Overall summary This inspection took place on 30 November and 1 December 2014. The inspection was unannounced. The previous inspection was carried out 22 May 2013 and there had been no breaches of legal requirements at that time.
Crossley House is registered to provide accommodation for up to a maximum of 17 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 16 people living in the care home.
A registered manager was not in post at the time of inspection. 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 and associated Regulations about how the service is run. The home did have a registered manager in post.
People in the home were not always safe. We found errors in the recording and auditing of medicines. This was around the maintaining of stock levels, administration of medicines and lack of effective auditing process.
One person did not attend a medical appointment that should have taken place. The manager or staff had not noticed the appointment hadn’t taken place. This person was placed at risk of not receiving safe care.
Staffing levels were not always sufficient to meet the current needs of people living in the home. The majority of staff and some relatives told us that staffing levels were insufficient at peak times, especially during the evening.
Some people’s risk assessments lacked detailed guidance for staff to follow as they were not always comprehensively completed. This meant that staff did not have full information to ensure people were kept safe and protected from harm
Not all records were completed fully. Some people’s care files lacked recordings in relation to their care and treatment. This included nutritional recording charts. This posed a risk to people’s individual needs not being met effectively.
People were not always protected from the risks associated with Infection Control. The home did not follow the Department of Health infection control guidelines or similar guidance. Areas of the home were cluttered and the laundry and kitchen were not clean. Some staff did not use the correct procedures when handling used laundry.
Some people had not received food hygiene training and were involved in the meal preparation. Therefore people could be at risk of food borne illnesses.
People were happy with the food and drink they received in the home. However we observed a mealtime where some people’s needs were not being met effectively. We found that some people did not receive the support they required.
The provider had not ensured that staff had the knowledge and skills they needed to carry out their roles effectively to ensure people who used the service were safe. Some staff had not completed their safeguarding adults training to ensure their knowledge was current and in accordance with current guidance.
Staff had training and awareness of the Mental Capacity Act 2005. Documentation confirmed correct processes had been followed. Staff that we spoke with had a good understanding of the processes that needed to be followed.
There were positive and caring relationships between staff and people at the service. People praised the staff and told us they provided a good standard of care even when they were very busy. We observed people to be relaxed in the company of staff and engaged in conversations.
We received some positive feedback from relatives and visitors while they also acknowledged staffing levels appeared not always to be sufficient.
Some people’s care records demonstrated their involvement in care planning and decision making processes. Some people had signed their documentation. This was confirmed when we spoke with people living in the home and their relatives.
People received regular reviews of their care needs; however we did find the service had failed to ensure some people’s risk assessments were fully reflective of their current needs. We have made a recommendation that the provider reviews peoples risk assessments and ensure they are cross referenced against each element of their care plans.
Staff meetings and manager meetings were scheduled regularly and staff were encouraged to express their views. Meetings were held with people and their relatives to ensure that they could express their views and opinions about the service they received. People could also raise any complaints at these meetings.
Quality and safety in the home was monitored to support the manager in identifying any issues of concern. However they were not robust and had not identified all the shortfalls found during this inspection. This included medicines and infection control.
We found breaches of six regulations relating to medicines, staffing, care of people in the home, records, infection control and quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report.