Cressington Court 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 people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of legal regulation in relation to need for consent.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.We observed confusing signage throughout Cressington Court Care Home, including pictures of a chair stuck on the wall. This could be disorientating and stressful for a person living with dementia. We asked the home manager about the pictures, and they could not explain why this picture had been placed on the wall. Some people’s rooms did not have their names on them which could add to confusion, disorientation and increase the risk of accessing rooms which may contain personal items or equipment which may pose a risk to individuals who were unable to maintain their own safety.

People had care plans in place for a known medical condition however, the information was confusing and did not give accurate guidance what support people required with regards to these conditions, and how to identify and respond to signs of change.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. The provider could not be assured they were delivering safe care and treatment because restrictions such as lap straps and sensor mats were being utilised without following the principles of the Mental Capacity Act 2005 (MCA). For example, one person’s care plan stated a lap strap in place however, there was no capacity assessment to support the use of this restriction. This meant there was no evidence the equipment was necessary, proportionate and safely applied. This meant staff could not be assured the measures in place were appropriate, necessary or safely implemented. By not evidencing the principles of the MCA were being followed, people were at risk of unsafe and unlawful care.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. We saw information was difficult to access and some staff did not know where key information such as referrals had been stored. The provider could not be assured they had a system in place for recording and storing key updates for staff to be able to read when required. Some staff raised concerns about use of agency staff and how information was shared between staff. Staff gave examples showing how they had escalated healthcare concerns to people’s GP's, speech and language therapists, and social care professionals.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The provider did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. There was no evidence people were encouraged to participate in planning their care. We saw multiple examples in care records where decisions and discussions were incomplete, not clearly recorded or not signed or dated.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves. We observed communal areas were not always actively supervised. While some people did not require continuous observation, we saw occasions where people were left without staff presence and where responses to people showing signs of discomfort or distress were not always timely. Care plan reviews did not always clearly demonstrate whether people’s care was improving as much of the guidance and information was out of date or still in draft.

The provider did not tell people about their rights around consent or respect these. Where a person lacked capacity to make specific decisions about their care the principles of the Mental Capacity Act had not been followed to ensure decisions made were in the person’s best interests. When restrictions were implemented, the provider did not ensure they involved the right people in the decision-making process to ensure decisions were made in the person’s best interest. For some people, restrictions were implemented without evidence of a Mental Capacity Assessment or best interest decision being in place.