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Cromwell House Residential Care Home Good

Reports


Inspection carried out on 19 January 2018

During a routine inspection

This unannounced comprehensive inspection took place on 19 and 22 January 2018. At our last inspection in September 2016 we found a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. ‘Fit and proper persons employed’. This was because we found that the service was unable to provide a hard copy of a staff member’s Disclosure and Barring Service (DBS). This inspection found improvements had been made and the provider was now meeting regulations.

Following the last inspection in September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘safe’ to at least good.

Cromwell House provides care for one individual with a learning disability in one adapted building. Cromwell House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. At the time of our inspection the registered manager, who was also the provider was in the process of ‘stepping back’ from the day to day running of Cromwell House. Their deputy manager was in the process of registering as 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.

There were effective staff recruitment and selection processes in place. A member of staff had been employed since our last inspection and the recruitment process had been robust. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication between staff at the service.

People were safe. Staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf. Staff ensured infection control procedures were in place. People’s individual needs were met by the adaptation, design and decoration of the premises.

Care files were personalised to reflect people’s personal preferences. The service adopted informal methods when seeking people's views. This was through regular family contact, via phone calls and visits. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. The organisation’s visions and values centred around the people they supported, which ensured their equality, diversity and human rights were respected.

A number of effective methods were used to assess the quality and safety of the service people received and make continuous improvements.

Inspection carried out on 29 September 2016

During a routine inspection

This inspection took place on 29 September 2016. This was the second comprehensive inspection. We gave short notice of our intention to inspect on this day as the service is small and we needed to ensure people and staff would be available to speak with. The last inspection was completed on 8 July 2015, where we found a number of breaches in regulation. These related to poor record keeping, lack of detail within risk assessments, staff not having the right training and lack of understanding and application of the Mental Capacity Act (MCA) in order to protect people’s rights. The service was rated as overall requires improvement. Following the inspection we received information from the service about how they intended to ensure they were meeting all regulations.

Cromwell House is registered to provide care and support without nursing for one person with learning disabilities.

The registered manager is also the director of the limited company who is the provider of this service. He usually visits the service weekly, and has delegated the day to day running of the service to the assistant 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the registered manager was not available and subsequently was out of the country for a number of weeks. They did not inform CQC about this absence.

We found there had been improvements in the way staff recorded how they worked with people and how they monitored their wellbeing and incidents. There were also improvements in the way risks were being managed which helped to ensure people’s safety as well as the safety of staff, when out in public. Training had been completed to ensure staff had the right skills to work with people with complex needs. This included positive interventions, safe holding and working with people with autism.

We found the staffing arrangements at night did not keep people or staff safe. The arrangements were for one member of staff to provide sleep-in cover. Although the provider had been commissioned to provide an on-call system, staff were doing this on a ‘good-will basis’. For example no staff were rostered or paid to provide on-call back up in an emergency. This meant the systems were not robust if there was an event where people were distressed and needed more than one staff member. Since the inspection took place we have been assured by the provider that there was now an on call system in place. He told us he was always available to provide support.

Records had improved since the last inspection, although some care plan details did require updating, which the assistant manager was addressing. There were clearer guidelines about how best to support people. These had been developed by a specialist from Somerset County Council following a safeguarding incident in relation to managing one person’s behaviour when out in public. It included looking at trigger points and positive intervention strategies for staff.

Staff said they had benefitted from additional training and clearer guidelines. They said they all knew people’s needs and worked well as a team to support people to do things they enjoyed and were meaningful. Staff were knowledgeable and talked about people with compassion and genuine kindness. It was clear people were at the heart of how the core staff worked and planned activities.

People’s medicines were well managed and staff knew when and why they might consider additional medicines when a person may require this to relieve agitation and help them stay calm.

People were protected because staff understood how and when to report any abuse. Monies were well managed with clear systems for recording when and how people’s persona

Inspection carried out on 8 and 13 July 2015

During a routine inspection

This unannounced inspection took place on 8 July 2015. We returned on 13 July 2015 as arranged with the assistant manager who was employed by the registered manager. After receiving information of concern from health and social professionals about how people’s complex needs were being managed by staff, we brought the inspection forward.

Cromwell House is registered to provide care for one individual with a learning disability.

When we visited 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.

People’s risks were not managed robustly. As a result health and social care professionals had needed to intervene to support the service. Staff did not have up to date physical intervention training tailored to people’s needs and said they felt ill-equipped to deal with incidents if they occurred.

Staff had not received up to date training in core subjects specific to people’s needs. The training programme had only been recommenced following involvement of outside agencies who were concerned about staff being unable to support people appropriately. Staff also had not received an annual appraisal to help them develop in their roles.

The service was not working in accordance with the Mental Capacity Act (MCA) (2005). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

There were some systems in place to ensure the quality and safety of the service but staff had not proactively managed situations where a person using the service presented behaviour that was challenging to the service.

Staff relationships with people were strong, caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.

People’s likes, dislikes and preferences were taken into account in care plans. They were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment. Staff understood their safeguarding responsibilities and knew how to report concerns.

We found a number of 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 this report.

Inspection carried out on 28 March 2014

During an inspection in response to concerns

We carried out this responsive inspection visit on 28 March 2014, as a result of receiving concerning information from a professional involved in visiting the service about staffing levels not meeting the needs of the person living in the home.

This visit took place unannounced and we met two staff and the person living in the home. Cromwell House provides bespoke care and support for a single person, with complex communication needs. Much of our inspection findings were based on our observations and talking with the person and staff supporting them. We found staffing arrangements had been reviewed and meant the person had good levels of support and care, which corresponded with their planned care package.

Staff anticipated the person’s needs very well and promoted an inclusive atmosphere that was free from restrictions but was managed safely. This meant the person was able to express themselves and live their life as they chose to. The person proudly showed us around their home pointing out their own artwork and other things which were important to them. We saw another example of how their independence and choices were supported, they said they had told staff they wanted to get their “Weekly” magazine. As we left the home, we saw everyone getting into the vehicle which they now had access to every day .

We found the provider was compliant in the two outcomes we looked at. The care and welfare of people who used the service and staffing.

Inspection carried out on 30 September 2013

During a routine inspection

Cromwell House provides bespoke care and support for a single person. The home had been closed and the person had moved elsewhere. This had not proved successful and the home had re-opened specifically to provide a service for the person.

In this report we use the term “manager” to refer to the person in day to day charge of the home. This is not the same person as the registered manager, who is also one of the owners of the care home.

The staff knew the individual very well and were well able to anticipate the person's needs to provide the support that they required. When the person became anxious or unsettled they could physically damage fixtures and fittings or hurt people. Staff were seeking to create a homely atmosphere whilst also taking care to ensure the environment is maintained in such a way as to minimise any potential damage. Staff were skilled in anticipating when the person was becoming anxious and at diffusing situations.

One member of staff told us "I chose to return back to Cromwell House when it re-opened." When asked if they liked living at Cromwell House the person responded "Yes".