Background to this inspection
Updated
20 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
This inspection which took place on 17 and 18 February 2016 and was unannounced and was undertaken by two inspectors.
The last inspection took place in May 2013 where no concerns were identified.
Before the inspection we looked at information provided by the local authority. We reviewed records held by the CQC including notifications. A notification is information about important events which the provider is required by law to tell us about. We also looked at information we hold about the service including previous reports, safeguarding notifications and any other information that has been shared with us.
Before the inspection, the provider completed a Provider Information return (PIR). A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used the PIR to help us focus on specific areas of practice during the inspection.
Most people living at Crest House were able to tell us about their experiences of living at the home. For those who were not able to talk to us, we carried out observations in communal areas and looked at care documentation to see how they had their care provided. We looked at the care documentation for three people and daily records, risk assessments and associated daily records and charts for other people living at Crest House. All Medicine Administration Records (MAR) charts and medicine records were checked. We read diary entries and other information completed by staff, policies and procedures, accidents, incidents, records, meeting minutes, maintenance and emergency plans. Recruitment files were reviewed for three staff and records of staff training, and supervision for all staff.
We spoke with nine people using the service and four staff. This included the registered manager, care staff and other staff members involved in the day to day running of the service.
We spoke with four relatives visiting the home. We received only positive feedback from everyone we met and spoke to.
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 Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.