27 July 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Two inspectors, a medicines inspector and an Expert by Experience undertook the inspection on the first day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector visited the service on the second day.
Service and service type
Crawshaw Hall Medical Centre and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Crawshaw Hall Medical Centre and Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced on the first day.
What we did before the inspection
We reviewed information we had received about the service, such as notifications. These are events that happen in the service that the provider is required to tell us about. We also sought feedback from the local authority and from the medicines optimisation team based at East Lancashire Hospitals Trust.
The provider completed a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We observed how staff provided support for people to help us better understand their experiences of the care they received. We spoke with 8 people living in the home, 2 relatives, 6 members of care staff, the positive behaviouralist, the occupational therapist, the deputy manager, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We carried out a visual inspection of the premises with the registered manager and reviewed a range of records. This included 4 people’s care documentation, 2 staff files and 8 people’s medication records. We also reviewed a range of records relating to the management of the service.
After the inspection
Following the inspection, the nominated individual sent us additional information in response to the inspection findings.
27 July 2023
Crawshaw Hall Medical Centre and Nursing Home is a residential care home providing accommodation and nursing care for up to a maximum of 50 people. The service is provided in 2 interlinked buildings known as Orion Court and Ariana Court. At the time of the inspection, there were 39 people accommodated in the service.
People’s experience of using this service and what we found
People told us they felt safe living in the home. Staff had received training on safeguarding vulnerable adults and had access to the provider’s policies and procedures. The registered manager agreed to refresh staff knowledge on external reporting procedures. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. There were shortfalls in the recruitment records of 2 staff. The nominated individual addressed this issue following the inspection. Individual and environmental risks had been assessed and managed. People were protected from the risks associated with the spread of infection.
The service managed medicines safely, however we recommended care plans to support staff to administer ‘when required’ medicines were reviewed to make sure they were person centred and in place.
People were supported to eat and drink. However, we made a recommendation about improving people’s dining experiences. 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. People's needs were assessed prior to them using the service. There was ongoing training for all staff. Staff were supported with regular supervisions and were given the opportunity to attend regular meetings.
People were mostly complimentary about the service provided. People’s rights to privacy and independence were promoted and maintained. However, we observed some staff comments compromised people’s dignity. The management team agreed to investigate this issue further and remind staff about the importance of respectful interactions. People were supported to express their views on the service and their care.
All people had an electronic care plan which was updated regularly and in line with people’s needs. Whilst the provider had records to demonstrate a variety of activities were offered in the home, people spoken with told us they had little to do to occupy their time. The nominated individual explained an activities coordinator was due to commence work in the home. People had access to an easy read complaints procedure and there were arrangements to record and investigate any concerns.
The provider and the management team carried out a series of audits to check and monitor the quality of the service and ensure records were completed accurately. The provider and registered manager considered the views of people, their relatives and staff in respect to the quality of care provided and used the feedback to make ongoing improvements to the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for the service was good (published 30 January 2021).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have made recommendations in respect of reviewing care plan information to ensure staff had access to appropriate protocols for the administration of medicines prescribed ‘when required’ and improving people’s dining experiences.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.