This inspection took place on 25 and 30 May 2017.Critchill Court provides care and accommodation for up to 50 people. At the time of our inspection there were 37 people using the service. There is a separate part of the home known as Cedar Oak which provides care to people living with dementia. The “main house” provides care and support to older people some of whom are living with dementia. The home does not provide nursing care and people who require nursing assistance are supported by the local district nursing team.
The registered manager had been absent from work since 02/05/2017 and prior to this had been absent due to routine annual leave and other leave. Immediately following the inspection we were informed they had resigned. Since the inspection an interim manager has been put in place. We were told the provider is advertising for a permanent manager who will, if suitable, make an application to be the registered manager for the service. 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.
The recruitment arrangements whilst generally safe and meeting required standards in relation to checks did not ensure full employment history was obtained so the provider could be assured there were no gaps in employment history. Such gaps if identified may have questioned the suitability of the perspective employee to work with vulnerable adults.
The manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. However, we identified two people where such applications needed to have made and had not been.
Social activities were an area which needed to improve reflected in comments made by people. There had been a change with new appointments of activities coordinators as previous coordinators had left. This had impacted on the quality of activities provided with lack of a organisation and reduction in the availability of activities particularly one to one activities.
One person was being administered their medicines covertly i.e. disguised in food or drink. This was an appropriate decision and referred to as "best interests decision". However, there was no consultation with the pharmacist to ensure the method used to administer the medicine was safe and retained the effectiveness of the medicine.
Improvements had been made in the arrangements for the administration of "as required" medicines. This had been an area for improvement identified at our last inspection. There was a robust system for the management of medicines which ensured people received their medicines at the time it was required.
All of the people we spoke with said they felt safe living at Critchill Court. One person told us "It is lovely here staff are very kind and look after us." This was also reiterated by relatives we spoke with who also commented on how caring and welcoming staff were.
People spoke of staff being caring and kind. We observed staff supporting people in a sensitive and caring manner. They were confident in responding to people who were distressed or confused and needed re-assurance. They did so in a respectful professional way engaging with people in a positive manner.
People and relatives told us staffing arrangements were good and staff were available at a time they were needed. Staff responded promptly to requests for help and support.
People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.
Mealtimes were calm and relaxing occasions with people being offered meal choices and supported to have their meal. On Cedar Oak staff sat having their meal with people which helped ensure people ate their meal and added to the social nature of the mealtime.
There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.
People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home could give feedback about the quality of care provided in the home.
Staff spoke of an open culture with some areas for improvements specifically around communication and staff performance. The management of the service recognised these concerns from staff and were open to and had taken action particularly around staff performance.
Improvements in the quality of care had been identified through a quality assurance system and action was being taken to address these areas for improvement.
We have made a recommendation about the employment history of perspective employees.