Cromwell House Care Home

Updated 2 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and further supported by 2 Expert by Experience’s. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Cromwell House Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Cromwell House Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced, and we visited the care home on 2 occasions.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who worked with the service. We used the information the provider sent to us in the provider information return (PIR). This is information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 13 people, and 12 of their relatives about their experience of the care provided. We spoke with 16 members of staff including care workers, senior care workers, registered nurses, domestic and catering staff, activities staff, administration staff, the registered manager and nominated individual.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records at the service. This included recruitment documentation for staff, and staff training and induction records. We also reviewed certain care records, medicine, and monitoring records for 21 people during the inspection. We asked for other records to be sent to us, which we reviewed away from the service. These records included monitoring documentation, staff rotas and training records and quality assurance records. Additionally, we requested some policies and other records which related to the management and oversight of the service.

Updated 2 December 2023

About the service

Cromwell House Care Home is a residential care home providing regulated activities of personal and nursing care to up to 66 people. The service provides support to older people, some of whom may live with dementia. At the time of our inspection there were 49 people using the service.

Cromwell House Care Home accommodates people across three separate floors, each of which has separate adapted facilities.

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

We found extensive improvements had been made since the last inspection, however, enough time had not passed to ensure these were fully embedded. The registered manager and nominated individual were aware ongoing reviews to monitor and further improve the service were required, and they were committed to undertaking this.

Oversight and processes within the care home should be reviewed and further monitored by the provider. Specifically, the provider should ensure appropriate oversight and guidance is available to staff in the absence of the registered manager.

We have made a recommendation for the provider to ensure continued review of processes and systems takes place. Furthermore, staff support, oversight and guidance should be effective and robust in the absence of the registered manager.

People and their relatives told us they were not routinely involved in the care planning process on an ongoing basis.

We have made a recommendation for the provider to review how people and their relatives, where appropriate, are involved in the care planning process on an ongoing basis.

Staff had undertaken the required safeguarding training, and people told us they felt safe. Lessons learnt were appropriately shared with staff, and learning from incidents took place. Risks to people had been assessed, and staff were confident of the risk reducing measures in place. The care home was clean and tidy, and good infection prevention control practice was observed. Medicines were managed safely by suitably trained staff.

There were enough staff to meet people’s assessed needs. The provider had followed safe recruitment procedures. Staff had the right level of training and support to deliver effective care and meet the needs of people living at the care home.

People were supported to access health professional services, as required, and had access to a variety of food and drinks which met their dietary needs and wishes. Effective monitoring and support were provided by staff to those who required assistance with eating and drinking.

The care home environment had received extensive refurbishment since the last inspection. People told us they were happy with the décor and facilities available. 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.

Staff were kind and caring in their duties and showed people respect and dignity. People were supported in a person-centred way, and their likes and dislikes were adhered to. People were satisfied with the activities available at the care home, however, these could be improved upon with additional staff recruitment. People, and their relatives, knew how to raise a complaint or concern and felt confident to do so. Care plans were in place to support people nearing the end of their life.

A positive, open, and inclusive culture was now evident at the location. This had been firmly led, embedded, and sustained by the experienced registered manager who began working at the care home following our last inspection. Governance systems were appropriately used and managed, and effective oversight was in place.

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 inadequate (inspection completed August 2022, summary report published 22 April 2023).

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.

This service has been in Special Measures since August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to information received that the provider had made and sustained the necessary improvements we told them to take. This meant their CQC rating from August 2022 may not have been reflective of the service provided to people. A decision was made for us to inspect to follow up on action we told the provider to take at the last inspection.

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

Recommendations

We have made 2 recommendations during this inspection. One recommendation is for the provider to continue to monitor, review and embed their systems and processes. Furthermore, staff support and guidance should be effective and robust in the absence of the registered manager. Another recommendation is for the provider to review the involvement of people, and their relatives, in the ongoing care planning processes.

Follow up

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