Description of the service
Carr Holm is located in Prestatyn and has easy access to local amenities and transport
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
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.
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.
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.
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
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
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
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
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.
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.
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
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.
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
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. Improvements required and recommended following this inspection
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
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
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: www.careinspectorate.wales
About the service
|Type of care provided
||Care Home Service
|Registered maximum number of places
|Date of previous CIW inspection
||5 July 2017
|Date of this inspection visit
||3 January 2019
|Operating Language of the service
|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.