Crowlin House

Crowlin House is a rehabilitation unit for people with severe and enduring mental health issues. The unit offers care for up to 18 people across three houses each of which accommodate six people. There were 16 people using the service at the time of this inspection.

The registered manager confirmed that none of the people currently using the service received personal care. This is help with tasks related to personal hygiene and eating. This inspection considered the wider social care provided.

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

On our arrival staff did not follow the procedure for admitting visitors, therefore we were not fully assured that the provider was preventing visitors from catching and spreading infections. The registered manager undertook to make sure the procedure was being followed in future. We were assured about other areas of infection control. The home had remained free of COVID-19 during the pandemic.

Health and safety checks were completed consistently to ensure the safety of the environment.

We received feedback that staffing levels had been low; however, the provider and registered manager were addressing this concern and improvements had been made. Staff were recruited safely, received a range of training and had access to supervision.

People had access to information and support about safeguarding and how to stay safe. Staff completed safeguarding training and safeguarding matters were investigated. Feedback from some staff indicated that they were not always clear on what happened with concerns that they had raised.

Some staff did not feel well supported to manage risk and did not feel that management were communicating clearly what they were doing. Other staff reported feeling confident about using their training and the risk assessments that were in place. We saw evidence that learning from incidents took place and that this process was being developed further.

Medicines management systems were robust and we were assured that people received the right medicines at the right time from staff who had received appropriate training. People were supported in becoming more independent and confident in managing their own medicines.

Staff involved people in the review of their support plans and risk assessments. People’s support plans were mostly detailed and person-centred and also addressed any risks identified. In one person’s support plan where we identified this was not the case, the registered manager took immediate action to address the issue.

There are issues the provider needs to address in order to support the registered manager in working to create a more positive culture and atmosphere within the service. Feedback from staff and the leadership team showed a sharp division of views. Some staff did not feel valued or listened to by the management. Other staff felt well supported by their colleagues and managers.

The service promoted people’s independence and there was evidence of good outcomes for people moving back into the community.

The leadership team was committed to driving improvements to the service and had a detailed action plan in place to facilitate this.

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 good (published 25 September 2019).

Why we inspected

We received concerns in relation to the management of risk, staffing levels, preventing and controlling infection and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe section of this full report. The provider has a clear action plan to continue to make improvements to the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crowlin House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Crowlin House is a residential care home providing personal care and support to 12 people at the time of the inspection. The service can support up to 18 people whose main need is in relation to their mental health.

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

People told us they were well supported by the staff and managers. Staff we spoke with were enthusiastic about their work and also felt well supported by the management. A health and social care professional said, “I have found (staff names) to be outstanding in their caring and commitment to the residents. They have a great sense of humour and genuinely want the best outcome for residents”.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences. People were supported to express their views and be involved in making decisions about their care and support.

There were systems and processes in place to protect people from harm, including how medicines were managed. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

Safe recruitment practices were followed, and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

People were supported to have 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 received regular and on-going health checks and support to attend appointments. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

The registered manager was promoting an open, empowering and inclusive culture within the service. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

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 good (published 03 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation for up to 18 people whose main need is in relation to their mental health. On the day of the inspection the service was fully occupied. The service is situated in Calmore near Southampton, close to local amenities. There are good transport links to Southampton and the surrounding area. There are three separate two storey buildings, each building has a communal lounge, dining room and kitchen where people can prepare food. There are six bedrooms in each building. One of which had three ground floor bedrooms. There is also a self-contained flat which can be used as part of a person's care pathway to develop independent living skills.

The service had a registered manager in place. 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 and staff were aware of the procedure to take if abuse was suspected.

People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had been minimised to better protect people's health and welfare.

There were enough staff deployed to meet the care and support needs of the people living in the service. The management team monitored staffing levels on a regular basis to ensure appropriate numbers of staff were deployed.

Medicines were stored, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records. Medicines records were regularly audited.

The registered manager understood their obligations under the Mental Capacity Act 2005. Staff had received training and were fully informed of any changes at team meetings to ensure they continued to provide care within the framework of the act.

People told us the staff were caring and knew them well as individuals. We observed people and staff interacting in a relaxed and friendly way.

People told us they were offered choice about what they wanted to eat, where they wanted to eat and at what time they wanted to eat.

People told us they had been involved in reviewing their risk assessments and support plans and described how staff encouraged them to build their independence.

People and their relatives thought that the service was well-led. They all spoke positively about the registered manager and the staff team.

There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The results of these audits were monitored by the management team, who acted on the results to improve the quality of the service and care.

Complaints policies and procedures were in place and were available to people and visitors. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with appropriately,

We saw that care plans were clear and detailed and kept under regular review. There was some evidence to show that people's capacity to consent to their care had been assessed. Suitable arrangements were in place to ensure decisions were made in people's best interests if they were deemed not to have mental capacity to do so themselves.

We looked at the procedures for safeguarding people's monies and saw that this was carried out safely to protect both the person and staff.

We looked at the procedures for storing and administering medicines and found them to be safe and suitable to the needs of the people living there.

There was a suitable recruitment procedure in place that protected people.

The manager named in this report no longer works at the service. The current manager has applied to be registered with the commission.