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Archived: Crest House Care Home Requires improvement

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 April 2016

Crest House is a care home in St Leonards-on-Sea, registered to provide residential care for up to 25 older people. There were 19 people living at the home at the time of the inspection with one person staying for a period of respite care.

People required a range of help and support in relation to living with memory loss, dementia and personal care needs.

The home is two houses which have been converted into one building with large communal rooms. The home has a passenger lift and wide staircases with handrails to assist people to access all areas of the building.

This was an unannounced inspection which took place on 17 and 18 February 2016.

Crest House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risk assessments and care documentation had not been completed for all identified care needs. For example pressure area care and diabetes. When changes to people’s health and care needs had occurred this information had not been clearly updated, we saw that accidents and incidents had not been documented consistently and wound maps did not contain dates to show when injuries had occurred.

Mental capacity assessments had not been completed and information in relation to decision making for people was unclear. Training and in house procedures had not been updated to ensure that all staff were aware of current protocols and guidance around MCA and DoLS.

We found that recruitment information needed to be improved to ensure a clear picture was available to evidence that new staff had appropriate checks and training completed before they commenced work. Induction information was not completed in all staff files seen.

Medicine systems and ‘PRN’ procedures needed to be improved. Checks when people moved into the service were not robust. This meant that people may be at risk of receiving medicines in an inappropriate manner.

Robust systems were not in place to ensure the continued assessment and monitoring of systems within the home. Notifications had not been completed by the registered manager or provider in a timely manner.

The registered manager was in day to day charge of the home, supported by a deputy manager and the registered provider. People and staff spoke highly of the registered manager and provider and told us that they felt supported by them. Staff told us that the manager spent most days at the home and therefore had a good overview of the home and knew everyone living there well.

We received only positive feedback from people, staff and relatives. People felt that Crest House was homely and had a warm and open atmosphere.

Staff felt that training provided supported them to provide the best care for people. Staff were encouraged to attend further training, with a number having achieved National Vocational Qualifications (NVQ) or similar and staff were supported by a programme of regular supervision. Staff demonstrated a clear understanding on how to recognise and report abuse.

People were encouraged to remain as independent as possible and encouraged to participate in regular activities. People had their privacy and dignity respected and staff knew people and their preferences well.

Feedback was gained from people and meetings had taken place.

People gave positive feedback about the food and told us the food was ‘Very good.”. People’s nutritional needs were monitored and people had a choice of meals provided. Staff were aware of people’s likes and dislikes and we saw that meal times were a positive interactive experience for people. People who required assistance had this provided by reassuring and patient staff.

We found a number of breaches of Regulations of the Health and Social Ca

Inspection areas

Safe

Requires improvement

Updated 20 April 2016

The service was not consistently safe.

Individual risks to people were not always identified to ensure people remained safe at all times.

Individual and environmental fire risk assessments needed to be reviewed to ensure people�s safety was maintained.

The services response to accidents, incidents and wounds was not consistent.

There were enough staff to meet people�s needs. Call bells were answered promptly and staff had time to provide care to meet people�s individual needs.

Staff displayed a good understanding around recognising and reporting safeguarding concerns.

Effective

Requires improvement

Updated 20 April 2016

The service was not consistently effective.

MCA had not been completed to show how decisions around people�s capacity and ability to consent to care and treatment had been made. For people who lacked capacity to make decisions it was unclear who was legally entitled to make decisions on their behalf.

Appropriate training and protocols had not been maintained in relation to MCA and DoLS. Induction and training information was not fully completed in staff files.

Staff felt supported by the manager and provider and received regular supervision.

People enjoyed the meals provided. Meal choices were available and people were encouraged to maintain a balanced diet. People�s weights were monitored.

Caring

Good

Updated 20 April 2016

The service was caring.

Staff knew people well and displayed kindness and compassion when providing care.

People given support when needed and treated with patience and dignity.

Relatives felt welcome to visit and all times.

Responsive

Requires improvement

Updated 20 April 2016

The service was not consistently responsive.

Documentation needed to be improved to ensure information was person centred, up to date and included all relevant health care needs.

Activities were provided for people to allow them to spend time doing things they enjoyed.

People felt that the home kept them informed of changes. People�s views and feedback had been sought.

A complaints procedure was in place and displayed in the main entrance area for people to access if needed.

Well-led

Requires improvement

Updated 20 April 2016

Crest House was not consistently well led.

Crest House did not have a robust system in place to continually assess and monitor the quality of service provided. Audit information was not always documented.

Analysis of falls, accidents and incidents had not taken place to identify areas for improvement.

There was a registered manager in place who was supported by the registered provider.

Staff and people living at Crest House and relatives spoke highly about the manager and provider.