Archived: The Crest Care Home

At the last inspection in July 2017 we found the provider had breached five regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, staffing, recruitment, and overall oversight of the home. Also Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 requirement to notify. We asked the provider to take action to make improvements and this action has been completed.

A new company HC-One Limited has become the provider of the service since December 2017.

The service is a ‘care home’. 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 service can accommodate up to 31older people and younger adults, some of whom may be living with dementia. 23 people lived at the service when we inspected.

(A manager was in post. Following the inspection they were successful in becoming a registered manager.) They are referred to as registered manager in this report. 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 registered manager had a very clear vision of what high quality person centred care looked like. Firstly, they have safely recruited a staff team who shared their vision. They have supported the staff team through effective training, coaching and supervision to implement the changes needed to ensure quality and safety. Secondly, they have effectively used the provider’s quality assurance processes and have been a visible supportive presence in the service to achieve this.

Part of the outcome of this work has meant systems and arrangements have improved relating to health and safety, staffing, recruitment, medicines management and safeguarding people from abuse.

The registered manager and provider were aware of the areas which still required improvement. At this inspection we found clearer records and communication was needed to ensure risks to people receiving care were known by staff. The registered manager responded immediately during the inspection to make improvements needed. This proactive approach was also seen when accidents or incidents occurred, as the registered manager reflected and analysed the situation to put changes in place to prevent a reoccurrence.

Staff treated people with dignity and respect. Staff displayed a caring and compassionate attitude towards people. People and their relatives agreed with this. Staff were aware of people’s preferences, likes and dislikes and they used this knowledge to deliver care for people how they wanted it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. Where people displayed anxiety or distress staff responded with kindness and patience. Staff knew how to intervene to support the person to become calm. The team were working together to understand people more so they could promote people feeling confident to engage in personal care or tasks they found stressful. This meant the culture of the service was person centred.

Healthcare professionals were involved in supporting people to achieve good health outcomes; this included their nutrition and hydration needs.

People and their relatives were listened to when they had concerns or ideas to improve the service.

The Crest Care Home is a large property which consists of a Victorian main building with modern extensions. The service can provide personal care for up to 31 older people. At the time of our visit 20 people lived at the Crest Care Home.

A registered manager was in post but was not at work at the time of the 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 2008 and associated Regulations about how the service is run.

We found that staff morale was low when we visited. Staff had not received appropriate induction, support and training to enable them to feel confident in their role. The staff team was made up of a small group of staff employed to work at the service and Bupa staff who worked elsewhere in the company, plus agency workers. Because these staff had not received the induction, support and training required they did not know people’s needs as they should. This had led to a risk that people might not receive the support that had been agreed with them. This had also led to systems such as falls management, fire evacuation and medicines management not being robust enough to provide staff with the details on how to prevent avoidable harm.

We saw the provider had failed to ensure incidents they are required to inform the CQC about had been reported. This is being addressed outside of the inspection process.

Staff were aware of the signs of abuse and felt confident in how to report such concerns.

We saw the recruitment of staff and agency workers was not robust enough to ensure staff had good character and were suitable to work with vulnerable people before they commenced employment. The provider has assured us of the improvements made since the inspection visit. We saw the mealtime experience for people which included choice of food, environment and staff approach could be better. The area director explained the dining room was due to be moved to another area of the home to assist with this.

People and their relatives told us that they found staff caring and that staff treated them with respect. People told us overall they felt happy living at the service. People’s nutrition and fluid intake (where needed) was monitored and we saw appropriate professionals had been involved if required.

People were offered choices and staff understood how to empower people to make such choices. This meant they were working within the principles of the Mental Capacity Act. Records to evidence this practice were being updated to make them more effective.

The inconsistency of staff was an issue. This had also impacted on the opportunities available for meaningful activities.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

People knew how to raise concerns and felt they received an inconsistent approach as to whether their day to day concerns were dealt with or not. Formal complaints had been dealt with appropriately.

The quality assurance systems in place had not highlighted all of the concerns outlined above and therefore were not effective enough to ensure a quality and safe service for people. The provider had responded to some of the issues prior to the inspection by deploying a registered manager from another service to oversee and provide leadership at The Crest Care Home, alongside support from their regional quality and support team. This had already impacted positively on recruitment and quality at the time of the inspection.

Breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. These related to safe care and treatment, person centred care, staffing, fit and proper persons employed and good governance. You can see what action we told the provider to take at the end of this report.