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Archived: Crawfords Walk Care Home

Overall: Inadequate read more about inspection ratings

Lightfoot Street, Hoole, Chester, Cheshire, CH2 3AD (01244) 318567

Provided and run by:
Bupa Care Homes (CFHCare) Limited

Important: The provider of this service changed. See new profile

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Background to this inspection

Updated 24 June 2017

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.

We visited the service on 27 and 28 March and the 5 June 2017. Our inspection in March 2017 was unannounced on the first day of our visit and the inspection team consisted of one adult social care inspector. On the second and third days of our visit three adult social care inspectors and an inspection manager visited the service. Our visit on the 5 June 2017 was an unannounced and took place at 6am in the morning.

We spoke with thirteen people who used the service and eight of their family members. We also spoke with seventeen members of staff, the home manager and area director. We looked at the care records relating to thirty eight people who used the service, which included, care plans, daily records, supplementary charts and medication administration records. We observed interactions between people who received support and staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed care and support in communal areas and staff interaction with people during a mealtime.

Prior to the inspection we reviewed the information we held about the service including notifications of incidents that the registered provider sent us since the last inspection, complaints and safeguarding information. We also contacted local commissioners of the service, prevention of infection and control teams and the safeguarding teams who had previously visited the service to obtain their views. They informed us that the service was continuing to make improvements to service delivery.

Overall inspection

Inadequate

Updated 24 June 2017

This inspection was carried out on 27and 28 March 2017 and was unannounced on the first day. Following our inspection visit in March 2017, CQC received concerns regarding unsafe care and institutionalised poor practice undertaken at the service. A further unannounced visit was undertaken on the 5 June 2017.

Crawford's Walk nursing home comprises of four purpose-built units in the Hoole area of Chester. The service is owned and operated by BUPA care homes. Northgate is a unit for people with enduring mental health illness, Watergate and Eastgate are units for people living with dementia and Bridgegate unit provides support for those with physical health needs. At the time of our inspection there were 109 people living at the service.

At the time of our March 2017 visit the service was not managed by a person registered with the Care Quality Commission (CQC). 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. Subsequent to our visit the manager was successfully registered with CQC in April 2017.

At the last comprehensive inspection on the 16 and 17 May 2016 we identified a breach of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and found that a number of improvements were required at the service. The registered provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of care. Consent to care and treatment was not always sought in line with relevant legislation. The registered provider was issued with a requirement notice for Regulation 11 and a warning notice for Regulation 17. We asked the registered provider to take action to address these areas.

At our subsequent focused inspection on the 8 and 9 August 2016 we identified a breach of regulations 10, 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and found that further improvements were required at the service. People were not always protected from the risk of unsafe care and treatment or supported or treated in a dignified and respectful manner. Staffing levels at the service were insufficient to meet people’s needs and the skills and knowledge of staff to effectively undertake their roles required improvement. The registered provider was issued with a requirement notice for Regulation 18 and a warning notice for Regulations 10 and 12. We asked the registered provider to take immediate actions to minimise the risk of harm to people supported.

We told the registered provider they would need to meet legal requirements in relation to the breaches identified by 3 October 2016. This inspection found continued breaches of Regulation 10, 12, 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

People living on Bridgegate and Eastgate units were not always treated with dignity and respect. We identified continued institutional practices in place between the day and nights shifts. People’s human rights and choices had not always been respected and this had not been identified or addressed by the registered provider. People’s personal appearance was not always well maintained. Language used in care records at the service did not always afford people dignity and respect.

Staffing levels on all units were regularly assessed by the registered provider through the use of a dependency assessment tool. However, people told us and our observations showed that care and support during the day time was not always provided to people in a timely manner on Bridgegate and Eastgate units. Our visit on the 5 June 2017 identified that staffing levels on Watergate unit did not effectively meet the needs of people supported. Allocated 1:1 support hours on Eastgate unit were not fulfilled. This placed people at the risk of harm due to a lack of staff, reduced observation and support.

The quality assurance systems in place were not effective. We found continued issues as part of our inspection relating to the analysis of accident and incidents, accurate completion of supplementary charts and care records at the service. Information analysed regarding accidents and incidents was not always accurate or reviewed in line with the registered providers own timescales. There were no actions recorded to identify that the registered provider had considered risks, patterns or changes required to people’s care needs. Quality assurance systems used by the registered provider had not identified issues we raised as part of this inspection.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. The registered provider had policies and systems in place regarding the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff practice on Northgate and Watergate units showed that consent was sought (where possible) from people prior to care being provided. However practice observed on Bridgegate and Eastgate units did not afford people the right to make decisions about their morning care routines. During our visit of 5 June at 6am we found that several people had been washed, dressed and placed back in bed. Records evidenced how people’s capacity had been assessed and how decisions had been made in people’s best interests in line with the Mental Capacity Act (2005). However, this information was not always adhered to or respected by staff.

People had access to regular drinks and food. The registered provider had supplementary records which were used to record food and fluid intake for people who may be at risk of dehydration and malnutrition. However, we found that charts were not always completed effectively or in a timely manner by staff. There were gaps of up to 20 hours where no food or fluid intake had been recorded. Information relating to what people had eaten was not always completed in detail to accurately reflect what they had consumed. Food and fluid charts were not consistently totalled to accurately assess whether people had received adequate food and fluids to protect them from the risk of dehydration and inadequate nutrition.

Personalisation of care plans had improved and records contained information about people’s individual preferences about how they would like their care and support to be provided. However, we noted information relating to peoples preferred night routines was limited. Advice and guidance was sought from other professionals where appropriate to ensure that people remained well. However, records viewed did not always evidence how, why and what decisions had been made where people required the use of ‘thickening agents’ in their fluids.

New staff underwent an induction programme, which included training relevant to their role and shadowing experienced staff, until they were competent to work on their own. Staff confirmed they had received supervision and training in line with the registered provider’s own timescales. We noted that mental health training had not been provided to staff working on Northgate unit. The registered provider confirmed following our inspection that training had been accessed and dates had been arranged for staff to attend. However, observations of institutionalised practice during our visit on 5 June 2017 raised concerns with regards to the level of supervision, training and competency assessments undertaken by the registered manager and provider.

Health and safety checks had been carried out and equipment serviced. The service was clean and the manager and maintenance staff carried out regular checks of the environment to ensure it was safe. However, during our visit on the 5 June 2017 we noted that a fire exit on Bridgegate unit was blocked. We raised this with the registered provider and asked them to take immediate action to address this concern. Following our inspection the Fire authority confirmed that appropriate actions had been taken by the registered provider to minimise risk.

People or their family member’s involvement in the review of care plans was not always clearly recorded. Care plans and risk assessments for four people living at the service had not been reviewed or updated following the receipt of important information or incidents that had occurred. Actions taken in response to changes had not been recorded by staff. The registered provider completed a review following our visit and provided us with updated care plans for these people.

Day staff morale had improved and there was a more relaxed atmosphere throughout the service. Discussions with night staff identified that improvements had started to be made, however the shortage of night staff continued to impact on their roles. We noted that staff who usually worked on days had been requested to undertake night shifts to cover staff shortages. Day staff were aware of the importance of encouraging people to maintain their independence and respecting their confidentiality. Family members said they had always been made to feel welcome when visiting.

The majority of people we spoke with said they were happy with the service that they received and that they felt safe. The registered provider had clear policies and procedures in place for reporting any concerns they had about the safety and well-being of people they supported.

Medication management on Watergate and Eastgate units was good. People received their medication as prescribed and staff were competent in the administration and management of medication. Medication administration records