Crown House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Since the last inspection, the provider had taken significant steps to respond to concerns raised and had implemented safer systems and processes across the home. They had worked constructively with staff, families and partner professionals and had used the learning from the last inspection to strengthen practice. The registered manager told us, “We just carry on embedding the improvements.” Staff also described a culture where people had reflected on the concerns raised and used them as a basis for learning and improvement.

Following accidents and incidents, records now demonstrated the staff were following professional advice appropriately. For example, where falls had occurred, staff were no longer using hoists to assist people from the floor without prior authorisation, and care records were updated promptly after incidents. The new auditing systems also provided stronger oversight of accidents and incidents, particularly in relation to falls.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff described effective handovers at every shift change and told us information was shared clearly both verbally and through the new digital system. One staff member said, “Every shift change has a handover, and [managers] put everything in that we need to know, and on the new system, you can go back and have a look at that as well.”

The management team worked closely with health professionals to support people whose needs were changing. We saw evidence of regular GP involvement, including weekly GP ward rounds, and relatives told us people had access to timely healthcare support. The provider had also increased physiotherapy visits to twice monthly, funded entirely by the provider, which supported ongoing monitoring and review of people’s mobility and physical health needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The registered manager was able to clearly explain safeguarding processes and knew when concerns should be raised and escalated. Although no formal safeguarding alerts had been required since the last inspection, the registered manager demonstrated a clear understanding of the process and who they would seek advice from if needed.

People told us they felt safe living at Crown House Care Home. The provider had strengthened oversight systems and risk management processes since the last inspection, which gave greater assurance that safeguarding concerns would be recognised and acted on appropriately.

DoLS authorisations were in place for people who needed them, and the service understood their role in adhering to any conditions, where relevant.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care plans and risk assessments had improved significantly since the last inspection and now provided much clearer information to guide staff. We found a marked improvement in the quality and detail of risk assessments reviewed during this inspection. The new digital care planning system had enabled staff and leaders to record much more person-centred and specific information about people’s needs, risks and required support.

Risk management had improved in areas previously identified as concerning, including skin integrity, falls and specific health conditions. Where people required monitoring or equipment to reduce risk, this was now recorded clearly and reviewed appropriately. Staff demonstrated a better understanding of the risks people faced and how to manage them. This meant people were receiving care which was safer and more consistent based on their individual needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Significant improvements had been made to fire safety since the last inspection. The provider had installed new fire doors, purchased evacuation chairs, trained staff in the use of this equipment and updated Personal Emergency Evacuation Plans to provide much clearer guidance for staff on how to support people in an emergency. The provider had also complied with all actions on their latest Fire Risk Assessment, and there were no actions outstanding.

The home environment was clean, tidy and homely. Previous concerns with limescale build up had been addressed through replacement of affected taps. People spoke positively about the environment and told us the home was comfortable and pleasant to live in.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were enough staff at the service to ensure people received safe care.

Staff told us training completion had improved significantly and that learning had been prioritised since the last inspection. One staff member said, “The staff have been doing more training, we are all up to date.” Staff also spoke positively about adapting to the recent system changes and improvements, with one staff member saying, “I am proud of myself for being able to change onto the digital systems - I am not normally computer literate so it was quite scary to start with all the change, I think we have done so well.”

Recruitment processes had improved and staff were being recruited safely. We reviewed recruitment records and found these now contained the required checks and documentation.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean, tidy and well maintained, and previous concerns had been addressed. There was plenty of personal protective equipment available throughout the home.

People told us cleanliness standards were good. One person said, “Oh [staff] change the towels everyday – and the flannel.” The general environment was visibly clean, and staff had access to the equipment and resources needed to maintain good infection prevention and control standards. The provider had implemented a new environmental audit which now also included checks on bedding.

The provider ensured that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were now managed safely. Since the last inspection, the service had moved to a new pharmacy which provided printed Medicine Administration Record (MAR) charts, meaning handwritten MAR charts were no longer needed. The provider had also introduced an electronic medicines system which supported clear and accurate recording of medicines administration. We reviewed medicines and found they were being administered at consistent times and in line with people’s prescribed treatment. Where medicines needed to be spaced apart, such as omeprazole and aspirin, this was clearly recorded and followed.

We found improvements in medicines protocols and monitoring. For people prescribed ‘as required’ medicines, appropriate protocols were in place and there was evidence of staff reviewing effectiveness and escalating to the GP when required. Allergy information was clearly visible, the medicines room was clean and tidy, fridge temperatures were recorded regularly, and a sample review of controlled drugs was good. When we asked a person if they received their medicines on time from staff, they told us, “Yes [staff] are pretty good on that.” A relative said, “I can confirm medicines are given at the right time.”