Crimson Manor

Crimson Manor is a residential care home providing regulated activity to up to 20 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 16 people using the service.

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

The management of people's weights required improvement as these were not consistently recorded. Most of the audits we looked at were effective, although some needed further detail. Feedback had been gathered by the provider from people and relatives. Findings were acted on and the provider looked at ways they could improve the survey in the future. People, relatives and staff were complimentary about the running of the home.

Risks to people were assessed, monitored and reviewed. We observed a moving and handling incident on the day of inspection and found the provider took appropriate action. People’s care plans sufficiently reflected their needs.

People received their medication as prescribed. Staff were trained and assessed as competent in administering medicines.

People felt safe living in this care home and their relatives agreed. Staff received safeguarding training and knew how to recognise and report abuse.

There were sufficient numbers of staff who had been safely recruited to the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Learning opportunities were identified and acted on. Infection control was discussed at a staff meeting and signage related to COVID-19 was on display in the home. Staff wore their PPE correctly.

People had an enjoyable mealtime experience. They received freshly cooked food and were complimentary about the meals. Special dietary needs were being met.

People received access to healthcare when they needed it. The provider had developed working relationships with healthcare partners.

Suitable adaptations had been made to the home to support people living with dementia. The provider adopted innovative models of care for people living with dementia.

Staff communicated well with people living in the home and showed empathy towards them. Staff were able to describe how they protected people’s privacy and dignity. A programme of activities people responded well to was taking place and plans were in place to have external entertainers return to the home.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 11 October 2019) and there were breaches 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 and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People's experience of using this service: People and relatives told us they felt the home provided safe care. However, during this inspection, we identified concerns in relation to the safety of the care provided.

We found the service had deteriorated since last inspection.

At this inspection, we found failings in the oversight, monitoring and management of the service and we could not be reassured people were always receiving safe care.

During this inspection, we found the service was in breach of regulations in relation to safe care and treatment, consent, person centred care and good governance. We made three recommendations in relation to management of risks to people’s skin integrity, falls and submission of statutory notifications.

The provider had policies and procedures to deal with safeguarding concerns and staff told us about signs of abuse they would report and how, however during this inspection, we identified safeguarding concerns in relation to people having bruises which had not been accurately recorded or fully investigated. We contacted the local safeguarding in relation to these.

We found the provider was not always managing risks to people’s care appropriately. The home’s buzzer system had been inoperative for several weeks before our inspection; the provider had put in place additional checks on people however, we could not be reassured they had taken all the reasonable steps in a timely way to manage the risks associated with people falling or people not being able to summon help. At this inspection, we could not be sure risks to people’s skin integrity were effectively assessed and advice from professionals always incorporated in the care plans and followed. The provider informed us they were aware of the guidance in relation to checking the temperature of the water in people’s baths and showers. They had the appropriate equipment fitted and were checking the temperature of the water every four weeks.

During this inspection, we found the home was not always free of malodours and we identified concerns in relation to infection control procedures. We shared our concerns with the local authority’s infection control team. There were areas of the home that required maintenance and we could not be reassured action had always been taken promptly.

We found people’s medicines were administered in a person-centred way. However, we found improvements were required in the recording of people’s prescribed creams and ‘as and when required’ medication as well as the information recorded during medication audits.

People were supported by staff who told us they were motivated and enjoyed their job. Staff felt supported by their management however at this inspection we found staff were not offered supervision as often as stated by the provider.

We found the quality of care plans was variable; some areas of people’s care plans were individuated, included their choices and preferences and met the needs of people using the service however, other areas lacked detail in relation to important areas of their care.

There was a regular and varied programme of activities at the home and people spoke positively about the activities they were involved in.

Feedback from staff and people was mostly positive and they felt the service was well-led. Relatives shared mixed views in relation to the management of the service. Our findings at this inspection indicate management’s oversight was not robust.

There were several audits in place however these had not always been effective in identifying the issues found at this inspection and in driving the improvements required.

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

Rating at last inspection: At our last inspection the service was rated good. Our last report was published on 22 November 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Please see the 'Action we have told the provider to take' section at the back of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority, clinical commissioning group and safeguarding team.

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

Crimson Manor is a residential home, registered to provide care for up to a maximum of 20 people. Accommodation is provided in single en-suite rooms, over three floors, accessible by a passenger lift. There were 15 people living at the home at the time of this inspection.

The service had a registered manager in post at the time of our 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.

People told us they felt safe living at Crimson Manor. The registered manager and staff were aware of relevant procedures to help keep people safe and staff were aware of signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people’s needs.

Risks to people had been assessed, however, some of these were generic in nature and some did not detail risk reduction measures which were in place for individuals.

Staff had received training in order to administer medicines safely. However, although staff had been trained, they did not always follow correct procedures when administering medicines.

Staff told us they felt supported and we saw staff received regular training and supervision.

Where people lacked capacity and were being deprived of their liberty, the registered manager had made appropriate applications to the supervisory body in order for this to be authorised. The registered manager acted in accordance with the Mental Capacity Act 2005.

People were given choices throughout the day and we saw staff sought consent from people prior to providing care and support.

People received appropriate support in order to have their nutritional and hydration needs met. A variety of healthy snacks and drinks were offered throughout the day.

People’s rooms were clean and personalised. Pictorial signage was used throughout the home, to assist people to navigate around the home.

People told us, and we observed, staff were caring. People’s privacy and dignity were respected.

Care plans were person centred and contained information to enable staff to provide care and support to people. Appropriate information was shared between staff to enable continuity of care.

Complaints were well managed and people we spoke with told us they would feel able to make a complaint if the need arose.

The registered manager was visible throughout the home and knew people’s needs. We were told by staff, family members and a visiting professional that the home was well led.

The registered manager undertook regular audits in order to improve provision of service, although action resulting from these was not always recorded.