Archived: Croxley House

Croxley House is a residential care home providing personal and nursing care to 22 people at the time of the inspection. The service can support up to 33 people.

Croxley House consisted of two floors. The ground floor had living facilities which included staff office space, the kitchen, dining rooms, living rooms and people's individual bedrooms, all of which had a toilet attached. The second floor was made up of all bedrooms.

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

People were at significant risk of harm in relation to poor manual handling and support with meeting nutritional needs. Risk assessments and care plans did not identify people’s up to date support needs and staff were inconsistent with their knowledge of what support people needed.

Where safeguarding risks had been identified in the past, the registered manager and staff team had not learnt from this and implemented changes to protect people.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice

The staff did not have adequate training and knowledge of processes. For example, in the event of a fire staff could not confidently tell us what they would do. The service did not have a dedicated person responsible for this.

Records showed there was a risk of people not being supported at night in the event of an emergency. Night spot checks had not been carried out by the management team.

Overall, the service had processes in place for infection prevention control. Although we observed some staff in the home not wearing the correct Personal Protective Equipment (PPE).

The registered manager did not lead effectively, and this put people at risk of harm. Quality audits completed were not robust and did not find areas where significant improvement was needed.

Relatives we spoke with were happy with the overall support their family member was receiving.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 April 2019). 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 regulations.

Why we inspected

We received concerns in relation to staff training, meeting nutritional needs and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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.

Enforcement

We have identified breaches in relation to unsafe moving and handling, risk to people whilst eating and drinking, lack of staff training and governance practices at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

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.

People’s experience of using this service:

People told us that staff were kind and caring, however we observed occasions when staff did not always show people the respect that they deserved. People received the medicines they needed, however we observed a medicines error which was not reported.

People were cared for by staff who had undergone good pre-employment checks and had access to training, although there were insufficient staffing to help ensure people received the attention they required and that staff had to spend with people. When people had accidents and incidents these were recorded.

Risks to people had been identified, although we found many people had had unwitnessed falls and we observed people walking around without staff, when they were at high risk. The environment in which people lived required improvement to ensure its appropriateness and cleanliness. This included its suitability for people living with dementia.

People’s consent was not sought in line with the Mental Capacity Act 2005 (MCA) as decision-specific mental capacity assessments had not been completed. Although regular audits of the service were carried out, shortfalls identified, such as the failure to follow the principles of the MCA had not been identified.

People received sufficient nutrition and hydration and where staff were concerned about people’s eating or health, they involved appropriate healthcare professionals. Some people were seen to retain a sense of independence and make their own choices about how they wished to spend their time. However, there were mixed views on the activities offered to people.

People’s care needs were clearly recorded in their care plans. These included their likes, dislikes and background information on people. People could express their views and opinions about the service through regular residents’ meetings and surveys.

During our inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected Croxley House on 26 April 2016 when we rated the service as Good. The report was published on 17 June 2016.

Why we inspected: This was a routine, scheduled comprehensive inspection which we carried out in line with our inspection methodology.

Follow up: We will ask the registered provider to draw up an action plan telling us how they propose to rectify the shortfalls we have identified. We will review this action plan when we carry out our next inspection to check that actions have been addressed as stated. We will next inspect the service in line with our inspection timescales methodology.

Croxley House provides care and support for a maximum of 33 older people. Some of whom may be living with a form of dementia. At the time of our inspection there were 27 people living in the home.

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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff also said that they knew the people they supported well.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits, such as GP appointments, optician appointments, chiropodists and hospital visits.

There was a formal process for handling complaints and concerns. The registered manager encouraged feedback from people and acted on the comments received to continually improve the quality of the service. There were effective quality monitoring processes in place to ensure that the home was meeting the required standards of care.

We saw that the provider gave due consideration to people's capacity to consent, and that the provider had taken the relevant action to ensure that they complied with the Mental Capacity Act 2005.

We saw that staff were knowledgeable about people's needs and promoted their independence. When we talked with people they told us that the staff had a good understanding and awareness of their care needs and preferences. We saw that care plans and risk assessments were regularly reviewed and updated.

We saw that medicines were stored, administered and disposed of correctly.

We saw that staff had been provided with training and support to enable them to care for people living at Croxley House.

People who used the service told us they were aware of how to make a complaint and who to make it to. One person told us "I have a good relationship with the staff we have a laugh and a joke together, if I was unhappy I would tell them so."

There was good regard for people's privacy and dignity at the home. Care plans reflected people's wishes and preferences. Staff portrayed respect for people when speaking with us and in the language they used in records.

People commented positively about the food choices, activities and staff. Care plans were in place for each person which outlined their needs and how those were to be met. Risk assessments had been written to reduce the likelihood of people being injured or harmed. All documentation we looked at had been kept up to date and regularly reviewed.

There was a system in place to ensure people were protected against the risk of abuse. We found there were sufficient staff on duty to meet people's needs. Staff had access to training courses. This meant their skills and knowledge were kept up to date. Staff communicated well with each other to make sure people's needs were met. The home had a system in place to regularly assess and monitor the quality of the care people received.