Archived: Crest Lodge

Updated 28 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 4 April 2018 and was unannounced.

The inspection team consisted of two inspectors, two members of the medicines inspection team and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service

Before the inspection visit we looked at all the information we held about the service. We looked at the last inspection report. We spoke with the local authority quality monitoring team and viewed a report from a visit they undertook to the service in February 2018. We looked at information we had received from members of the public, such as complaints. We also considered notifications from the provider. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. The provider had completed a Provider Information Return (PIR) in February 2018. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

As part of the planning for the inspection we also looked at public information about the service, such as care home review websites and the Food Standards Agency website.

During the inspection we spoke with nine people who used the service and one visiting relative. We observed how people were being cared for and supported. We looked at the environment and equipment being used. We spoke with the staff on duty, who included the mental health specialist, nurses, care workers, domestic and catering staff, the activities coordinator and the administrator. Two regional managers were at the service throughout the inspection and we spoke with them. We examined records used by the provider which included the care records of six people who used the service, six staff recruitment and training files, meeting minutes, records of complaints and other records such as audits and quality monitoring. The medicines team inspectors witnessed the administration of medicines and looked at storage, records and information around the management of medicines.

At the end of the inspection we gave feedback to the nominated individual and the regional managers.

Updated 28 April 2018

The inspection took place on 4 April 2018 and was unannounced.

The last inspection was on 27 April 2017 and we rated the service Requires Improvement in the key questions of Safe, Responsive, Well-led and overall. We asked the provider to complete an action plan to show what they would do and by when to improve these key questions to at least ‘Good’.

Crest Lodge is a 'care home'. People in care homes receive accommodation with nursing and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to accommodate up to 47 people with mental health needs. The main building has three floors of accommodation and there is additionally a two bedroom bungalow in the grounds. Communal rooms are situated on the ground floor of the main building. The provider employs registered mental health nurses and general nurses who work at the service 24 hours a day. At the time of our inspection 43 people were living at the service. Everybody had a diagnosis associated with a long term mental health need, although people had a range of different needs including psychosis, brain injuries, anxiety, depression, Schizoaffective disorders, Huntington's disease and dementia. Some people needed support with aggression, self-harm or self-neglect. A small number of people were supported with rehabilitation with a view to moving to a more independent setting, although this was not the case for the majority of people who required on-going long term care and treatment. Some people also had a physical disability.

Crest Lodge was the only location for the provider who was an individual. The management of the service was overseen by the CHD Living Group who employed the staff and developed policies and procedures. The CHD Living Group is a provider of care homes and home care services in London and South East England.

The registered manager left the service at the beginning of 2018. The provider had employed another manager who had previously been the clinical lead at the service. They had been in post since February 2018. They had applied to be registered with the Care Quality Commission and this application was being processed at the time of the inspection. 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 and associated Regulations about how the service is run.

People were happy living at the service. They felt well cared for and supported. They liked the staff and said that they had good relationships with them. We saw evidence of this and saw that interactions between staff and people who lived at the service were kind, friendly and positive. People felt their needs were being met. They were involved in planning and reviewing their care. We saw that they had been consulted and their opinions had been recorded.

The staff were happy working at the service. They felt well supported and they liked the manager. They told us they had the training and information they needed to carry out their roles and responsibilities. They demonstrated a sound knowledge of essential policies and procedures and about the people who they were caring for. There were enough staff to keep people safe and meet their needs. There were effective systems for communication so that the staff had a consistent approach.

The provider had assessed whether people had the mental capacity to make decisions about their care and asked them to consent to this. Where people lacked the mental capacity the provider had acted within accordance of the Mental Capacity Act 2005 and had made decisions in their best interests alongside people's representatives.

People had enough to eat and drink from a varied menu of freshly prepared food. The staff supported people with their mental and physical healthcare needs. People were encouraged to take responsibility for staying healthy and were provided with support and guidance about this. The provider employed a mental health specialist who oversaw how people's needs were being met. They provided individual and group support, reviewed care plans and risks assessments and trained the staff so they understood people's needs.

People were safely cared for. They received their medicines as prescribed and in a safe way. There were procedures designed to protect people from abuse and the provider had responded appropriately when people had been placed at risk of harm. The environment was safely maintained and people had unrestricted access around the home and grounds.

People were able to make complaints or suggestions for improvements and the provider listened to them. There were effective systems for monitoring the quality of the service. Records were up to date, accurate and appropriately maintained. There was evidence the provider had made significant improvements to the service since 2016. There were plans for further improvements. The provider had a team of senior managers who offered support and regularly visited the service.