Archived: Critchill Court

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

People, their relatives and staff told us people were safe living at Critchill Court. Staff knew how to recognise and report abuse. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and staff were recruited safely.

People were given their medicines safely. There were a range of health and safety checks in place to ensure the environment was safe. Learning from incidents and accidents was cascaded to the team. There were appropriate infection control measures in place.

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.

People enjoyed the food and the mealtime experience was positive. People’s healthcare needs were met and planned for. Staff received a timetable of training; some staff required refresher training in some subjects, the registered manager had a plan in place to address this. Staff supervisions and appraisals had been identified as an area to improve, the registered manager had a plan in place to address this. Staff felt supported. The environment was suitable for people living with dementia.

People had access to a wide range of activities to keep them active, involved and stimulated. People and their relatives felt able to raise any concerns. There were plans in place to improve people’s end of life care plans.

There were effective systems in place to monitor the quality and safety of the service. People, their relatives and staff were positive about the management of the service. People liked living at Critchill court and commented positively about the staff team. There was a positive culture within the service, staff said morale had improved and were passionate about the people they supported.

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 21 June 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 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.

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: There were systems in place to safeguard people from the risk of abuse. Risks to people were identified, some risk assessments required more details. Where people experienced anxiety whilst receiving personal care, we received some different examples from staff on how they supported people with this. People’s care plans required more detail around how staff should support them at these times.

Some areas of medicines management needed to be improved. Incidents and accidents were recorded and reported, people’s risk assessments were not always updated following incidents. Some areas of infection control needed to be reviewed and improved. There were a range of checks in place to ensure the environment and equipment was safe.

We received mixed feedback from people and staff regarding the staffing levels in the home. There were times when staffing levels were reduced, due to sickness for example. The registered manager said they or the deputy manager covered at these times. There were systems in place to ensure suitable staff were recruited.

Although people had access to a range of healthcare services and professionals, staff had not always sought medical advice when people had become unwell. People’s rights were protected because the correct procedures were followed where people lacked the capacity to make specific decisions.

People were positive about the food; our observations of the mealtime experience were mixed. Staff had not always received one to one supervision in line with the providers policy, however staff told us they felt supported.

People told us staff were kind, caring and respectful. Our observations around staff interactions with people were mainly positive. Some interactions however did not promote dignity and respect.

People’s opportunities to be involved in activities and stimulation in Cedar Oaks needed to be improved. The quality of people’s care plans was mixed.

People and relatives felt able to raise concerns and that they would be listened to. The service had received positive comments regarding the support people and their families received at the end of their life.

There were systems in place for people, their relatives and staff to give feedback on the service. There were quality assurance systems in place to identify shortfalls in the service, these had not identified all of the concerns we found during the inspection.

People, their relatives and staff were positive about the registered manager and felt supported. The service worked in partnership with other organisations.

Rating at last inspection: Good (Report published July 2017)

Why we inspected: This inspection was brought forward due to concerns we had received. At this inspection we found the quality of service requires improvement.

Enforcement: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014.

Follow up: We have requested the provider sends us an action plan. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Critchill Court provides care and accommodation for up to 50 people. At the time of our inspection there were 37 people using the service. There is a separate part of the home known as Cedar Oak which provides care to people living with dementia. The “main house” provides care and support to older people some of whom are living with dementia. The home does not provide nursing care and people who require nursing assistance are supported by the local district nursing team.

The registered manager had been absent from work since 02/05/2017 and prior to this had been absent due to routine annual leave and other leave. Immediately following the inspection we were informed they had resigned. Since the inspection an interim manager has been put in place. We were told the provider is advertising for a permanent manager who will, if suitable, make an application to be the registered manager for the service. 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.

The recruitment arrangements whilst generally safe and meeting required standards in relation to checks did not ensure full employment history was obtained so the provider could be assured there were no gaps in employment history. Such gaps if identified may have questioned the suitability of the perspective employee to work with vulnerable adults.

The manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. However, we identified two people where such applications needed to have made and had not been.

Social activities were an area which needed to improve reflected in comments made by people. There had been a change with new appointments of activities coordinators as previous coordinators had left. This had impacted on the quality of activities provided with lack of a organisation and reduction in the availability of activities particularly one to one activities.

One person was being administered their medicines covertly i.e. disguised in food or drink. This was an appropriate decision and referred to as "best interests decision". However, there was no consultation with the pharmacist to ensure the method used to administer the medicine was safe and retained the effectiveness of the medicine.

Improvements had been made in the arrangements for the administration of "as required" medicines. This had been an area for improvement identified at our last inspection. There was a robust system for the management of medicines which ensured people received their medicines at the time it was required.

All of the people we spoke with said they felt safe living at Critchill Court. One person told us "It is lovely here staff are very kind and look after us." This was also reiterated by relatives we spoke with who also commented on how caring and welcoming staff were.

People spoke of staff being caring and kind. We observed staff supporting people in a sensitive and caring manner. They were confident in responding to people who were distressed or confused and needed re-assurance. They did so in a respectful professional way engaging with people in a positive manner.

People and relatives told us staffing arrangements were good and staff were available at a time they were needed. Staff responded promptly to requests for help and support.

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

Mealtimes were calm and relaxing occasions with people being offered meal choices and supported to have their meal. On Cedar Oak staff sat having their meal with people which helped ensure people ate their meal and added to the social nature of the mealtime.

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home could give feedback about the quality of care provided in the home.

Staff spoke of an open culture with some areas for improvements specifically around communication and staff performance. The management of the service recognised these concerns from staff and were open to and had taken action particularly around staff performance.

Improvements in the quality of care had been identified through a quality assurance system and action was being taken to address these areas for improvement.

We have made a recommendation about the employment history of perspective employees.

We looked at people's individual records which incorporated their care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People who use the service and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management and that they had received regular training.

We looked at the management of medicines and the quality of the service and found that the provider had adequate systems in place to ensure the safety of the people regarding the administration of medicines and that people were given the opportunity to provide feedback on the service.