2 June 2021
During an inspection looking at part of the service
The people supported by the service had a wide range of needs including decreased mobility, general frailty, dementia, care needs related to age and people who live with a learning disability. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 32 people being supported with personal care by Carewatch (Cranbrook Court) at this time.
People’s experience of using this service and what we found
Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, not all were effective at this inspection. For example, medicine audits were undertaken but were lacking detail, for example, had the medicine been missed and of possible impact on people of not receiving their essential medicines. There were shortfalls in the care plans and risk assessments that had not been identified through the audits of care plans. Feedback from people and staff had not always been acted on.
Not everyone’s specific health needs were identified and planned for to promote responsive care to ensure their safety and well-being, for example, risk assessments for risk of choking were not consistently completed. People who lived with a mental health disorder did not have person specific care plans and risk assessments to enable staff to ensure their health and well-being. COVID-19, person-specific risk assessments were not seen in files at the time of inspection so there was no guidance or information to guide staff. The Manager rectified this.
The service were not following their medicine policy in the management of medicines, which meant there was an element of potential risk to people and staff. The risk of harm to people had not always been mitigated as incidents and accidents were not consistently reported, recorded and investigated.
People received care and support by staff who had been appropriately trained to recognise signs of abuse or risk and understood what to do to safely support people. One person told us they “Totally trust the staff here, I feel safe with the care staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with their personal care and mobility.
There was minimal evidence that learning from incidents and accidents took place. Specific details and follow up actions by staff to prevent a re-occurrence were not clearly documented. Action from incidents and accidents were not shared with all staff or analysed by the management team to look for any trends or patterns.
Staff received essential training to meet people’s needs. All new staff completed an induction programme where they got to know people and their needs well. One staff member said, “We do receive regular training, and refreshers.” Where there was an assessed need, people were supported to eat and drink enough to maintain a balanced diet. Referrals and advice were sought from relevant health care professionals to ensure people remained as healthy as possible. 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. People were asked for their consent prior to any care or support tasks being completed. The registered manager had taken the necessary steps to ensure that people only received lawful care that was in line with legislation.
The management team actively looked for and took up opportunities to work in partnership with local health care and community services to improve people's health and wellbeing.
Staff had a good relationship with the community nurses and other health care professionals and contacted them for advice when needed.
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 requires improvement (published 20 April 2020). There were no breaches of regulation but we asked for improvements to be made. The provider completed an action plan after the last inspection to show what they would do to improve. The service remains requires improvement.
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 have identified breaches in relation to safe care and treatment, safeguarding people from abuse and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Why we inspected
This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to review the previous ratings.
We looked at infection prevention and control measures under the Safe key question. We look at this in all 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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.