Crest House Care Home

Crest House Care Home is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to older people. At the time of our inspection there were 14 people using the service.

People’s experience of using this service and what we found

Quality assurance systems were not always effective in identifying issues at the service. Improvements were needed to audits relating to the environment and medicines. The provider needed to improve oversight of quality assurance processes to ensure that risks to people could be identified and managed.

The provider and registered manager instilled a caring, person centred culture which the staff team reflected. People’s care plans were person-centred and written in partnership with people. People were supported by staff that were safely recruited and trained to meet people’s assessed needs.

People, relatives and staff told us they were given regular opportunities to give feedback on the service and felt listened to by the management team. Health professionals were positive about partnership working with staff at the home.

People and their relatives were positive about their experience of the service and the support provided by staff. One relative told us, “It’s smashing there, like a home from home. They are like extended family and [person] is well cared for. The carers are amazing people. Because it’s a small home, you get to know everyone, and they make me feel welcome too. You couldn’t ask for more.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were offered choices by staff and were empowered to make their own decisions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 December 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of the environment. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crest House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff supported people to socially distance from each other. There was a communal area risk assessment which detailed how staff should support people in communal areas. This included encouraging people to sit in the same seats each day where possible and cleaning of communal areas. Most people preferred to sit in the same place each day in both the lounge and the dining room. Some chairs had been removed in communal areas to allow for more space.

People who chose to go for walks outside the home were supported to do so safely. There was a risk assessment for people to take local walks. Measures included encouraging people not to walk past areas which were likely to have a high number of people. People usually enjoyed external entertainers as their main activities but due to the pandemic, staff had taken over the role of providing activities. This included leading sing-a-longs, quizzes and reminiscence activities.

Staff had received training in the safe use of personal protective equipment (PPE) and the registered manager completed monthly competency checks to ensure staff were using PPE appropriately. PPE was available throughout the home.

The home was clean and hygienic. There were enhanced cleaning schedules for day and night staff. Frequently touched surfaces such as door handles were cleaned four times a day. The provider had changed some of the flooring during the pandemic and had changed some carpeted areas to lino flooring to improve infection control. The provider had also ordered some vinyl chairs which could be easily cleaned.

Crest House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide personal care and accommodation for up to 25 older people. At the time of the inspection there were 14 people living there. Most people were independent, while others needed some assistance to move around the home safely and support with personal care.

At the last inspection in August 2017 the overall rating for Crest House was Requires Improvement as more work was needed to ensure the quality assurance system identified areas for improvement. For example, accident and incidents were not consistently reported to the local authority. Recruitment procedures were also not robust and records did not consistently demonstrate that suitable people were employed. At this inspection we found these areas had been addressed and the overall rating had improved to Good.

The registered manager was present during the inspection. 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 quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. The recruitment process was robust and staff had completed relevant training, including medication, infection control, equality and diversity and safeguarding people. Staff understood people’s needs and how to protect people from abuse. They explained what action they would take if they had any concerns and followed current guidelines.

People were involved in writing and reviewing their care plans and staff offered support based on each person’s individual preferences. Risk had been assessed and people were supported to be independent in a safe way, using walking aids or with staff assistance. There was a varied programme of group and one to one activities, that were discussed and agreed with people living in Crest House. The provider and staff asked for feedback from people and visitors about all aspects of the services provided, through day to day discussions and regular residents meetings. People said they were comfortable talking to staff about the support and care they received and the activities they chose to do.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff said people could communicate their needs and the registered manager had arranged AIS training.

People said the food was very good. They were offered choices for each meal and drink and snacks were available at any time. Visitors to the home were made to feel very welcome and people were supported to keep in touch with relatives and friends.

People, their relatives, staff and professionals spoke highly about the registered manager and felt the service was well-led. The provider sought feedback to improve the quality of the service and involved people and relatives in planning any changes.

Further information is in the detailed findings below.

People required a range of help and support in relation to living with memory loss, dementia and personal care needs. The home provides individual rooms for people with communal areas including a lounge and dining room. The home has a passenger lift and wide staircases with handrails to assist people to access all areas of the building. This was an unannounced inspection which took place on 12 October 2017.

Crest House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Systems were in place to assess and monitor the service, however, these had not identified all shortfalls found during the inspection. Accident and incident reporting needed to improve. Although staff understood how to recognise safeguarding concerns and risks were identified to help ensure people remained safe, notifications had not always been completed to the local authority as required. However, the impact of this was minimised as systems were in place to ensure that health care was sought and regular checks completed to assess and monitor people’s condition after an accident or incident occurred.

Recruitment processes needed to be reviewed, not all information had been documented to give a clear audit trail and to ensure that recruitment systems were robust.

The training programme needed to be improved to ensure staff training was completed and recorded in a timely manner. We were informed immediately after the inspection that adequate steps had been taken to address this. The impact of some training being out of date was reduced as the majority of staff had worked at Crest House for many years and knew people and well and had received training in the past. However, for new staff and to ensure skills and knowledge were maintained and current a robust training schedule was needed.

People were actively involved in day to day choices and decisions. The registered manager had an understanding of Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) although documentation around how decisions were made and who was involved needed to be improved.

A complaints procedure was available for people to access if needed. And people told us they would be happy to raise and discuss any issues with staff or management if they arose.

People had detailed care documentation which was person centred and based on their individual preferences and support needs. The registered manager had ensured that care documentation was detailed to inform staff and reviewed regularly.

Medicines policies and procedures were in place to ensure people received their medicines safely.

People had access to healthcare services to maintain good health.

Staffing levels were appropriate to meet people’s needs. Staff felt supported and had meetings and supervision. Staff felt the registered manager was open and supportive.

People gave positive feedback regarding the food and meals at Crest House. People were supported to eat and drink well, with choices provided. Staff provided support for people who needed it and ensured that mealtimes were relaxed and sociable.

Staff knew people well and spoke kindly to people, taking the time to stop to chat and support people. People’s privacy and dignity was supported and respected. Staff spoke positively about people, and showed concern for people’s wellbeing. People were actively encouraged to maintain relationships with family and friends and relatives or next of kin were involved in decisions when appropriate.

People had opportunity to give feedback and suggestions were listened to and actioned. Staff felt supported by the registered manager and regular staff meetings took place. The registered manager was keen to ensure that Crest House was homely and friendly, providing person centred care for people based on their needs and preferences. They demonstrated an open approach and were keen to engage with other professionals and organisations to ensure people received safe and appropriate care.