Background to this inspection
Updated
30 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 29 April and 4 and 5 May 2016. Two inspectors visited the service for all three days of the inspection. They were supported by a specialist advisor nurse on two of the days of the inspection.
We met and spoke with twelve people living at the home. Because some people were living with dementia we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
We spoke with three visiting relatives and also spoke with the interim consultants, acting proprietor and nine members of staff.
We looked at eight people's care and support records and care monitoring records in detail, and at monitoring records and specific elements of four other people's care plans. We looked at nine people's medication administration records and documents about how the service was managed. These included three staff recruitment and training records, audits, maintenance records and quality assurance records.
Before our inspection, we reviewed all the information we held about the service. This included the information about incidents the provider had notified us of. We also contacted the local authority safeguarding team and the local commissioners for information.
Updated
30 June 2016
We last inspected Crosby Lodge Care Home in September 2015 where we identified some shortfalls and made a number of recommendations. The home received an overall rating of requires improvement at that inspection.
This inspection took place on 29 April and 4 and 5 May 2016. The inspection was unannounced and carried out in response to information of concern received by the commission. During the inspection we identified serious shortfalls and breaches of the regulations.
Crosby Lodge Care Home is registered to provide personal care for up to 26 people living with dementia or severe and enduring mental health conditions. Nursing care is not provided. There were 16 people living at the home at the time of the inspection.
The home is made up of two separate buildings. These are called 2 and 2a. The two buildings are separated by a freestanding garage in its own driveway that does not belong to the service. This means that the movement of staff and certain activities such as meal distribution can only be achieved by leaving one building, walking a short way along a public road and entering the second building.
The home is currently being managed by the acting proprietor following the death of the proprietor in January 2016. The acting proprietor was supported by two interim consultants they had engaged as a result of serious safeguarding concerns identified by the local authority. The interim consultants had acted swiftly and responsibly to ensure people’s basic care needs and safety were met.
There was a registered manager at the home. However, they were not available at the time of 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.
One relative told us that the home was, “Perfect”, and an agency staff member told us, “This place is the best, it’s like family, it’s very personal and they are very close to residents”. However we identified serious issues that impacted upon people’s health, safety and wellbeing.
People were not cared for safely. Prior to the appointment of the interim consultants, risks to people were not assessed and action was not taken to mitigate these risks. In addition, accidents and incidents were not robustly investigated to make sure patterns or trends were recognised to minimise the risks of further incidents. The interim consultants had taken action to ensure people’s basic safety needs were met and that people were not at imminent risk of serious harm. However, there remained a number of shortfalls because the interim consultants had not had sufficient time to fully safeguard people. In addition, the premises had significant infection control and environmental issues. Shortfalls in recruitment meant the acting proprietor could not be sure that the staff recruited were suitable to work with vulnerable people. Medicines were not managed safely so people had not received their medicines as prescribed.
Staff did not have the knowledge and skills to effectively care for or support people. Staff had not been supported through either training or supervision and appraisals to gain these skills.
Staff were not adhering to the principles of the Mental Capacity Act 2005 (MCA). Decisions made for people who lacked mental capacity had not been made in their best interests using the statutory framework, and one person was unlawfully deprived of their liberty at the time of the inspection.
People had not been supported to meet their nutritional needs although following their appointment, the interim consultants had taken action to ensure that there was enough food available for people to eat and that there was a chef in place to prepare meals.
Most of the staff had a caring approach and were genuinely interested in and concerned about the people they supported. However, they sometimes communicated with people, or supported them inappropriately because they had not been supported to develop the right skills.
People’s needs were not responded to appropriately. Some people’s needs had not been assessed or planned for. Other people had care plans in place which provided staff with inaccurate guidance. Some people had not received the care they required. Other people had not been supported to receive the healthcare they required, including in one circumstance healthcare that was urgently required in response to a fall.
The home was not well led. There was no effective governance and the management in place prior to the appointment of the interim consultants had not supported staff, assessed or monitored the quality or safety of care, or sought feedback from people or their relatives.
The overall rating for this service is inadequate. The death of the proprietor in January 2016 means that there is no registered person for CQC to take action against. The acting proprietor has made a decision to close the home and the last person moved out of the home on 27 May 2016. The home is now closed.