Craighaven Care Home

Craighaven Care Home is a residential care home providing personal care to 27 people at the time of the inspection. The service can support up to 35 people, including older people and those living with dementia.

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

Risks to people’s health and safety were not always robustly assessed and used to develop effective risk management plans. Recent changes in management and a move to electronic care management systems meant some governance systems were not in place or operating effectively to monitor and improve safety and quality in care.

Staff received safeguarding training to help them identify potential signs of abuse, and when to report potential safeguarding concerns. There were enough staff to provide safe care, and feedback received from staff about staffing levels was positive. Medicines were ordered, stored and administered safely. We assured by the infection prevention and control practices. Accidents and incidents were recorded and analysed for trends or patterns.

Assessments were carried out prior to people moving to Craighaven Care Home to ensure the service could meet their needs safely. Staff received an induction and training relevant to their roles and understood how to care for people effectively. People were encouraged to eat and drink enough to maintain a balanced diet and overall, people gave positive feedback about the food provided. Staff worked closely with external health professionals in response to changes or concerns regarding people’s health and well-being. Signage helped to orientate people to their surroundings, and people’s bedrooms were personalised.

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.

There was a positive culture which was echoed in feedback from staff and relatives. People and relatives spoke positively about the leadership of the home. When important events and incidents occurred in the home, the registered manager understood their responsibilities to tell us, CQC, and inform people’s relatives. Annual surveys were used to gather feedback from relatives to help identify and plan for improvements. The service worked in partnership with external health professionals to improve people’s outcomes.

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 good (published 8 August 2019).

Why we inspected

We received concerns about managing risks to people’s safety, access to medicines, staffing and care quality. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

In response to our inspection the provider took immediate action to address the shortfalls and ensure risks to people were assessed and managed.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Craighaven Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Craighaven Care Home is a residential care home providing personal care and accommodation for up to 35 adults aged 65 and over living with dementia. At the time of our inspection visit there were 32 people receiving care. The care home is a four-storey building and care and support is only provided in areas located on the ground and first floors.

People’s experience of using this service:

People felt safe using the service. Staff managed the risks to people’s health, safety and well-being and understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People received support from staff when needed. People were supported to have enough to eat and drink to maintain their well-being. They were supported to obtain advice from healthcare professionals when required.

People were supported to have their medicines as prescribed. Best practice had not always been followed with regard to management of some medicines. However, improvements were made straight after our visit.

Staff had training to meet people’s needs and the registered manager shared guidance with staff on how to support people effectively.

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.

People were treated with dignity and their independence was promoted wherever possible. They were encouraged to take part in activities which interested them.

People were involved in planning their care with support from staff. People and their families understood how to complain if they wanted to. The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required. There were checks in place to ensure good standards of care were maintained.

Rating at last inspection:

The last rating for this service was requires improvement (published 18 July 2018).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

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.

We last inspected this service in June 2017, when we rated the service as ‘Requires Improvement’ overall. Following the last inspection, we asked the provider to complete an action plan to show how they would improve the rating of all the key questions to at least good and how they would address the breach of regulations 12 and 17 HSCA 2008 (Regulated Activities) Regulations 2014. The provider had not ensured staff responsible for the management and administration of medicines were suitably trained and competent. The provider had not ensured medicines were administered in line with nationally recognised guidance. The provider was not conducting regular audits of the service to assess, monitor and improve the quality and safety of the service and had not ensured their audit and governance systems remained effective.

At this inspection, we found some improvements had been made and there were no longer breaches of regulation. However, the improvements did not reach the required standards and further changes were still needed to assure us effective systems were in place to protect people’s safety. We have rated the service as ‘Requires Improvement’ in the key questions of safe and well-led and ‘Good’ in all other key questions. Therefore the service is rated as ‘Requires Improvement’ overall. This is the second consecutive time the service has been rated ‘Requires Improvement’.

Improvements had been made since our last inspection. The provider had improved staff training and there were enough staff to meet people’s needs safely. However, not all important events had been referred to senior staff in accordance with the provider’s policies and the risks to one person’s safety had not been fully assessed. Medicines continued to not always be administered in accordance with best practice.

Staff had the skill, experience and support to enable them to meet people’s needs effectively. The registered manager checked staff’s suitability to deliver care and support during the recruitment process.

Staff worked within the principles of the Mental Capacity Act 2005 (MCA) and supported people to have choice and control of their lives.

Staff monitored people’s health and referred them to other healthcare professionals to maintain and improve their health.

People told us staff were caring. People were encouraged to maintain important relationships. Staff knew people and understood their likes, dislikes and preferences for how they wanted to be cared for and supported. Staff respected people’s right to privacy and supported people to maintain their independence.

People decided how they were cared for and supported and staff respected their decisions. People knew how to complain and were able to share their views and opinions about the service they received.

People were satisfied with the service and were positive about the leadership of the service. The provider’s quality monitoring system included checking people received the care and support they needed, however it was not always effective.

Craighaven Care Home is registered to provide accommodation and personal care for up to 35 older people who are living with dementia. On the day of our inspection visit 32 people lived at the home.

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.

At our last inspection in April 2015, the service was meeting the regulations and we had rated the home as ‘Good’ overall. During this visit we found previous standards had not been maintained and the homes rating was now ‘Requires Improvement’ overall.

A combination of staff deployment and/or insufficient staff meant staff were not always available to respond to people’s requests for assistance and to support people’s social and emotional needs.

The provider’s medicine systems and checks did not ensure medicines were consistently administered safely and by trained staff. People saw health professionals when needed.

Staff had not been supported to complete essential refresher training to ensure they continued to have the knowledge and skills to carry out their roles effectively. Staff had been recruited safely and received an induction when they started working at the home. However, the induction for new staff did not follow the expected Care Certificate standards.

The provider had not maintained effective procedures to check and monitor the quality and safety of the service people received. This meant the provider was not aware of potential poor practice and areas where improvement was necessary.

People’s care records were not always detailed and contained conflicting information. This meant they did not provide staff with accurate and consistent information about how people should be cared for and supported. However, staff spoken with had a good understanding of the needs and preferences of the people they supported.

People were not always offered a choice of meal in a way they could understand and some people did not always receive the necessary support they needed at meal times. People had opportunities to take part in in individual or group activities and were encouraged to maintain links with friends and family who could visit the home at any time.

People and relatives told us staff were caring, kind and patent. People received care and support from staff they knew and who respected their privacy. Where possible, staff encouraged people to be independent and involved them and their relatives in planning their care.

People and relatives told us they felt safe using the service. Staff understood how to protect people from abuse and most understood their responsibility to report any concerns. Risks associated with

people’s care and support had been assessed. Premises were well maintained and equipment was checked to ensure it was safe for people to use.

The registered manager and staff had an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty Safeguards (DoLS) for people whose freedoms were restricted. However, some best interests’ decisions had not been assessed and people’s consent had not always been sought in line with the requirements of the legislation.

Relatives felt the registered manager was approachable and the home was well managed. Complaints were managed in line with the provider’s policy. Staff felt supported and valued by the management team who were accessible and responsive.

We found two 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.

People's care needs were assessed and care plans were detailed and reviewed regularly providing staff with clear information regarding how to care and support people.

We saw that the home was clean and tidy with systems in place to promote and maintain a clean environment.

There was a sufficient number of staff on duty who were appropriately trained to provide care for people.

People appeared relaxed and we observed positive interaction with the staff and participation in a varied programme of activity.

A complaints procedure was in place. We found that staff were aware of how to direct people who wished to make a complaint.

We observed that people were relaxed and comfortable with each other and with staff. We saw that staff offered people re-assurance and assistance effectively and encouraged people to stay active and involved in the activities on the day.

We found that people's written care plans were centred on their individual abilities, needs and preferences and were regularly reviewed. Care staff we spoke with knew people well and understood their preferred habits and routines. Care staff understood their role and responsibilities in keeping people safe from harm.

Care staff we spoke with told us they were helped to be effective in their role because of the training and support they received from the team and manager. One member of care staff told us, "I can always talk and discuss things with seniors and other care staff."

The manager kept appropriate records for staff and for people who lived at the home. The records were kept securely, and were accessible when needed.