Archived: The Crest Care Home

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.

We inspected the service on 20 and 23 February 2018. Day one was unannounced and we told the provider we would be visiting on day two. The inspection team consisted of two adult social care inspectors on both days. On day one a specialist advisor nurse in medicines and risk management joined the inspection. On day two an expert by experience joined the inspection. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed all of the information we held about the service. This included information we received from safeguarding and statutory notifications since the last inspection. We sought feedback from the commissioners of the service prior to our visit. The registered provider also completed a provider information return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan the inspection.

At the time of our inspection there were 23 people who used the service. We spoke with five people and three of their relatives. We spent time in the communal areas and observed how staff interacted with people and some people showed us their bedrooms. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the visit we spoke with the registered manager, quality manager and six members of staff including senior care workers, care workers and the chef. We spoke with two visiting professionals during the inspection. Following the inspection we spoke with the deputy manager.

During the inspection we reviewed a range of records. This included 11 people’s care records, including care planning documentation and medication records. We also looked at four staff files, including staff recruitment and training records, records relating to the management of the home and a variety of policies and procedures developed and implemented by the registered provider.

Updated 28 April 2018

We inspected The Crest Care Home on 20 and 23 February 2018. The inspection was unannounced on the first day and we told the provider we would be visiting on the second day.

At the last inspection in July 2017 we found the provider had breached five regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, staffing, recruitment, and overall oversight of the home. Also Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 requirement to notify. We asked the provider to take action to make improvements and this action has been completed.

A new company HC-One Limited has become the provider of the service since December 2017.

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service can accommodate up to 31older people and younger adults, some of whom may be living with dementia. 23 people lived at the service when we inspected.

(A manager was in post. Following the inspection they were successful in becoming a registered manager.) They are referred to as registered manager in this report. 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 registered manager had a very clear vision of what high quality person centred care looked like. Firstly, they have safely recruited a staff team who shared their vision. They have supported the staff team through effective training, coaching and supervision to implement the changes needed to ensure quality and safety. Secondly, they have effectively used the provider’s quality assurance processes and have been a visible supportive presence in the service to achieve this.

Part of the outcome of this work has meant systems and arrangements have improved relating to health and safety, staffing, recruitment, medicines management and safeguarding people from abuse.

The registered manager and provider were aware of the areas which still required improvement. At this inspection we found clearer records and communication was needed to ensure risks to people receiving care were known by staff. The registered manager responded immediately during the inspection to make improvements needed. This proactive approach was also seen when accidents or incidents occurred, as the registered manager reflected and analysed the situation to put changes in place to prevent a reoccurrence.

Staff treated people with dignity and respect. Staff displayed a caring and compassionate attitude towards people. People and their relatives agreed with this. Staff were aware of people’s preferences, likes and dislikes and they used this knowledge to deliver care for people how they wanted it.

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. Where people displayed anxiety or distress staff responded with kindness and patience. Staff knew how to intervene to support the person to become calm. The team were working together to understand people more so they could promote people feeling confident to engage in personal care or tasks they found stressful. This meant the culture of the service was person centred.

Healthcare professionals were involved in supporting people to achieve good health outcomes; this included their nutrition and hydration needs.

People and their relatives were listened to when they had concerns or ideas to improve the service.