Archived: Cressage House

Updated 14 April 2017

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 over one evening and three days on 11, 12 and 29 February 2016, and 17 March 2016 and was unannounced. The inspection team consisted of two inspectors on the evening visit and one on the subsequent days. We undertook a further unannounced visit on 30 January 2017 to make sure our findings from the previous February and March were still valid. The inspection team on this occasion consisted of an inspector and an inspection manager.

We visited on the evening of 11 February 2016 following concerns that there were insufficient staff on duty at night. Our visit found these concerns to be unfounded.

Before the inspection we reviewed information we had about the service, including previous inspection reports and notifications the provider had sent to us. A notification is information about important events which the provider is required to tell us about by law.

Before the inspection, the provider completed a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We looked at the care plans and associated records of three people in detail. We observed staff interactions with people in the shared areas of the home. We looked at medicines administration records, staff duty rota records, four staff recruitment files, records of staff supervisions, appraisal and training. We looked at records of complaints, accidents and incidents, policies and procedures and quality assurance records. We saw maintenance and servicing records. We talked with seven care workers, six people who lived at the home in depth and had brief chats with several others. We talked to the registered provider and the manager.

We saw all communal areas of the home and some people’s bedrooms.

Updated 14 April 2017

The inspection took place over one evening and three days on 11, 12 and 29 February 2016, and 17 March 2016 and was unannounced. We undertook a further unannounced visit on 30 January 2017. At our previous inspection in June 2013 we found concerns with the safety and suitability of the premises. A follow up inspection in October 2013 found the necessary improvements had been made in this area.

Cressage House is registered to accommodate up to 14 people. It provides personal

care services without nursing for people with mental ill-health. At the time of our inspection there were 13 people living in the home.

The provider was registered as an individual (sole trader) with direct responsibility for the carrying on of the regulated activity at the location. As a "registered person" they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. As a consequence they did not need to have a registered manager. There was a manager in post who was not registered with us.

The premises were not maintained to a standard which made sure people were accommodated safely. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

However people told us they felt safe, and staff had a good understanding of how to protect people from risks to their safety and welfare, including the risks of abuse and avoidable harm. There were sufficient staff deployed to support people safely and the provider carried out the necessary pre-employment checks. Processes were in place to manage people’s medicines safely, although we identified improvements to be made in the processes for medicines prescribed “as required”.

Staff were not supported by a formal system of appraisal and supervision. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified improvements to be made in staff training.

Staff were aware of the need to obtain people’s consent to care and support and of their legal responsibilities where people lacked capacity to make decisions about their care and support. People were supported to eat a healthy diet, and had access to external healthcare services when they needed them.

There were caring relationships between people and staff. Staff respected people’s independence, privacy and dignity. However we found examples of language in care and other records which did not reflect what we saw in practice.

People were satisfied the care and support they received met their needs and took into account their wishes and preferences. However we found examples of care plans where improvements were needed. If people raised concerns they were heard and actions were put in place to address them.

There was a caring, friendly atmosphere. Staff and management were motivated by a desire to support people in a respectful way. However informal management processes had not identified areas where the service could be improved. There was no formal process in place to monitor, assess and improve the quality of the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report. We also made recommendations about training and managing medicines safely.