Background to this inspection
Updated
30 September 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Crowley Care Homes Limited- St Annes Care Home 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 service had a manager who had applied to register with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
We spoke with five people who used the service and six relatives about their experience of the care provided. We spoke with ten members of staff including the provider, manager, deputy managers, care workers, maintenance worker and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
30 September 2021
About the service
Crowley Care Homes Limited- St Annes Care Home is a residential care home providing personal care to 21 older adults who may be living with dementia, a sensory impairment or a physical disability at the time of the inspection. The service can support up to 22 people. The service is split across two floors and people have their own bedrooms and share facilities such as a lounge, garden and bathrooms.
People’s experience of using this service and what we found
People were not always supported in a person-centred way and the provider had not identified shortfalls at the service and how these could be improved. One relative told us, ‘‘I am disappointed in the care that [family member] receives. It does not need to be luxury, but the basics should be right.’’
Audits completed by the provider and management team were not effective in identifying where improvements needed to be made. This included areas such as supporting people to communicate or have a clean and comfortable home. The provider had failed to learn and improve from previous inspections and the service continued to be rated requires improvement for the sixth time. We could not be assured that the provider would be able to implement and sustain improvements.
The culture of the service was negative as people were not being empowered to achieve positive outcomes and continued to receive a service where improvements needed to be made. People and relatives were not being supported to feed back about the service or be involved in decisions about their care and support. We have made a recommendation that the service improves the way they collect feedback from people and relatives.
The service was not kept clean and this placed people at the risk of infection. The furniture provided for people was old and worn which could also pose an infection control risk. Not all safety measures were taken regarding protecting people from the risk of infection of COVID-19.
People were not supported in line with the Accessible Information Standard (AIS) meaning that they were unable to communicate effectively and feed back about their care. The service had not been adapted to support people living with dementia to orientate to the best of their ability. People’s living environment was not maintained to a good standard. It was not clear how people who chose to spend time away from communal areas were having their personal preferences met.
People were kept safe by a staff team who were trained to understand safeguarding and how to report concerns. Risks to people with regards to their daily living were assessed and updated regularly. There were enough suitably trained and skilled staff to support people safely. People were supported safely with their medicines. Incidents and accidents were reviewed for lessons learned and shared with the staff team.
Staff treated people with kindness and respect and knew them well. The manager had adapted people’s care plans to focus on their likes, dislikes and preferences. Feedback about activities which had been provided by the previous activities’ coordinator was mostly positive, and the manager was recruiting into this role. Complaints were responded to appropriately. People received kind and compassionate care at the end of their life.
The new manager was working hard to put improvements in place and feedback about them was positive. They and the provider responded during and after the inspection to show us that action was being taken to put improvements in place.
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 requires improvement (published 11 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.
Why we inspected
We carried out an announced comprehensive inspection of this service (published 11 March 2020). Whilst no breaches of legal requirements were found, we made two recommendations to guide improvements at the service and rated the service as requires improvement.
We undertook this focused inspection to check they had made these improvements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those recommendations.
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.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement- Please see the safe, responsive and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crowley Care Homes Limited- St Annes 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.
We have identified breaches in relation to safe care and treatment (infection control), person centred care and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 also meet with the provider to discuss how they plan to make and sustain improvements. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.