Archived: Sweetcroft Residential Care Home

Sweetcroft Residential Home is a residential home providing personal care for up to 20 older people often living with the experience of dementia. At the time of the inspection 18 people were using the service.

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

People’s needs were assessed prior to moving to the home. However, one file we viewed did not have a care plan and reviews were not being undertaken in a timely manner. Additionally, end of life wishes were not consistently recorded.

Supervisions, appraisals and competency testing were not carried out consistently, which meant staff may not have been getting the support they required to undertake their job effectively and safely.

Activity provision was not person centred, therefore people’s individual interests were not always met.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people but these were not always effective and did not identify issues raised at the inspection.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and manage risks. Safe recruitment procedures were in place and there were enough staff to meet people’s needs. Medicines were managed and administered safely.

People were supported to maintain healthier lives and access healthcare services appropriately. 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.

Staff were kind and respectful of people’s wishes and preferences and provided support in a respectful manner.

There was a complaints procedure in place and the provider knew how to respond to complaints appropriately.

People using the service and staff reported the registered manager was approachable and promoted an open work environment.

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 15 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of two out of three regulations identified at the April 2018 inspection. The service remains rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the effective, responsive and well led sections of this full report.

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

The last comprehensive inspection took place in September 2017. The service was rated ‘Inadequate’ in the key question ‘Is the service Well Led?’ and ‘Requires Improvement’ in the key questions ‘Is the service Safe, Effective and Responsive?’ and overall. We found seven breaches of Regulations relating to staffing, fit and proper persons employed, safe care and treatment, person-centred care, requirement as to display of performance assessments, good governance and notifications of other incidents. After the inspection we served a warning notice on the provider for a breach of regulation in relation to good governance because they were not maintaining accurate, complete and contemporaneous records in respect of people using the service and staff. We asked the provider to meet the requirement of the regulations by December 2017. We also served Fixed Penalty Notices on the provider for a failure to send statutory notifications to the Care Quality Commission and also for a failure to display the rating of Sweetcroft Residential Care Home on their website.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’ to at least good. At this inspection we found the provider had made some improvements but not enough to fully meet the Regulations.

Sweetcroft Residential Care Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sweetcroft accommodates a maximum of 20 people. At the time of the inspection, 16 people were using the service.

The service had a registered manager. 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.

During the inspection we found that risk management plans were not always robust enough to minimise risks. In addition, we saw poor moving and handling techniques used by care workers that could put people using the service at risk of poor care.

Some care workers had not had medicines training since 2015 and there were no written records of medicines competency testing to confirm care workers were assessed as competent to administer medicines safely. We recommended that the provider seek and implement national guidance in assessing staff competencies including those relating to the management of medicines.

We had mixed feedback regarding the home having enough staff on duty to meet people’s needs. They were dependent on agency staff but had hired new care staff which would reduce the need for agency staff.

We saw individual acts of kindness from staff, but people were not always treated in a person-centred manner. Lunchtime in particular was task orientated instead of meeting people’s individual needs. We also found that activity provision was not person centred to meet people’s individual interests.

The provider had procedures in place to protect people from abuse. Staff we spoke with knew how to respond to safeguarding concerns.

Care workers had relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service. Safe recruitment procedures were followed to ensure staff were suitable to work with people.

The principles of the Mental Capacity Act (2005) were generally followed, but not all care workers we spoke with understood about people consenting to their care.

Staff had completed training in infection control and wore appropriate protective equipment to reduce the risk of the spread of infection.

People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met.

The service worked well with other professionals and we saw evidence that people were supported to access healthcare services appropriately.

People were involved in planning their care and care plans contained information to give staff guidelines to care for people in their preferred manner.

There was a complaints procedure in place, however the service had not had any complaints in the last year.

People using the service and staff told us the registered manager was available and listened to them.

The service had a number of systems in place to monitor, manage and improve service delivery to improve the care and support provided to people. However, these were not always effective in identifying the quality of the data.

We found three breaches of regulations in relation to safe care and treatment, person-centred care and good governance. We are taking action against the provider for failing to meet regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Sweetcroft Residential Care Home is part of Ilford Homes. It provides personal care to older people and accommodates a maximum of 20 people. At the time of our inspection there were 20 people living at the service.

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.

At the inspection, we found the service did not have sufficient staff to meet the needs of the people using the service and the provider did not always follow safe recruitment practices.

Risk assessments were not robust enough and incident forms did not record outcomes or indicate what preventative measures were taken to minimise risks to people using the service. Not everyone had a personal emergency evacuation plan (PEEP) so staff and others were clear how to support people in an emergency.

The provider did not always notify The Care Quality Commission when people were granted deprivation of liberty authorisations and not all people’s files had completed consent to care forms.

The service did not always provide meaningful activities for people using the service.

The provider did not have effective quality assurance procedures. They did not ensure record keeping was always complete or contemporaneous and there was no analysis of information to develop and improve service delivery. Additionally, the provider did not display their ratings in the home or on their website.

Medicines administration records (MARs) were correctly signed and medicines stock tallied with the numbers that had been supplied and administered. However, there was no staff signature sheet to indicate who had initialled the MAR charts.

Staff we spoke with had completed safeguarding adults training and knew how to respond to keep people safe from potential harm. Staff had the relevant training and support through supervisions and appraisals to develop the necessary skills to support people using the service.

People were supported to have maximum choice and control of their lives and staff were responsive to individual needs and preferences. People using the service had developed positive relationships with staff.

People’s dietary requirements were met and we saw evidence that relevant health care professionals were involved to maintain people’s health and wellbeing.

Relatives and staff said the registered manager was accessible and approachable. People knew how to make a complaint but there had been no complaints to the service.

We found seven breaches of regulations during the inspection. These were in respect of staffing, fit and proper persons employed, safe care and treatment, person-centred care, requirement as to display of performance assessments, notifications of other incidents and good governance.

We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The last inspection visit took place on 7 August 2014 at which time we found the standard for supporting staff was not being met because the service was not completing appraisals. An action plan was submitted on 28 August 2014 and we reviewed the evidence the provider sent to us, which included samples of completed appraisals. We carried out a review of the information on 31 December 2014, which confirmed the standard was being met. At the inspection on 1 September 2016, not all the staff had an up to date appraisal.

Sweetcroft Residential Care Home is part of Ilford Homes. It provides personal care to older people and accommodates a maximum of 20 people. At the time of our inspection there were 20 people living at the service.

The registered manager was previously a care worker in the home and became the registered manager in 2012. 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.

We found three breaches of the Regulations. People's capacity to make decisions had not been assessed and their consent to care and treatment was not always recorded.

The provider had not always followed procedures for raising incident notifications to the Care Quality Commission.

The service had some systems to monitor the quality of service delivered and ensure the needs of the people who used the service were being met. However, files for staff and people who used the service were missing relevant information. Additionally there was a lack of analysis of information used to improve service delivery.

The service had a safeguarding policy. Staff had attended safeguarding training and knew how to report safeguarding concerns. Risks to people’s safety and wellbeing had been assessed to keep people safe and staff knew how to record incidents and accidents. The provider followed safe recruitment procedures.

There were a number of regular maintenance and service checks carried out to ensure the environment was safe. Medicines were administered and stored safely but there was not information on PRN (as required) medicines included in the policy. We recommended that there are robust systems in place to ensure the proper and safe management of medicines at all times.

Team meetings were not held consistently. We recommended that team meetings be held on a regular basis.

We recommended the provider improve the decoration.

People were supported to have enough to eat and drink and were able to have food and drinks when they wanted to.

People had access health care services and the service worked with other community based agencies such as the community matron.

People who used the service told us staff were kind and their dignity and privacy was respected.

Activities were not meaningful for everyone who used the service. We recommended that the provider review activity provision in line with the National Institute for Health and Care Excellence (NICE) guidelines.

An appropriate complaints procedure was available in the service user guide. However, complaints were not always recorded. We recommend the service formally records all future complaints made.

All stakeholders indicated they could speak to the registered manager, who they felt listened to them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The provider sent us their action plan and told us they would meet Regulation 23 (1)(a) by the end of November 2014.

The registered manager confirmed that all staff had now received their annual appraisal. She provided a sample of completed appraisal forms to show that this had been addressed. These looked at where staff were working well and identified any areas for development.

As part of this inspection we spoke with four people who used the service, four relatives and six staff including the manager and their deputy. We also reviewed records relating to the management of the home which included the care records of five people who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the 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.

Is the service safe?

We looked at five people's care files which contained risk assessments related to general risks, manual handling, falls and mental health. There were plans in place to manage the identified risks to reduce them and to ensure people's welfare and safety. We saw the plans were subject to regular evaluations and updated when people's needs changed.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were arrangements in place to deal with foreseeable emergencies. The service had a fire evacuation plan and there were emergency plans in place to deal with various emergencies such as failure to energy supplies and staff shortage. Relevant emergency contact details were kept in a folder in the office and the manager or the deputy manager was 'on-call' during out of hours to support staff in case of an emergency. Training records showed that except the relatively new members of staff, staff had completed first aid and fire training.

People who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act (2005) and they aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. At the time of our inspection people at the home were not subject to the DoLS.

Is the service effective?

Before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes. People at the home had dementia or varying levels of memory problems and they required help with their personal care and activities of daily living. Four staff we spoke with said they read people's care plans and always asked people to get their agreement prior to providing care and support. This meant people's consent was obtained verbally prior to providing care and support to them. We spoke with four people who used the service and four relatives and they all gave us positive feedback and indicated staff had provided care and support which was agreed with them and was not against their will.

Daily notes were kept about people's care and their health was being monitored. Records showed people were supported to receive medical check-ups and the service worked together with people's GPs, district nurses and other community services in order to promote people's well-being and to address health issues.

We found people were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard as no annual appraisals had been provided to them. People who used the service and people's relatives said about staff 'they have been really good', 'they all very nice and helpful', 'staff are nice', 'staff is excellent' and 'they are very good.' Relatives told us they felt the staff had the knowledge and skills to provide good quality care.

Is the service caring?

We spoke with four people who used the service and four relatives to get feedback on their experiences in the home and about the quality of the service. Their comments included 'We are very impressed', 'I had no problems at all', 'I do like it here', 'it's nice' and 'I strongly recommend (the home) to anyone.' They also said the home was welcoming, the 'communication (between staff and them) is very good' and 'it's better here than at home.' People said they would not change anything with regards to the service.

We observed the care provided during our inspection and saw people were treated as individuals with patience and respect. People had their own room and we saw their privacy was respected by knocking on the door and not entering the room if permission wasn't given.

Is the service responsive?

We found that the views of people who use the service were regularly sought through daily conversations, key-working sessions and through their care plan reviews. People and their representatives' feedback had also been sought through annual surveys. Record showed the responses were very positive and one comment was 'I think Sweetcroft is a wonderful environment for my Mother and that the staff do an incredible job.'

People were enabled to maintain relationships with their friends and relatives. Relatives we spoke with said they were free to visit anytime and the home was welcoming.

Is the service well-led?

The home had a system in place to monitor the quality of its service through internal audits and checks on different aspects of the service. We found monthly quality assurance visits were carried out by the manager. Records showed the premises, maintenance issues, health and safety arrangements and accident/incident records were subject of the check. We also saw records of weekly infection control, medication and health and safety audits. We saw one recorded action which was to inform the proprietor regarding a maintenance issue. The health and safety audits showed that various checks were carried out to ensure people were getting and living in a safe service for example fire alarm tests and fire drills.

We found the views of people who use the service were regularly sought and were acted upon. There was also evidence that learning from incidents or investigations took place and appropriate actions were made in response.

Staff told us that 'I wouldn't choose any other job', 'it's a nice place to work' and 'I would be happy to have one of my family members live here.' They also said they felt well supported by the manager and their deputy.

People were treated with dignity and respect. Their views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People felt safe at the home. One person said 'I would speak to the manager if I had a concern.' Staff knew the steps to take if they had any suspicions of abuse.

Appropriate checks were undertaken before staff began work. We found all the necessary pre-employment checks had been completed. Staff had received induction training, supervision and training was updated annually. This ensured they could meet the needs of the people who use the service.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People had been asked their views of the service and their wishes had been taken into account.