Cromwell House

Cromwell House is a residential care home providing accommodation and personal care to up to 38 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 37 people using the service.

The care home has 2 floors. There were shared spaces such as a lounge, a dining room, bathrooms, toilets and 2 kitchenette areas for people to use. People’s bedrooms had ensuite facilities and some had showers. There was a garden for people to access.

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

Risks associated with peoples care needs had not always been assessed thoroughly. Care records and risk assessments did not always accurately reflect the care people needed.

Medicines were not always managed safely, and people did not always receive their medicines as prescribed.

Quality assurance systems and service oversight was not always effective. The provider took action when prompted by our findings.

The service had enough staff but they were not always safely recruited.

People were treated with dignity and respect. People told us they enjoyed the activities within the service. We observed, and people told us, that mealtimes were a sociable and pleasant experience.

Staff knew people’s life histories well. People were encouraged to stay independent and continue their hobbies and interests at the service.

People spoke positively about the atmosphere within the service. People using the service and their relatives found the registered manager to be approachable and caring. The service sought the views of staff and people using the service.

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.

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 10 July 2018). At this inspection we found the provider was in breach of regulations. The service is now rated requires improvement.

Why we inspected

We inspected this service due to the length of time since the last inspection. As a result, we undertook a comprehensive inspection of the 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 found evidence that the provider needs to make improvements. Please see the safe, responsive, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

The service was safe, as staff had a good knowledge of safeguarding, and there were risk assessments meeting people’s needs. The environment was maintained and kept safe for people, and there were enough staff to keep people safe. Staff were recruited safely. Medicines were administered as prescribed.

Staff had training relevant to their roles and people were confident in their ability. People received a choice of meals, and enough to eat and drink. Staff supported people to have specialist diets, and to access healthcare services when needed.

People’s needs were preassessed to ensure the service could meet these needs before they moved in. Care plans were in place to guide staff on how to meet people’s needs and these were reviewed regularly.

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. However, further records relating to individual’s mental capacity assessments and best interest decisions were needed.

Staff were caring towards people and respected their privacy and dignity, and encouraged independence.

There were many activities on offer throughout the week in the home and people were supported to go out. People and their visitors felt comfortable to speak with staff or raise any concerns.

There was good leadership in place, and the registered manager was known to everybody. The staff team worked well together. There were effective quality assurance systems in place to monitor and improve the service.

Further information is in the detailed findings below.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe ?

During our inspection we spoke with ten people who used the service. We asked four of them whether they felt safe living at Cromwell House. They all told us that they felt very safe. One person we spoke with told us, 'I feel safe and well cared for." We looked around the service. We found that it was clean and well maintained and equipment in use was maintained regularly.

There were sufficient staff working on the day of our inspection to meet the needs of people who used the service, and when we looked at staffing rotas for the period before and after our inspection, these showed that staffing levels remained sufficient to meet the current needs.

Records were well maintained and readily available, guiding staff in their day to day duties.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with told us that they were well looked after. They said that the service was meeting their needs. One person said, "I am well looked after and well fed." Another person told us, 'I can't think of any problems, everything is good.' We observed staff during our inspection as they carried out their day to day duties. We noted that the staff were aware of people's needs and their likes and dislikes, for example the chef knew who preferred tea and who coffee when serving the after lunch drinks We looked at recent training records which showed that the service had provided staff with suitable training to ensure the needs of people who used the service would be met.

Is the service caring?

People who used the service were well cared for. The service supported their needs but also helped them maintain their independence, for example one person was still able to drive and had their own car and several others attended a church friendship group. One person we spoke with told us that, 'The staff are wonderful, they are here for me when (or if) I need them.'

We spoke with a visitor to the service who told us that they thought it was excellent. They said, 'I never have any concerns here.'

Is the service responsive?

People who used the service met with the registered manager before moving to the service. A detailed assessment was carried out to identify their needs and whether Cromwell house were able to meet those needs. People we spoke with told us that staff completed their care plans every day and sometimes talked to them about the care plan. Care plans were kept by the person they related to and recorded their likes and dislikes, life history and significant events, health and social care needs and professional support received.

People were able to access a variety of activities including bingo, quizzes, flower arranging and craft work if they chose to do so although some of the people we spoke with told us they preferred to spend their time in their room reading or watching television.

Is the service well-led

People we spoke with told us that there were regular residents meetings and that they were able to discuss a variety of topics including changes to the menus and trips and activities. We looked at the quality survey completed by people who used the service late in 2013. The results of this were shared with people who used the service at their residents meeting and the service scored highly in most areas. We spoke with staff who told us about a staff forum that was now held by senior managers. They were able to voice any concerns or issues and told us that they felt listened to. They told us of changes that had resulted from concerns raised within the staff forum.

We observed the lunch time meal service and found that people were provided with a choice of suitable and nutritious food and drink. People were supported to eat their meals and to maintain good nutrition.

We found that people were cared for in a safe and suitable environment. A member of maintenance staff undertook regular checks to ensure that the exterior and interior of the building remained safe. People were cared for in a well decorated and furnished environment which promoted their dignity.

We found that there was not enough suitably qualified and experienced staff to meet people's needs. People were waiting extended periods of time to have their call bells answered, and staff told us that they did not feel they could meet people's needs.

We found that staff received the appropriate training to be able to undertake their role safely. The provider may find it useful to note that staff did not always receive appropriate supervision and appraisal.

We found that there was an effective complaints system available and people were made aware of how to complain. The service had not received any complaints.