Archived: Cromwell Court Care Home

Cromwell Court is a two-storey purpose-built building that is situated in the centre of Warrington. Cromwell Court is registered to provide personal care for up 67 older people, some of who are living with dementia.

Accommodation can be found across four separate units, each of which have separate adapted facilities. At the time of our inspection, 31 people were living across two of the ground floor units.

People’s experience of using this service and what we found:

People's level of risk was established from the outset, however some people did not have the relevant risk assessments in place and not all risks were effectively recorded or monitored.

Quality assurance measures were in place however these were not always effective. We identified a number of concerns during the course of the inspection in relation to the quality and safety of care people received.

Medication processes were in place; although it was identified that some areas of practice could be improved to ensure people received a safe level of care.

At the time of the inspection there was no activities co-ordinator in post; however, this area of responsive care had improved since the last inspection.

Complaints processes had improved since the last inspection. Complaints were recorded, regularly reviewed and monitored.

Staffing levels were analysed and assessed in relation to the dependency support needs of people who were living at Cromwell Court. Pre-employment checks were carried out and people received care by staff who had been appropriately recruited.

Staff were supported with training, learning and development opportunities. Staff received regular supervision and told us they felt supported on a day to day basis.

Safeguarding and whistleblowing procedures were in place. Staff received appropriate training and understood the importance of keeping people safe.

People and relatives told us that staff provided care in a dignified, respectful and compassionate manner.

A person-centred approach to care was provided. Care records contained person-centred information and we observed staff providing care and support that was tailored around the needs of people living at Cromwell Court.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 14 August 2018) as we identified a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, however the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment people received and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cromwell Court Care Home was previously inspected in January 2017. During the inspection we found breaches of Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered person had failed to maintain accurate records necessary for the management of the regulated activity. Furthermore, we found that the registered person had failed to clearly demonstrate that staff employed by the service had received training appropriate to the work they perform.

At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection.

During this inspection we found a breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 related to notification of incidents.

We found that the registered person had not always notified the Commission of incidents or allegations of abuse. We have written to the provider regarding their failure to notify us.

Cromwell Court is a ‘care home’ run by DRB Healthcare Limited. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home is two-storey purpose built building that is situated in the centre of Warrington. It is located close to bus routes, a train station, local shops and other public amenities.

Cromwell Court is registered to accommodate up to a maximum of 67 people across four separate units, each of which have separate adapted facilities. The home was awaiting refurbishment work to commence on the first floor and therefore only two units on the ground floor were in use. At the time of our inspection, the care home was therefore accommodating 27 people.

The care home did not have a registered manager. 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.

The care home provided a homely, comfortable and relaxed environment for people to live in. People could receive visits from family members and friends each day and staff were seen to be attentive and responsive to the needs of people using the service.

We found that people’s needs had been assessed and planned for and that a range of risk assessments had been completed to ensure staff were aware of how to keep people safe.

Appropriate arrangements were in place for checking the environment was safe. For example, equipment and services were routinely serviced and health and safety audits were completed on a regular basis. Accidents and incidents were also reported and recorded appropriately.

The provider had developed policies and procedures relating the Mental Capacity Act 2005 and deprivation of liberty safeguards. Staff had completed training in this key legislation and staff spoken with understood the needs of the people they cared for including people who lacked capacity. People were observed to have choice and control over their lives and staff supported them in the least restrictive way.

We found that staff’s suitability to work with people using the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken.

Staff had received access to induction, mandatory, service specific and qualification level training in addition to formal and informal supervision. This helped to equip staff with the necessary knowledge and skills to ensure people received appropriate care.

Systems were in place to ensure medication was managed safely and people’s medication was kept under review with the assistance of a dedicated care home pharmacist from the Clinical Commissioning Group.

People were supported to attend healthcare appointments and staff liaised with GPs and other health care professionals when required.

The provider had a quality assurance system in place that included seeking the views of people who used the service and their representatives and monitoring of the service.

People using the service had access to a choice of wholesome and nutritious meals that were well presented and took into consideration each person’s dietary needs.

We have made a recommendation about the provision of activities in the care home in response to feedback from the last service user questionnaire and satisfaction levels. This will help to ensure people receive activities that meet their social, recreational and leisure expectations.

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This was the first inspection of Apple Court following a change of service provider.

Apple Court Care Home is a purpose built care home located in the centre of Warrington. It offers accommodation, personal and / or nursing care for up to 67 older people with memory problems associated with dementia. At the time of our inspection the service was providing accommodation to 47 people.

At the time of our inspection one of the area managers was registered as the manager of the service. 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.

A home manager had recently been appointed who was due to apply for registration with CQC as a matter of priority. The home manager had extensive experience in the management of residential services for people living with dementia.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of good governance and staffing. A number of audits could not be located during our inspection and significant gaps in training were noted for some staff. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we undertook a Short Observational Framework for Inspection (SOFI) during our inspection and noted that people using the service appeared calm and relaxed in their home environment. We also saw that staff interactions were positive and that people using the service were treated with dignity and respect.

Systems had been established to ensure that staff working at Apple Court had been correctly recruited and to ensure people were protected from abuse. A complaints process was also in place to ensure concerns and complaints were listened to and acted upon.

People had access to health care professionals subject to their individual needs and medication was ordered, stored, administered and disposed of safely.

The home was going through a period of transition following the registration of a new provider. The management team shared with us their future plans and demonstrated a commitment to addressing outstanding issues and to developing and improving the overall service provided at Apple Court.