Crown House Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some care plans reviewed during our assessment lacked important information about people’s specific needs, and inaccuracies and omissions were found in essential care documentation. For example, care plans failed to include vital information on how to keep people safe and lacked information about their preferences and wishes. This meant staff did not have access to person centred information about people which negatively impacted the care they received.

Although it was noted people’s care records were reviewed frequently, people's assessments did not always reflect the complexity of their needs and so did not support staff to meet these needs and as people’s needs changed, records had not always been updated to reflect the changes.

The provider mostly planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Concerns were identified during the assessment in relation to integrity and protecting people from the risks associated with poor skin integrity. We raised these with the provider during the assessment who took action to remedy the concerns.

People’s assessed needs regarding eating and drinking were taken into consideration by the provider and kitchen team. Some people living at the service had food allergies, and this required them to eat an allergen free diet. The kitchen team were very knowledgeable about people’s needs and went to great lengths to prepare an allergen-free equivalent meal to ensure people still felt included and could enjoy the same menu as others living at the service.

Food preparation areas were kept separate, along with food storage, and kitchenware had been purchased to enable the items used in allergen free meals to be kept solely for this purpose.

People were offered plenty of fluids and snacks throughout the day.

Nationally recognised clinical tools were used to assess and monitor risks to people, such as Waterlow to record a person’s likelihood of skin breakdown.

The provider mostly worked well across teams and services to support people.

Concerns were identified during the assessment around the poor management of delegated healthcare tasks. The provider could not evidence they had worked with local partners to source the correct level of training for staff. The provider took action following us sharing our serious concerns, and contacted stakeholders to arrange training for staff in this area.

Staff worked closely with the local GP practice who ran weekly GP ward rounds in the service.

The local GP provided positive feedback during our inspection process, and told us, “The staff know the residents very well and can provide reliable and helpful information to me. They are able to report when there is a change in a resident’s health or mood. I find they raise very sensible queries, and report concerns appropriately and in a timely manner. If I request further information such as a blood pressure or photo to be sent, they respond efficiently. Staff follow my advice appropriately and request review for patients when there are ongoing concerns.”

The provider did not always support people to manage their health and wellbeing, so peoplecould not always maximise their independence, choice and control. Staff did not always supportpeople to live healthier lives, or where possible, reduce their future needs for care and support.

Whilst people spoke positively of the service and the support they received, we identified a number of risks which meant people did not always experience positive outcomes in respect of their health and wellbeing. Critical information was found to be missing from several people’s care plans and this meant staff did not have the necessary information to support them to manage their healthcare needs.

Management and staff worked with relatives and healthcare professionals to ensure people had access to healthcare. Health professionals such as district nurses and therapists visited regularly to review people’s health needs.

Feedback from a visiting District Nurse was positive, with them telling us they felt the staff and provider were, “on top of everything” and that staff complied with any requests.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Where people lived with diabetes, and required support to manage this safely, we found inconsistent records demonstrating safe care, and that staff did not have the necessary training to be able to support people in a safe manner.

This was raised with the provider, who liaised with a Diabetes Specialist, and organised the required training for staff to complete.

The provider did always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider failed to ensure the correct procedure was followed in relation to the Mental Capacity Act 2005 (MCA). The Mental Capacity Act (MCA) 2005 provides a legal framework for supporting people who may lack the ability to make certain decisions for themselves.

Although staff supported people with day-to-day decisions, mental capacity assessments were not completed in line with the requirements.

Mental capacity assessments had not been carried out when specific decisions needed to be made, such as, receiving support with diabetes management, when sensors were implemented to monitor a person’s movement, and drinking alcohol whilst taking specific medicines. Where capacity assessments had been carried out, records did not demonstrate how people were supported to be involved in making decisions and some assessments lacked sufficient detail.

None of the staff employed at the service had evidence within their training records to show they had completed Mental Capacity Act training.

Following the inspection, the provider told us they had immediately arranged training in this area for staff.