Archived: Crantock Lodge

At the time of the inspection there were 10 people living at the service, some of whom were living with dementia. The accommodation is over two floors with a shared lounge and dining room on the ground floor. The first floor is accessed either by a passenger lift or stairs, which are fitted with a stair lift.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We spent most of the inspection in the shared lounge and dining room observing and talking with people. There was a calm and relaxed atmosphere at the service throughout the day of the inspection visit. People and staff welcomed us into the service and were happy talk to us about their views of living and working there.

People received care and support that met their needs because staff had the skills and knowledge to provide responsive and personalised care. People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, “You couldn’t wish for more than we have here”, “I love everything about it here. We are lucky to have this place”, “I like things right and they are right here”, “It’s very, very good here. I get on well with the carers” and “I have a lovely room. I like it here, no problems.”

People’s care plans contained personalised information about their individual needs and wishes and they were involved in the planning and reviewing of their care. These care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Incidents and accidents were logged, investigated and action taken to keep people safe. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risk assessments had been kept under review and were relevant to the care provided.

Safe arrangements were in place for the storing and administration of medicines. People were supported to access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. Staff enabled people to eat a healthy and varied diet. People told us they enjoyed their meals and there were ample choices on offer.

There were activities available for people to take part in such as, board games, cards, arts and crafts, quizzes and external entertainers. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff knew how to recognise and report the signs of abuse. Staff were supported to develop the necessary skills to carry out their roles through a system of induction, training, supervision and staff meetings.

There was a positive culture within the staff team and the management provided supportive leadership. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. People and their relatives described the management of the service as open and approachable.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The service had a suitable complaints procedure.

Further information is in the detailed findings below.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focussed inspection on the 21 March 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crantock Lodge on our website at www.cqc.org.uk

Crantock Lodge is a care home for up to 14 older people, some of whom who are living with dementia. At the time of the focused inspection there were 10 people living at the service.

There was a registered manager in post. 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.

At this focused inspection we found the registered provider had taken action to address the concerns found at the last inspection. People’s care plans had been put into a new format and had been reviewed regularly. Risks were identified, assessed and regularly monitored and daily care notes helped ensure any changes in a person’s needs were recorded.

There was a process for recording all medicines that arrived and were returned from the service. The Medicines Administration Record (MAR) clearly showed people received their medicines as prescribed. The registered manager was auditing the medicines management each month and addressing any issues that arose.

Staff had attended training on the MCA and associated DoLS and had access to a comprehensive information folder including key facts on the legislation together with easy read formats for people who required this.

Accidents and incidents that took place at the service were audited and action taken to help reduce the risk of re-occurence. Staff were supported by the registered manager through staff meetings. This gave staff the opportunity to meet up and share their views and information was shared.

A recent survey carried out in July 2016 received positive responses from people, their families and friends. Any issues raised had been addressed by the registered manager.

Regular audits of infection control, first aid provision and medicines held ensured the service was monitoring the service provided and identifying any improvements that may been needed.

The service was clean and well maintained. There was a vacant room being re-furbished at the time of this inspection. There were no unpleasant odours found anywhere in the service. Equipment such as the lift, call bell system and moving and handling aids were regularly serviced to ensure they were safe to use.

People sent many compliments and thank you letters to the service for providing good care and support to people. People were able to access the details of the complaints procedure should they need to raise any concerns. The service displayed the latest comprehensive CQC report and notified CQC of any events or incidents such as deaths that occurred at the service as they are required to do by law.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Crantock Lodge on the 14 January. The registered manager was not present and as we needed to discuss some issues with the registered manager we revisited the service on the 28 January 2016.

From our visits we found that some systems in the service needed to be more robust. The registered and deputy manager acknowledged that people’s care plans needed further development and had started to address this. We saw examples in some care plans where certain care needs, such as information regarding people’s social and emotional wellbeing were not up to date. We found examples where people’s physical needs had changed but this had not been up dated on their care plans. As staff had worked at the service for some time they knew people’s care needs well and had ensured people received appropriate care but the paperwork was not as current as staff knowledge. This could cause potential errors especially if new staff joined the service.

From our visit certain process had been amended. For example medicines systems needed further development to ensure they were safe. We also found that staff lacked an understanding of the Mental Capacity Act and Deprivation of Liberties Safeguards (DoLS). This meant that people who had some restrictions on their liberties placed in their best interests in order to keep them safe had not been referred to the DoLS team for assessment. This was not following legislative practice. We were reassured that staff training in this area had been arranged.

The registered manager was aware that some of the services auditing processes needed more development. For example the registered manager investigated and reviewed incidents and accidents in the home. But the risk assessment format needed further development to provide guidance to staff in how to minimise further risks. We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We saw people were happy living at Crantock Lodge. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. People’s comments included; “It is good here” and “I couldn’t find anywhere better than this.” People felt staff responded to their needs promptly and were; “Fantastic” and “Marvellous.” People told us they were completely satisfied with the care provided and the manner in which it was given.

People looked well cared for and their needs were met quickly and appropriately. People who used the service and their relatives were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs.

People told us; “Staff are very friendly, I feel safe and secure and don’t worry.” Relatives felt their family member was cared for safely. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the persons wishes and preferences. Relatives felt this gave staff a very good understanding of their family member and how they could care for them.

People were supported to live their lives in the way they chose. People’s preferences in how they wanted to spend their day were sought, listened to and respected. Activities were provided by the service individually and in a group format, such as for arts and crafts and through outside entertainers coming into the service. Visitors told us they were always made welcome and were able to visit at any time.

Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. During our visit a person required emergency assistance. Staff were quick to recognise that the person needed emergency treatment and promptly contacted the relevant services. They provided paramedics with the information needed to ensure the correct treatment could be provided. Once paramedics had left managers reviewed how often the person needed monitoring and ensured all staff were made aware of the current situation. This showed that staff responded effectively to the person’s changing health needs.

People told us staff were very caring and looked after them well. We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a really good knowledge of the people they supported. Peoples' privacy, dignity and independence were respected by staff. At this visit we undertook direct observations to see how people were cared for by staff. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. People said that staff respond to the call bell promptly, which we observed. Relatives echoed this view commenting staff were always available if they had any queries at any time. One relative who worked in the care sector stated “If I had those staff I’d be more than happy. I am very confident with them.” Relatives told us staff were; “competent and professional.”

Staff told us they attended meetings (called supervision) with their line managers. Supervision meetings provided an opportunity to review the staff members aims, objectives and any professional development plans at regular intervals. Staff had an annual appraisal to review their work performance over the year.

Staff received a thorough induction when they started work at the service and fully understood their roles and responsibilities, as well as the values and philosophy of the home. People and relatives felt staff were skilled and competent to undertake their job.

We saw the service’s complaints procedure which provided people with information on how to make a complaint. People and relatives told us they had no concerns at the time of the inspection and if they had any issues they felt able to address them with the management team.

The registered manager promoted a culture that was centred on people’s needs. People told us how they were involved in decisions about their care and how the service was run. The management and running of the service was ‘person centred’ with people being consulted and involved in decision making. People were empowered by being actively involved in decision making so the service was run to reflect their needs and preferences.

The service was keen to gain the views of people’s relatives and health and social care professionals. Some of this was completed via a questionnaire and the results of these were compiled in a report which identified areas for improvement and any actions the provider needed to make.