Archived: Croston Park Nursing Home

Croston Park Nursing Home is a nursing and residential care home providing personal and nursing care to 45 people at the time of our inspection. The service can support up to 56 people who have a range of residential and nursing needs.

The home is a seventeenth century grade II listed building in its own grounds which has been suitably adapted for its purpose. Bedrooms are located over three floors with lift access to the upper floors. Most of the bedrooms are ensuite. The ground floor includes the dining room and several communal lounge areas and access to the outside garden and grounds.

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

Medicines were not always managed safely. This placed some people at risk of harm. The provider's systems had not always been effective in identifying and addressing risks related to medicines management.

The provider had made improvements in relation to recruitment practices, which helped to ensure only suitable staff were employed to work at the home. Staff had received training to keep people safe and knew how to report concerns. The home was clean and hygienic. Staff made good use of PPE and followed guidance to manage the risks of COVID-19. The provider used accidents and incidents as a learning opportunity to improve the service.

People were involved in the care planning process which took account of their preferences as well as their needs. Staff were well supported and received training to enable them to meet people’s needs effectively. People were complimentary about the food provision. Where people needed support with eating and drinking, this was provided.

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.

We found the culture was person-centred and caring. Staff were enthusiastic about their roles and spoke highly of the management team. The provider had made improvements to their quality assurance systems following our last inspection. The service worked with other agencies and engaged with people using the service, their relatives and staff.

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 (report published 3 September 2021). 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 the provider had made some improvements, but was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 12 May and 20 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

We carried out this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and the effective operation of the provider’s quality management systems at this inspection.

You can see what action we have taken at the end of this full report.

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.

Croston Park Nursing Home is a nursing and residential care home providing personal and nursing care to 51 people. This service can support up to 56 people who have a range of residential and nursing needs.

The home is a seventeenth century grade II listed building in its own grounds which has been suitably adapted for its purpose. Bedrooms are located over three floors with lift access to the upper floors. Most of the bedrooms are ensuite. The ground floor included the dining room and several communal lounge areas and access to outside garden and grounds.

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

People were not always safe. We found multiple failings within medicines processes. Medicines were not always managed safely, and people did not always receive them as they should. This placed people at risk of harm. Recruitment practices in the home were not always robust. Checks of suitability for new staff being employed had not always been completed prior to their employment commencing. This meant staff were not always checked as being suitable before commencing work with vulnerable people.

We were not fully assured staff consistently used personal protective equipment (PPE) correctly. There were enough numbers of staff deployed on each shift to meet people’s needs. Some risks in relation to fire safety within the premises had been identified by the local authority fire and rescue safety team. The provider had acted immediately to mitigate those risks.

Processes and systems to oversee, assess and monitor the safety and quality of service provided were not always effective in identifying risks associated with care and treatment. Information was not consistently recorded about people’s care and treatment. This meant appropriate actions could not be taken to ensure the service consistently provided safe care and treatment.

Staff told us they had received induction training when they commenced employment and had training to update their skills and refresh their knowledge. People had been referred to the appropriate external professionals and agencies for advice, treatment and support. All the staff we spoke with told us they were very happy to work at Croston Park Nursing Home. One staff member told us, “I enjoy working here, my manager is always hands on and approachable.” Another staff member said. “The manager always respects our views. I feel valued by the company.”

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 and their families had been involved, where relevant, in planning and reviewing the care and support provided.

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 22 May 2019).

Why we inspected

The inspection was prompted in part due to concerns we received about safe care and treatment and in part by notifications of specific incidents. As a result, this inspection did not examine the circumstances of the incidents. The information CQC received about the incidents indicated concerns about unsafe medicines management, this inspection examined those risks.

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 also looked at the key questions effective and well-led. 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. We reviewed the information we held about the service.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

The provider took action during and immediately after the inspection to mitigate any risks.This included completing detailed audits on people’s weight loss and medicines management and drafting an action plan in response to the inspection findings.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines, recruitment of staff and the systems used to oversee the quality and safe running of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The registered manager had been proactive in identifying the risks from COVID-19. This had included the early introduction of restrictions on visitors to the service. They had also purchased additional personal protective equipment (PPE) before the national disruption of supplies.

¿ The home had set up an infection control (IPC) station in the entrance way so all visitors could be monitored and risk assessed. This included a declaration and a digital temperature check. Visitors were also offered to take a COVID-19 test and full PPE to use.

¿ The home had reduced the number of visitors to the home to prevent the risk of spread of infection. The home's nursing staff had taken over more routine tasks from District Nurses for people who received residential care.

¿ The registered manager had followed national guidance on visiting for relatives and others. They had supported relatives to safely visit people at the end of life. They had also set up a visitors area with a separate entrance and Perspex screening, when national guidelines allowed for visits.

¿ The registered manager took advice from the local Infection Control team on adapting the environment and on staff practice within the limitations of a Grade 2 building.

Further information is in the detailed findings below.

The premises are in a seventeenth century grade II listed building in its own grounds, in the village of Croston. Bedrooms are located over two floors with lift access to the first floor. Most of the bedrooms are ensuite. All but three bedrooms are of single occupancy. The ground floor included the dining room and several communal lounge areas, there is access to outside grounds.

People’s experience of using this service

We received consistently positive feedback from people and visitors. They told us the home was warm and homely, people felt safe and the staff were excellent, kind and competent in their roles. Accidents and incidents were managed safely and risks had been considered. Medicines were managed safely. Relevant environmental checks were carried out and the service had relevant signage in place to support people who lived in the service.

Staff were recruited safely and duty rotas confirmed staffing was sufficient. Training records and staff we spoke with confirmed staff received training which supported them in their role. Relevant professional registration checks had been completed.

People were supported to have maximum choice and control of their lives and staff supported this in the least restrictive way possible, the policies and procedures were in the service supported this practice. Authorisations to restrict people’s liberty had been sought where necessary. The meal time experience was overall positive. Choices were available and reflected people’s individual dietary needs.

People and visitors were positive about the care they received and they were treated with dignity, respect and their privacy considered. There was evidence of working together with relevant professionals. Care planning was person-centred and reflected people’s current and individual needs. End of life care plans had been completed. The service used technology in a number of ways to enhance the service. There was a complaints policy which was followed in practice.

The registered manager had established good governance systems and records confirmed senior oversight was in place. The provider engaged with residents and staff. The provider used satisfaction surveys to assess and monitor the service.

Rating at the last inspection: At the last inspection the service was rated good (published 6 October 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will monitor as part of the inspection profile as a good service. We may inspect earlier If any concerning information is received.

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

Croston Park Nursing home is registered to provide 24 hour care and support for up to 44 people who have a range of residential and nursing needs. At the time of our inspection, there were 37 people living at the home. The home also cares for people who are living with dementia. The premises are located in a 17th century grade II listed building in its own grounds, in the village of Croston, Lancashire. Most rooms within the residential and nursing areas are ensuite and share ground floor lounges and a dining room. The smaller area on the top floor has a separate lounge where most of the people also eat.

The service had a long-standing registered manager in post. 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 were safe living at the home because they were supported by a sufficient number of staff who had the right skills and knowledge to meet their needs. Staff understood their responsibilities with regard to reporting suspected abuse, in order to safeguard people.

The service followed safe recruitment practices to ensure only suitable candidates were employed to work with people who lived at the home.

The service had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management.

Effective systems were in place to ensure people's medicines were managed safely. Only trained staff were allowed to administer medicines. We observed one member of staff did not follow published national guidelines when administering medicines. We have made a recommendation about this.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). The provider had identified some issues with regard to the completion of records for mental capacity assessments and was in the process of implementing new paperwork and procedures. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People were supported to eat and drink enough to maintain their health. People's dietary requirements were explored and the information was readily available to kitchen staff to ensure these were met.

People could access external healthcare services as they required and were supported to do so. People had access to a wide range of activities which were provided seven days a week.

Staff were kind and caring and treated people with respect. We witnessed many positive and caring interactions throughout or inspection. Staff knew people's likes and dislikes which helped them provide individualised care for people.

Plans of care were based around the individual preferences of people as well as their medical needs. People and their relatives were involved in reviews of care to ensure it was of a good standard and meeting the person's needs.

The provider had implemented effective systems to assess, monitor and improve the quality of care and support that was delivered to people. People, their relatives and staff were involved in developing the service.

Everyone we spoke with that lived in the home spoke positively about living there. One person said, 'The building is lovely, if I want to be with people I can but there is always somewhere I can go if I just want quiet time too.'

Everybody we spoke to including people living in the home, staff and people's relatives were all confident that people were kept safe. One person said,' I like being here; I know I'm looked after and am confident that the staff would deal with any emergencies as required.'

Staff working at the home we spoke with said they enjoyed it. One said, 'When people asked me what I did for a job I used to say 'I'm just a carer', now I say I'm a carer and I say it with pride.'

People we spoke with living in the home generally were content and felt listened to. We spoke to the management of the home who confirmed that regular resident and relative meetings continued to take place. Annual surveys collected the views of relatives and residents and the results of these were used to improved provision. A survey for residents and staff was currently being developed.

People we spoke with told us their care needs were being fully met by the staff team. People felt safe and secure within the home with one saying simply, 'It's all good'.

Two people living in the home were concerned about the amount of time it took staff to respond to them when they needed help. One said 'When I fell, I called for help and another resident went and got someone'.

We saw that people living in the home were able to personalise their bedroom with pictures and other belongings. The decoration and furnishings in the home were of a good standard. Decoration was generally of a standard that could be described as home from home. The provider may find it useful to note that developing the environment and improving signage can stimulate people living with dementia and aid greater independence.

People living in the home said staff were excellent. One relative said, 'Everybody is brilliant and the managers door is always open if I need to talk to someone'.

Relatives had been involved in an annual collection of comments and there was a suggestion box on site.