Culrose Residential Home

Culrose Residential Home is a care home providing personal and nursing care to 26 older people at the time of inspection. The service can support up to 32 people.

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

The service had failed to ensure that all moving and handling equipment was serviced in line with Lifting Operations and Lifting Equipment regulations 1998 (LOLER) regulations in order to ensure its safety and suitability.

Risks to people were not adequately planned for, managed or mitigated. Some care plans contained conflicting information, making it difficult to ascertain what care people required to keep them safe. The majority of the care plans we reviewed did not contain sufficient detail about the care people required to keep them safe.

Where people had distressed behaviours, there was not always sufficient information in care planning with regard to how people could be positively supported to avoid, reduce or deescalate the situation. Some people with complex mental health conditions which could impact their well being did not have care plans for these.

The service did not always identify signs of potential abuse such as unexplained bruising and investigate these to ensure people were safe.

The staffing level or the deployment of staff was not always sufficient to enable staff to respond to people’s requests for support in a timely manner or for staff to respond to alert equipment such as pressure mats to reduce the risk of falls.

There was a high number of falls in the service. Whilst the manager had identified this, they had not identified the shortfalls we found in staff responding to call bells and alerts in a timely manner. This created a risk of people having falls and could also have contributed to the number of falls.

The service was not consistently clean throughout. Some items could not be cleaned effectively as the surface was broken or damaged. This increased the risk of the transmission of infection.

The service was not decorated and adapted in line with dementia friendly guidance. The environment was poorly maintained in the older parts of the building and this did not uphold the dignity and respect of people using the service.

Medicines were managed, monitored and administered safely. Recruitment procedures were safe.

The service was found to be in breach of eight regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The quality assurance system did not appropriately identify the issues we found at inspection. Therefore, this was ineffective. The service had deteriorated in compliance with the regulations since the previous inspection.

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 19 September 2019).

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 safety of equipment. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Culrose residential home provides personal care to up to 20 people older people. At the time of the inspection there were 17 people living in the home.

Care Homes

The home comprised of one building over two floors. A lift was available to access the upper floor. A large extension had been built which was waiting to be registered. Once registered the home would be able to accommodate a further 12 people.

The home had a large lounge and separate dining room. Kitchen and laundry facilities were available on the ground floor. Five of the rooms had full ensuite facilities with others having sinks. There were four communal bathrooms to the ground floor and one on the upper floor. All rooms in the new extension were ensuite.

The home provided support to older people some of whom were living with early onset dementia.

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

Some risks had been identified in relation to the fire safety regulations which had not been addressed. The manager took action to address these immediately. We also noted some people’s risk assessments did not contain all the most recent information. Recruitment files did not hold references for everyone employed and medicine administration records were not always accurate. Again, the manager took action to address some of the concerns immediately they were informed.

There were enough suitably qualified staff employed to meet people’s needs and the home was kept clean and free from the risk of infection. Staff were aware of safeguarding procedures and reported any concerns as required.

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. However, the policies, systems and records in the service did not support this practice.

Staff told us they felt supported but formal records of how this was done were not available, other than records of training attended and their initial induction to the role. The extension was well designed and the registered manager was taking steps to ensure the space offered appropriate orientation tools for people to safely and confidently move around the space. People enjoyed the food and any special diets were catered for. Where referrals were required to external agencies for more support these were made as necessary.

Due to the provider moving to a more electronic based care planning system the oversight of this was not yet developed, to a standard required to support good governance. Audits which were being undertaken did not identify any concerns or areas to improve. The registered manager acknowledged they were to better use the tools on the new system to generate reports which effectively monitored the service delivered. All the staff we spoke with told us there was nothing they would change about the job they did. They all felt supported and told us they were equipped with all the necessary equipment and expertise to deliver the support people needed. People’s opinions were formally gathered and steps were taken to address any shortfalls.

Very positive relationships had developed between people in the home and the staff. The home was warm and friendly. People in the home were involved in the day to day management of the home and had influence over the decoration of the extension. We saw people asked their views consistently over the inspection and saw choices were given to people routinely this included access to a wide range of alcoholic beverages to have with their meals. People were encouraged to be as independent as they would like and were able.

The activities coordinator and all staff in the home knew people well. We heard friendly conversations about people’s hobbies and suggestions for events and visits into the community. People told us they got the support they wanted when they wanted it and that all the staff could engage in conversation with them, about things they were interested in. Information in peoples’ plans of care were written specifically for the individual and included suggestions to cheer people up if they were in low mood. All complaints were managed professionally and effectively to people’s expectations and when people received end of life care it was delivered in line with best practice guidelines.

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 (14 April 2017). We found the service had deteriorated and is now rated Requires Improvement.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Culrose Residential Home on our website at www.cqc.org.uk.

Enforcement - We have identified breaches in relation to risk management, supporting people to consent to their care and effective governance and oversight.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Culrose provides accommodation and care for up to 20 older people, some of whom may have developed dementia while using the service. At the time of our inspection, there were 17 people using the service. There are some bedrooms on the first floor, in the older part of the building, accessible by a lift. The majority of bedrooms and all of the communal space, is on the ground floor.

There was 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.

At the last inspection, the home was rated Good. At this inspection, we found the home remained Good.

Why the home is rated Good…

Staff understood how to keep people safe from the risk of harm or abuse. Risks to people's safety were assessed and staff followed guidance for minimising these. There were enough staff to support people safely. Recruitment processes contributed to protecting people from the employment of staff not suitable to work in care. People received support to take their medicines safely and any concerns about medicines management were addressed.

Staff were competent to carry out their roles and to support people effectively. 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. People were supported to eat and drink enough to keep them well and had a choice of meals. Staff monitored people's health and wellbeing and ensured people could access professional medical advice promptly when it was necessary.

People were supported in a caring way by staff who had developed compassionate relationships with them. Staff respected people's choices, privacy and dignity, and encouraged people to maintain their independence.

Staff were aware of people's preferences, what was important to them, and their hobbies and interests and responded to these. They supported people to maintain their interests and to keep in touch with their friends and family. People were confident that, if they needed to, they could make a complaint about their care and have their concerns investigated and addressed.

There was stable and consistent leadership within the home, contributing to good staff morale and teamwork. People's views were taken into account in the way the service was operating and there were regular checks to see what improvements could be made to ensure a good quality service.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risk assessments for care needs were completed and provided appropriate actions for the identified risk to be reduced.

The premises were not maintained and safe for people to work and live in or to visit. We found that there were a number of issues that had not been identified and put people at risk. However, equipment used at the home and by people living there had all been serviced and properly maintained.

Not all of the recruitment checks and documents that were required before new staff members started work were available or obtained. However, staff records showed that new staff members received training to carry out their role. We have asked for improvements to be made.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications have needed to be submitted, policies and procedures were in place. Work was in progress to review these in line with recently received guidance. Relevant staff had an increased level of knowledge to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with. One person's family member said they were not actively consulted about their relatives' support, care and treatment. However, they were satisfied with the care their relative received. Care records mostly reflected people's care needs and preferences, although we found that occasionally people's needs had no or little information to guide staff.

Health needs were responded to and people had access to health care professionals if they needed this.

There was enough space around the home and in people's own rooms for them to spend time together or alone and to see visitors in these areas.

Is the service caring?

People said that most staff were polite and kind, although they also felt that occasionally staff could be 'short'. Staff members knew people's care needs and their personal preferences.

Our observations showed that staff members were respectful towards people living at the home. People told us that staff were respectful and that their privacy was maintained.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and mostly planned for. Their individual choices and preferences regarding their support and care were valued and respected.

People's individual support and care needs were being met. People who used the service said that their health needs were responded to well.

Is the service well led?

Improvements had been made since our previous inspection, which we carried out on 30 August 2013. This was in respect of analysis of satisfaction surveys and accident/incident reports. Appropriate actions had been taken following accidents, although actions were not clearly described for the results of the satisfaction survey. Relatives of people who used the service were also provided with opportunities to share their views about the standard and quality of the service provision.

We were told by the registered manager that people's needs were assessed to ensure they could be met by the service before they moved in. One member of staff said, 'I went to assess someone in hospital and involved them, their family and the ward staff to find out their needs.'

Discussions with the catering staff told us that people received adequate nutrition to meet their needs. We saw that people were offered snacks during the day. One person said, 'They know my preferences and if I don't like something on the menu then they give me something else.'

We found that there were shortfalls in the recording of people's care, including care plans not being reviewed, how their weight was monitored and decisions people had made about their care.

We saw that a people who used the service had been asked to complete a survey about their views of the service. The survey was not dated and there was no evidence that their views had been acted upon.

The service was involved in the local community. It had taken part in the 2010 and 2011Christmas tree festivals and people were able to attend clubs in the village.

People's needs were assessed before they moved into the service and regular reviews were carried out. Results of quality assurance surveys were used to improve the service. Staff in the service received induction training and regular supervision.