Craghall Residential Home

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

Records provided guidance to ensure people received safe, person-centred care and support from all staff members. Systems were in place for people to receive their medicines in a safe way. People received a varied diet.

There was evidence of collaborative working and communication with other professionals to help meet people's needs.

There were enough appropriately skilled and trained staff to meet people’s assessed needs. Robust vetting procedures were in place when recruiting new staff.

People were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive. One person commented, “I very much trust the staff, if I ask I know they’d do it.”

Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe.

We were assured that the provider was monitoring the use of PPE for effectiveness and people’s safely.

There was a welcoming and cheerful atmosphere at the service. One person told us, "I can’t think of any improvements, it’s a good atmosphere, the staff are so good too."

Staff spoke very positively about working at the home and the people they cared for. Staff said the management team was very approachable and they were supported in their role.

A quality assurance system was in place to assess the standards of care in the service.

People and staff said communication was effective. There were opportunities for people, relatives and staff to give their views about the service.

People were involved in decision making and were supported to have maximum choice and control of their lives. 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 for last inspection

The last rating for this service was good (published 9 January 2019).

Why we inspected

We received concerns in relation to staffing and people’s care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 remained the same. This is based on the findings at this 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.

We found no evidence during this inspection that people were at risk of harm from these concerns as the provider had taken effective action to mitigate the risks. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Craghall Residential Home 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.

Craghall Residential Home is a 'care home'. Craghall is a residential care home for 38 people. There were 30 people living at the service at the time of inspection, some of whom were living with dementia.

We found the following examples of good practice:

• All visitors had to undergo a temperature check and answer a range of relevant questions before entry. There was ample PPE and handwashing facilities available.

• The acting manager had covered shifts and staff had worked additional hours during the outbreak to ensure people’s needs could be met without the need for agency staff.

• Rigorous additional cleaning regimes were in place.

• The acting manager had worked with staff to improve systems and processes to reduce the risks faced by prolonged periods of isolation and inactivity, brought about by the lockdown.

• The provider had installed an outdoor visiting pod so relatives could see their loved ones regularly.

At our last inspection 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.

At this inspection we found the service remained Good.

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. Staff were knowledgeable about the Mental Capacity Act and ensuring people were always supported to make choices.

Staff were complimentary about the training and support they received, which included regular supervisions and appraisals. We reviewed the recruitment processes and noted that staff completed a comprehensive recruitment process prior to starting in post. At the time of the inspection the service did have some vacancies, but these were being covered by the staff team whilst recruitment was ongoing.

Staff were knowledgeable about safeguarding procedures and confident they could speak to the manager about any concerns they had. People and relatives also told us they would be confident and speak up about anything they felt needed to change. We noted that any complaints received were acted upon accordingly.

The provider was in the process of rolling out a new electronic software package for care planning. We saw that all care plans were person centred and contained appropriate risk assessments.

The feedback we received about the activities organised by and within the home were “Outstanding.” We noted there was a variety of activities to suit everyone within the home. The activities coordinator had conduced a number of evaluations to ensure that everyone was receiving equal opportunities and that the events were well received and people were engaged. People were encouraged to have personal goals and the staff team aimed to help facilitate those goals being met.

The senior staff and the management team had thorough auditing process in place. The audits purpose was to ensure there was an effective tool for helping to improve the service.

Further information is in the detailed findings below.

Craghall Residential Home provides accommodation and personal care for up to 38 people, including people living with dementia. There were 35 people accommodated there on the day of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The building was safe and well maintained. As the service was provided in a period property adaptations had been made and additional signage provided to improve safety and highlight potential hazards, such as internal steps. Other risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean throughout.

We observed staff acted in a courteous, professional and safe manner when supporting people. Staffing levels were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Medicines were safely managed.

As Craghall Residential Home is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary, DoLS had been applied for. Staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs and where people were at risk of malnutrition, appropriate support was provided. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Activities were offered within the home and included occasional trips out. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the registered manager and they felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care and oversight from external managers.

We found that people were now protected against the risk of unsafe or unsuitable premises and the provider had taken steps to provide care in an environment that was adequately maintained.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. One person told us, 'I feel safe and secure here. The staff are very friendly, helpful and nice in all respects.' Another person said, 'You hear of some places that are terrible; but certainly not here. It's perfect and I can honestly say I am very happy here and more importantly ' I'm safe.'

People were cared for in an environment that was clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. One relative told us, "Staff are very confident and competent. I am asked to go along to six monthly reviews of her care and anything I ask for they get straight on to it. They even anticipate any help she may require before we even ask for it." Another relative said, "I feel she is definitely safe and well there. If the buzzer goes they are straight in action. I find it a very caring and well-run service and the leadership and management are very professional."

We found the provider undertook appropriate checks before staff began work and effective recruitment and selection processes were in place.

The building was clean, secure and other appropriate measures were in place to ensure the security of the premises. However, we found that the service had not always taken steps to provide care in an environment that was adequately maintained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to making improvements and repairs to ensure that people who used the service, staff and visitors are protected against the risks of unsafe or unsuitable premises.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We noted that staff received appropriate induction training and a period of shadowing an experienced and established colleague before working unaccompanied. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home. One person told us, 'I have everything that I could possibly want here. The staff know exactly what to do and when to do it and they do exactly what I ask them to do. It's not an old people's home; it's my home.' A relative told us, 'Staff seem well trained and have a genuine interest in people. They want people to have the best possible care and they are professional, with a good sense of humour.' Another relative commented, 'I think the staff are enthusiastic; they interact and get to know people. They encourage people to do things: promoting their independence.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'Staff are very good and I'm well cared for. They have plenty of time and never rush me.' One relative commented, "It's a major decision to put your parent in a care home. It gives me peace of mind and it's a huge relief knowing he's so well cared for.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed every six months to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People and their relatives' were consulted about the service people received and the environment in which they lived. Meetings for people and their relatives were regularly held. This demonstrated that the provider took account of the views of people using the service and their relatives. One relative told us, 'They seem well organised and they have meetings for people regularly.'

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

People and their relatives' knew how to make a complaint if they were unhappy. We saw that six complaints had been recorded, investigated and resolved to the satisfaction of the complainant within the last 12 months.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. One relative told us, 'As a family, we are very content with Craghall. It's a stand-out home, which is well-led and we have no issues about the management there.'

People who used the service told us that the home was 'absolutely as good as it gets' and the 'whole standard is excellent'. We were told that the staff were 'sensitive and look after us well' and that they were 'marvellous ' friendly, cheerful and happy'.

Relatives also commented upon the care that had been provided. They said the 'home is a suitable environment' and that they are fully involved in the reviews of care. We were told that 'any issues are taken to the manager who sorts everything straight away'. They said that staff were 'patient and respectful' and they had 'no concerns at all'.

We also checked on the safety and suitability of the accommodation and environment. We saw the shared areas were clean and tidy and bedrooms were well decorated and personalised by individual service users.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them and their family members.

We saw people were treated with consideration and respect. We reviewed four care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about people's care needs and what they should do to support them.

Both people who used the service and family members were complimentary about the home atmosphere and environment and the standard of food within the home. One person told us ' 'cooking good and the meals are excellent'.

We saw that staff spoke with people who used the service in a polite, respectful manner that encouraged decision making and independence.

People who used the service commented that they knew who to talk to if they had a problem but no-one said they had any complaints. People also told us that they had enough to do. People who used the service said the home was 'great' and there were 'no concerns'.

People who used the service and also family members spoken to, said that they had seen care plans, that they were consulted about changes to care and that the home included them in six monthly reviews of care plans.