per the regulation requirements. People can be assured that staff have sufficient employment checks in place.

The service is now registered under the RISCA Act. We reminded the RI that six monthly reports (as a minimum requirement), will be expected to demonstrate the quality of the service. We advised that staff and people using and connected with the service’s views should be included and any improvements made in light of this. We saw that some aspects of the service were audited, such as a pharmacy review of medication practices, findings were discussed in the staff meeting and acted upon. The Statement of Purpose document had been sufficiently updated to pass the RISCA registration process, we advised that it should be frequently reviewed to reflect any changes in service provision. The compliments and complaints process should be clear and the CIW address prominently displayed. The providers are committed to continually improving the service for people.

5.1 Areas of non-compliance from previous inspections


5.2 Recommendations for improvement

The following recommendations were made to encourage good outcomes for people:

  • Protection of personal data. We saw that files containing personal details were kept in people’s rooms where visitors could have access to them. We recommended that files be kept in a confidential manner to conform to data protection laws.

  • Check for correct window restrictors. New double glazing windows have been fitted in the home including rooms on the first floor and above. We recommended the RI check the health and safety legislation regarding window restrictors as they did not appear to be the specified ones.

  • Wardrobes to be fixed to walls. Some but not all wardrobes had been affixed to the walls to prevent them falling forwards and causing people injury. We advised they ensure all wardrobes are tethered to prevent injuries.

  • RI to provide reports as per the requirements of the RISCA act.

6. How we undertook this inspection

We inspected the home on 3 January 2019. The inspection was unannounced and conducted as part of CIW annual inspections. The following methodology was used:

  • We spoke with the RI, providers, administrative staff, manager, deputy manager, carers, and four people living in the home, two relatives and a district nurse.

  • We toured the premises and facilities including a selection of people’s rooms.

  • We looked at a wide range of records as kept by the registered service and concentrated on, three people’s care plans, three staff files, maintenance and fire records, staff meeting minutes, training and supervision records, Statement of Purpose.

Further information about what we do can be found on our website:

About the service

Type of care provided Care Home Service
Service Provider Carr Holm
Manager Fay Crotty
Registered maximum number of places 20
Date of previous CIW inspection 5 July 2017
Date of this inspection visit 3 January 2019
Operating Language of the service English
Does this service provide the Welsh Language active offer? The service has not been offering the active offer of Welsh, however, they now have a Welsh speaking member of staff and are considering bi-lingual signage for the home.