We carried out a review of the data available to us about Cromarty House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cromarty House, you can give feedback on this service.
About the service
Cromarty House is a residential care home providing personal care to 8 people at the time of the inspection. The service can support up to 8 people.
People’s experience of using this service and what we found
Right Support:
The care model focused on people’s strengths and promoted what they could do. People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported them to achieve their aspirations and goals.
People had proactive plans in place in case they experienced periods of distress. This helped ensure staff kept them safe and supported them in a person-centred way at these times.
People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met their sensory and physical needs.
Reasonable adjustments were made for people so they could participate fully in discussions about the service.
The registered manger and staff worked well with other organisations, so people had good access to specialist health and social care support in the community.
People were supported to make decisions by staff who used best practice in decision-making and communicated with people in ways that met their needs.
Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome
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. We made a recommendation about recording assessments of people’s capacity.
Right Care:
Staff actively promoted equality and diversity in their support to people. Care plans detailed people’s needs and preferences related to any protected characteristics.
Staff protected people from abuse and poor care. The service had enough appropriately skilled staff to meet their needs and keep them safe.
People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and helped them achieve good outcomes
Staff ensured individualised risk assessments were undertaken and that people were involved in these where possible. Where appropriate positive risk taking was encouraged and enabled. Staff supported changes that individuals might want to make and assessed risks continuously
Right Culture:
People lead confident, inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The registered manager modelled good practice and led by example
Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.
People and those important to them, were actively involved in planning their care.
People’s quality of life was enhanced by the culture of improvement and inclusivity within the service.
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 30 December 2017).
Why we inspected This inspection was prompted by a review of the information we held about this service. 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. The overall rating for the service has remained good based on the findings of this inspection.
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.
Follow up
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.
The service had sufficient supplies of Personal Protection Equipment (PPE) available. Signage was in place throughout the service regarding the requirements for wearing PPE and included doffing and donning of PPE safely. Additional information was provided on what PPE needed to be worn when a person was assessed as being at higher risk of infection.
Staff came to work wearing their own clothes then changed into their uniforms in a designated doffing and donning room. This was a separate building therefore this helped to reduce the risk of infection because staff did not enter areas of the home, where people lived, until wearing appropriate PPE.
The registered manager and staff had worked closely with external healthcare professionals to enable people to have access to the appropriate health care and equipment.
The service was clean and hygienic. Cleaning schedules had been updated to provide additional protection and additional schedules where in place in case of any outbreaks of Covid-19. Audits had been completed to ensure all infection control risks were minimised and people were kept safe. There were supplies of anti-bacterial wipes around the service to enable staff to clean surfaces and any areas, including bathrooms, they had used. There were posters around the service to prompt and remind staff about the infection control procedures in place. All high contact areas were cleaned regularly throughout the day and night staff also had a cleaning routine.
Procedures were in place regarding self-isolation for people and staff, if they showed symptoms of Covid-19. There had been no new admissions since the start of Covid-19. Specific Covid-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak. A practice run had been carried out to ensure the service was prepared for an outbreak. Policies were kept under continuous review as changes to government guidance was published.
Since the new Covid-19 restriction for visitors had been changed the service had developed new guidance. This included two designated visitors for each person living in the service. All visitors were required to make appointments and a designated room in the garden was made available for visitors and people living in the service. Friends and families were provided with the updated policy detailing the new restrictions. Where visiting was required for compassionate reasons, suitable infection control procedures were in place. Visitors were screened for Covid-19 prior to entering the service. Visitors were required to wear PPE at all times.
People were supported to speak with their friends and family using IT and the telephone as necessary.
Appropriate testing procedures for Covid-19 had been implemented for all staff and people who used the service and followed national guidance regarding the frequency and type of testing. Arrangements had been made to enable people and staff to access the vaccine. The service had provided extra support for one person who had been reluctant to have the vaccine.
Infection control policies and procedures had been updated in line with the national guidance relating to Covid-19. Staff had completed online infection prevention and control and Covid-19 training. The registered manager had completed additional Covid-19 training and passed this training onto staff. Infection control competency checks were carried out. The registered manager worked with all staff to ensure infection prevention and control measures were followed.
The service was a small family run home and the registered manager had been well supported by all staff within the home. Agency staff were not used, and staff covered and supported each other when shifts required filling to cover leave or other absences.
The registered manager had completed risk assessments regarding the environment and risks to staff and people who used the service. The registered manager was aware of people who used the service and staff members who were at increased risk from Covid-19. Risk assessments had been completed to support higher risk people and staff.
The provider had a detailed contingency plan to manage any outbreak of Covid-19.
We carried out this inspection on 25 October 2017. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.
People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, “I am safe here”, “[Person] is very happy at Cromarty”, “Really pleased with the home. Staff treat [Person] well” and “The home is exactly what I always wanted for [Person].”
There was a calm and homely atmosphere at the service. People, who were able to verbally communicate, happily chatted to us as they went about their day. Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People's independence and wellbeing was promoted because staff had developed positive and meaningful relationships with them. Staff interacted with people in an unhurried way and supported people at a time and pace convenient for them.
People were encouraged and felt confident to make decisions about their daily lives. People were able to take part in activities of their choice and staff supported people to develop interests. People were at the centre of every aspect of the service and routines were led by the people living at the service. It was clear the service was run for and by the people who lived there. The culture in the service was one where there were no unnecessary rules or routines, put in place to suit staff, rather than the people that used the service.
Risks in relation to people’s care and support were identified and when systems were put in place to manage any risks these were agreed with people. People were encouraged to be as independent as possible and where possible people managed their own risks with minimal intervention from staff.
Care plans were well organised and contained personalised information about the individual person’s needs and wishes. These had been developed with people and were reviewed regularly with the individual person’s involvement. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. External professionals visiting the service fed-back that the service was consistently focused on providing a person centred service. A professional commented, “Staff support people with profound and multiple learning disabilities and their care for people is very good. They have a good understanding of people’s needs and how best to support them, ensuring that the care is person centred and not too medicalised.”
People had access to healthcare services to help them maintain good health. They saw their GP and attended other necessary appointments such as the hospital visits, dentists and opticians when they needed to. Staff supported people to access annual health screening checks to maintain their health. Specialist services such as speech and language therapists, physiotherapists and dieticians were used when required.
Safe arrangements were in place for the storage and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.
Staff supported people with their food choices to help them maintain a balanced diet. People were involved in meal planning and preparation. Menus were planned in a way which combined healthy eating with the choices people made about their food. Where people had specific dietary needs staff supported them to plan meals that met those needs.
There were sufficient numbers of suitably qualified staff on duty. Staffing numbers were adjusted if people were unwell or to facilitate the activities people wanted to take part in. Staff completed a thorough recruitment process to help ensure they had the appropriate skills and knowledge to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to apply the principles of the MCA in the way they cared for people. Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.
People and staff worked together as one team, equally contributing to the culture of the service. Staff had a positive attitude and told us the registered manager provided strong leadership. Comments from staff included, “Absolutely amazing, best place I have ever worked”, “The manager always listens to what we have to say”, “Good staff team” and “It’s like a family environment.”
People and their families were given information about how to complain. Healthcare professionals and relatives all described the management of the home as open and approachable. Comments included, “It’s excellent. I would recommend the home to anyone”, “The management is excellent. They are always open to new ideas and listen to what we have to say” and “The service is open to working collaboratively and sharing ideas to make the best care and support decisions with their residents.”
There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered manager worked as part of the staff team and this enabled them to observe staff practice and check if people were happy and safe living at Cromarty House. People were involved in all aspects of the running of the service and were clearly comfortable in sharing their views with staff.
The inspection took place on 6 and 8 October 2015 and was unannounced. This service was also inspected on 18 November 2014 but, due to unforeseen circumstances, we were unable to complete a report for that inspection.
Cromarty House provides care and accommodation for up to eight people who have a learning disability. The service had a registered manager in post. 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.
People and staff were relaxed throughout our inspection. There was a lively, friendly and homely atmosphere. People, where able, told us they enjoyed living in the home and relatives confirmed they were happy with the care and support people received, saying "We think the place is wonderful."
Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People, as far as able, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.
Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.
People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful, reflected people’s interests and individual hobbies and helped to develop new skills.
People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.
People told us they felt safe. Comments included, “I feel safe”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be taken seriously and acted upon.
People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Relatives and friends were always made to feel welcome and people were supported to maintain relationships with those who mattered to them.
People, where able, and those who mattered to them knew how to raise concerns and make complaints. Nobody told us of any concerns or complaints they had made, and no written complaints had been received by the service.
Staff described the management as supportive and approachable. Staff talked positively about their jobs. Comments included: "I really enjoy it!" Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were trained and had the correct skills to carry out their roles effectively.
Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.
There were effective quality assurance systems in place. Incidents were recorded and analysed. Learning from incidents was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.
We examined people's care plans and found the records were up to date and reviewed as the person's needs and wishes changed.
We saw there was a choice of suitable and nutritious food and drinks, in sufficient quantities to meet people's needs.
People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises
Staff said they had received enough training and support to enable them to carry out their roles competently.
People experienced care, treatment and support that met their needs and protected their rights.
We saw people actively contributing to the running of the home. We saw one person prepare a cake mixture and another was pleased to have completed the cleaning of a bedroom.
People we spoke with said that they enjoyed the food they received. We were told the food was of a good standard, and usually cooked to order. This meant that people could choose, individually, what they wanted each day.
People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.