We carried out a review of the data available to us about The Crest Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Crest Care Home, you can give feedback on this service.
The Crest Care Home is a residential care home which was providing accommodation for older people who required personal or nursing care. There were 25 people using the service at the time of our inspection. The service can support up to 31 people in 1 adapted building.
People’s experience of using this service and what we found
People and their relatives told us they felt safe living at The Crest Care Home, and they were happy with their care and support. Feedback reflected recent improvements and people felt staff knew how to keep them safe.
Infection prevention control practices were in place. Staff were following current guidance and maintaining use of personal protective equipment (PPE) where it was appropriate. Additional cleaning of all areas and frequently touched surfaces was in place and recorded regularly by staff. Training included hand hygiene and other infection prevention control related subjects.
At our last inspection we recommended the provider should consider current guidance on 'as and when required medicines' and to ensure they update their practice accordingly. At this inspection we found the provider had acted and made improvements by implementing better recording methods and instructions for staff to follow.
Medicines were stored, managed, and administered safely and records regarding people’s medicines were completed effectively. Improvements to care plans and systems meant medicines were managed well. People received the medicines they needed to support their health needs. Fire safety was managed, appropriate checks and completed action plans were in place along with robust risk assessments.
The environment was clean and safe and was adapted to meet people’s needs. There were plans in place for more refurbishment work to be completed There were systems in place for communicating with people, their relatives, and staff to collect their views and feedback regarding people’s care and support.
Individualised risk assessments were improved to be more detailed. These were in place to ensure people could take risks safely. Staff were confident about how to raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and follow up.
The last rating for this service was requires improvement (published 30 March 2022) and there were breaches of regulation. 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.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The Crest care home provides personal care and nursing care for up to 31 older people living with dementia. At the time of the inspection 26 people were living at the service. The service is an adapted building, split over two floors and is serviced by a lift.
People’s experience of using this service and what we found
The systems for recording, managing and general oversight of accidents, incidents and safeguarding concerns was not effective. Whilst no one was hurt as a result, these shortfalls increased potential risk of harm.
We found gaps and inconsistencies in care plan records and other documentation such as monitoring forms and cleaning records. Where actions had been identified these had not always been completed in a timely manner.
Medicines were stored, administered and disposed of safely, however we have made recommendations around ‘as and when required’ medicines.
Staff were recruited safely, and this was on-going. The service was using agency staff which families and staff felt at times affected the quality of the service provided. The registered managed tried to ensure regular agency staff to minimise the impact.
Audits and governance processes were in place. However, these weren’t always effective in identifying issues found as part of this inspection. The Care Quality Commission (CQC) had not been made aware of notifiable incidents as required. However other relevant agencies had been made aware and families were informed and regularly updated.
During a COVID-19 outbreak, restrictions to all visitors into the home was not in line with government guidance or the providers own policy. The approach taken was not person-centred and did not seek alternative options to minimise impact on people.
Staff and their families felt the registered manager had made improvements since starting in their role and felt they were approachable and open to feedback. People appeared happy and comfortable at the service. One family member told us, “Shortly after my family member went in the home there was a real transformation in them. I can see they are healthy, and they appear happy.”
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.
Rating at last inspection
The last rating for this service was good (published 11 March 2020)
Why we inspected
We received concerns in relation to staffing and how the provider managed safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 changed from good to requires improvement based on the findings of 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.
The Provider has taken some action to address findings from the inspection and mitigate risk. However, the provider needs to make further improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Crest on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 safe care and treatment, person-centred care and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Since the last inspection we recognised that the provider had failed to notify CQC of incidents where required to do so. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.
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.
The care home was a large building that had been extended and adapted to meet people’s needs. There were bedrooms over two floors, serviced by a lift.
We found the following examples of good practice.
People and staff were regularly tested for COVID-19. All visitors were tested, screened for symptoms and provided with Personal Protective Equipment (PPE). Trained staff carried out testing in a designated area within the home.
The care home had a separate COVID-19 positive area within the building for use during outbreaks. Specific staff would be allocated to work in this area if there was an outbreak. This was to reduce the risk of transmission to other people living in the service.
New people admitted to the service were tested and supported to self-isolate in line with government guidance.
Staff had received training on infection, prevention and control, COVID-19 and correct use of PPE. Staff received more frequent supervisions to discuss and address COVID-19 specific information.
The Crest Care Home is a residential care home providing personal care for 30 older people at the time of the inspection. The service can support up to 30 people.
People’s experience of using the service
The home was not always well led as records were not always accurate or completed in a timely manner. We made a recommendation about this. The management team were open and responsive to our findings during the inspection and always looked to make improvements. The provider used audits to monitor the service and surveys to gather views from people and their relatives about their experiences. Actions were taken when concerns had been raised with the registered manager and staff were confident in their roles and responsibilities to provide quality care to people.
People said they felt safe living in the Crest Care Home. Staff knew their responsibilities to safeguard people from potential harm or abuse. Medicines were managed safely on an electronic system and risk assessments were carried out. Risks were mitigated as staff knew people’s individual needs and managed these. There were enough staff to meet people’s needs and recruitment procedures were robust.
Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive was possible. Staff completed an in-depth induction course and continuous training which helped them to carry out their role in caring for people. Supervisions and appraisals had not been recorded however, staff said they were supported by the registered manager regularly.
People were complimentary about the care they received. One person said the care was first class. People were offered choices and staff respected these. People’s privacy and dignity was valued by staff who cared for them. Staff knew how to support people to remain independent. We observed positive interactions between staff and people living in the home. People looked well kempt and staff took pride in making sure people looked their best. However, some relatives had said that personal care specific to shaving could be better.
Staff were responsive to people’s needs and knew them well. Care plans informed staff of how people wished to be cared for and these were reviewed when changes occurred. People’s preferences, likes and dislikes had been gathered and incorporated into their care plans. Wishes for end of life care had been recorded so staff knew how to support people when this time came. Complaints were managed effectively, and people knew who to speak to if required.
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 28 April 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and to inform our planning and decisions about the rating at this inspection.
Why we inspected
This was a planned inspection.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.