Archived: Craven Park

Craven Park is a care home that provides nursing care and accommodation for a maximum of 26 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. During our visit there were 15 people using the service, including one person who was in hospital until the afternoon of the second day of the inspection.

People’s bedrooms were located on three floors. There is a passenger lift to assist people to access their bedrooms located on the 1st and 2nd floors. People have access to safe outdoor space and the home is located close to shops and public transport.

The service does not have a registered manager. A registered manager is a person who has registered with the CQC 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. A manager had been in post since July 2018 but left the service in early January 2019. The service is currently being managed by the consultant operations manager with assistance from the deputy manager.

At the last inspection on 18 January and 2 February 2018, we rated the service Good overall but in the area of Well-Led, we rated the service Requires Improvement. This was because we found oversight of day to day delivery of the service was not always effective. We found shortfalls to do with the moving and handling of one person using the service and in the monitoring of two people’s fluid monitoring records. During that inspection management had been responsive in quickly addressing the deficiencies that we found, but their quality monitoring systems had not been effective in identifying the issues that we found. We made a recommendation that the provider sought advice from a reputable source about the development of ‘monitoring spot checks’ of the service, to ensure that deficiencies were identified and addressed promptly.

During this inspection we again found shortfalls in the monitoring of people’s drinking. We also found deficiencies in other areas of the service. People’s medicines were not always managed in a safe way, and not every person using the service were provided with regular access to meaningful activities that met their preferences and protected them from social isolation. Care plans were not in place to meet some people’s specific medical conditions. People’s risk assessments lacked detailed guidance, staff recruitment checks were not robust, and records did not show that all staff members had completed an induction.

Audits and quality monitoring checks had been carried out and identified deficiencies in the service, but audit records did not show details of proposed action by the service to address the shortfalls and show that shortfalls had been addressed and improvements made. This indicated that the quality monitoring and quality improvement systems of the service were not effective in mitigating all the risks to the health, safety and welfare of people using the service and possibly others including staff.

We found that there were five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Some areas of the interior surroundings had been improved, but there were parts of the premises and some furnishings, which remained tired looking. Also, some repairs had not been addressed.

There were some aspects of the service that were positive. People’s relatives spoke of a welcoming atmosphere. We found that staff engaged with people in a caring and respectful manner and they understood the importance of treating people with dignity and protecting their privacy.

The service had clear procedures to support staff to recognise and respond to abuse and keep people safe. Staff knew how to identify abuse and understood the safeguarding procedures they needed to follow to protect people from harm.

People and their relatives provided us with some positive feedback about the service.

Further information is in the detailed findings below.

Craven Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Craven Park provides nursing care and accommodation for a maximum of 26 people. During our visit there were 21 people using the service, some of whom were living with dementia. People’s bedrooms are located on three floors. There is a passenger lift to assist people to access the accommodation on the upper floors. People have access to safe outdoor space, and the home is located close to shops and public transport.

During the last inspection that took place on the 7 and 8 February 2017 we found that the provider did not ensure that people were always receiving proper care and treatment because accurate, complete and contemporaneous records were not maintained when monitoring people’s repositioning and their drinking. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions Responsive and Well-led to at least good.

We found that during this comprehensive inspection the provider had taken appropriate steps to ensure that people received proper care and treatment. People were assisted to change their position regularly to minimise the risk of developing pressure ulcers, which was documented appropriately by staff. When people were at risk of dehydration they had their fluid intake monitored appropriately.

Since the last inspection the provider had developed and improved the range of quality monitoring processes to ensure that appropriate checks of all aspects of the service were carried out. However, we found oversight of day to day delivery of the service could be improved, and have made a recommendation in Well-Led.

The service does not have a registered manager. However, there was a manager in post at the time of the inspection who had commenced the process of applying to register with us. A registered manager is a person who has registered with the CQC 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.

There were systems in place to keep people safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report it. People had risk assessments in place to minimise the risk of them being harmed and that respected their independence.

Arrangements were in place to make sure people received the service they required from sufficient numbers of suitably trained staff. Safe recruitment processes were in place to ensure only suitable staff worked at the service.

Fire safety checks and appropriate service tests had been carried out to make sure that the premises were safe. Arrangements were in place to manage people's medicines safely.

People made decisions about how their care was provided. People’s relatives were consulted about people’s care when people lacked the capacity to communicate their needs and make decisions about their care and treatment. Staff understood people's needs and preferences.

Staff supported people in the least restrictive way possible with the policies and systems at the home supporting this practice. People's diverse needs were met by the adaptation, design and decoration of premises.

People told us that staff were kind to them. There were opportunities for people and their relatives to provide feedback about their experience of the service.

People spoke in a positive manner about the food. Their dietary needs and preferences were understood by staff and met by the service.

Staff understood the importance of maintaining and supporting confidentiality. People were provided with the support they needed to maintain links with their family and friends.

Staff had the skills and knowledge to meet people’s needs. When required, staff assisted people to receive the advice, treatment and care that they needed from healthcare and social care professionals.

People and their relatives knew how to make a complaint and told us they felt comfortable providing feedback about the service. Complaints had been addressed appropriately.

There was a management structure in the service which provided clear lines of responsibility and accountability. There were quality monitoring checks in place but as mentioned above we have made a recommendation about developing day to day monitoring checks to ensure the service is at all times responsive and effective.

At our last inspection on 26 and 27 January 2016 the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people using the service were always treated with dignity and had their privacy respected. During this inspection we found the provider had taken appropriate action to meet the regulation. Throughout our visit we observed staff engagement with people using the service was caring, respectful and supportive.

Craven Park is a nursing home located in the London Borough of Brent. The home provides nursing care and accommodation for up to 26 people. During our visit there were 25 people using the service. Public transport and a range of shops are located within walking distance of the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 encouraged an open, inclusive culture within the home and promoted an ‘open door’ policy. Visitors and relatives were free to visit their family members at any time and told us they were welcomed.

The atmosphere of the home was welcoming. Throughout our visit we observed staff interact with people in a respectful, caring and friendly manner. When people needed assistance staff were quick to respond. People told us they felt safe living in the home and received the care they needed. People’s individual needs and risks were identified and managed as part of their plan of care and support. However some people may not have been receiving the care they needed as monitoring records were not always accurate, lacked detail and had not been fully completed.

People’s care plans contained information staff needed to provide people with the care and support they required. People’s relatives told us they were involved in decisions about people’s care. Some people’s care records did not demonstrate that people were always fully involved in the day to day and monthly review of their care needs.

People’s health and wellbeing were monitored by the staff who worked closely with other healthcare professionals to meet people’s range of health needs.

People had the opportunity to take part in a range of activities that met their needs and interests. People received a choice of freshly prepared meals, which met their dietary needs and preferences.

Staff had an understanding of the systems in place to protect people if they were unable to make one or more decisions about their care, treatment and other aspects of their lives. Management staff knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff were appropriately recruited to make sure they were suitable to work with people providing them with care and support. Staff received appropriate training and support, and received the information they needed to care for people. Staff we spoke with were knowledgeable about people's needs and how they should be met. Staff supported people, where appropriate, to retain as much independence as possible, when carrying out activities and tasks.

People and relatives told us they felt comfortable raising any issues or concerns directly with senior staff. There were arrangements in place to deal with people's complaints and issues appropriately.

There were appropriate systems in place to monitor, evaluate and improve the quality of the service. However, these checks had not identified the concerns that we found in relation to monitoring records.

The service was in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to some monitoring records not being accurate and effectively monitored.

You can see what action we told the provider to take at the back of the full version of this report.

Craven Park is a nursing home located in the London Borough of Brent. The home provides nursing care and accommodation for up to 26 people. On the day of our visit there were 23 people using the service. Public transport and a range of shops are located within walking distance of the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.

There was a clear management structure in the home. People told us the home was well managed and the registered manager was accessible and approachable. People had the opportunity to provide feedback about the service and issues raised were addressed.

The atmosphere of the home was welcoming. Throughout our visit we observed staff engagement with people using the service was caring, courteous and supportive. However there were occasions when the manner of interaction with people by some care workers lacked sensitivity and did not show that people were supported to be involved in decisions about their care.

Arrangements were in place to keep people safe. Staff understood how to safeguard the people they supported. People’s individual needs and risks were identified and managed as part of their plan of care and support. Care plans reflected people’s current needs. They contained the information staff needed to provide people with the care and support they required. People’s relatives told us and records showed that they were involved in decisions about people’s care but some care plans lacked detail that showed people using the service were involved [or why they were not involved] in the content of their care plan and its review.

People were provided with choice and their decisions respected. They had the opportunity to participate in a range of activities and were provided with the support they needed to maintain links with their family and friends. Staff had an understanding of the systems in place to protect people if they were unable to make one or more decisions about their care, treatment and other aspects of their lives. The registered manager knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain good health and their well-being was promoted. They had good access to appropriate healthcare services that monitored their health and provided appropriate support, treatment and advice when people were unwell. People were provided with a choice of food and drink which met their preferences and dietary needs.

Staff were appropriately recruited, trained and supported to provide people with individualised care and support. Staff told us they enjoyed working in the home and received the support they needed to carry out their roles and responsibilities.

The service had a complaints procedure and there were effective systems in place to identify and to monitor the care and welfare of people. Issues were addressed and improvements to the quality of the service were made when required.

We found one breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the inspection we spoke with most of the people who used the service. Several people were able to talk with us and answer the questions that we asked but others were unable to answer questions and communicated by gestures, facial expressions and sounds. We spent time observing and we spoke with three care workers, the activities co-ordinator, the maintenance person, cook, a domestic, a registered nurse, the registered manager, provider, a community dentist, and a relative of a person who used the service. There were twenty people who used the service at the time of our inspection

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and staff were friendly. We spent a significant part of the inspection observing people and staff and found that people who used the service approached staff without hesitation. A relative of a person who used the service told us that they felt confident that people were safe.

Staff understood their role in safeguarding the people whom they supported and they understood the whistleblowing policy.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

Checks of the environment and equipment were carried out by senior staff.

We saw that necessary employment checks had been carried out so people were cared for by suitably qualified, skilled and experienced staff.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the staff included 'They are nice to me and help me when I need it,' and 'They ask me things. They know what I like.'

Staff told us that they were very well supported by the registered manager and there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed. However, it was not always evident from records that people had participated in the review of their care.

A relative told us that they felt 'involved,' and were 'kept informed' about the care needs and progress of a person who used the service.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. Staff responded promptly when people asked them for assistance.

People who used the service were able to do things at their own pace and were not rushed. People's privacy and dignity were respected. Arrangements were in place to ensure that people's religious and cultural needs were met. People took part in a range of activities of their choice.

People told us that staff were 'friendly,' and 'kind.' A person who used the service spoke about the staff and told us told us that 'You can't fault them. They treat everyone well.'

Is the service responsive?

People's care and health were monitored closely. Staff told us that they were kept informed about people's care and support needs and reported changes to senior staff. Written notes about people's health and care were completed by staff.

People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff. Complaints had been responded to appropriately.

We heard staff asking people how they were. People told us told us that they were listened to and felt involved in decisions about their care. People had provided feedback about the service, which had been responded to by the registered manager and other staff.

Some areas of the environment were 'tired' looking.

Is the service well-led?

The home had quality assurance processes in place to help ensure that people received a good quality service. There were arrangements in place to monitor the quality of the service and checks of the environment and equipment were carried out.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities, and had the qualifications, skills and experience necessary for the work that they performed. Appropriate checks were undertaken before staff began work.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff knew about their roles and responsibilities in meeting the needs of people who used the service and they supported people in a friendly and respectful manner. People who used the service and visitors confirmed that they found that staff were generally very approachable, listened to them and responded appropriately when they had any questions about the service or concerns.

People who used the service had a plan of care that had been regularly reviewed and included information about the individual support and care that people using the service needed.

There were systems in place to monitor the quality of the service and to carry out improvements when needed.

At the last inspection on July 30th 2012 we had moderate concerns in a number of areas; Staff had not received an appraisal or training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), people using the service who were unable to make decisions about their needs had not received a mental capacity assessment, and people's records did not include appropriate information and documents in relation to the care and treatment provided to some people at risk of developing a pressure sore.

At this inspection we found staff had received recent training about the Mental capacity Act 2005 and people had received an assessment of their capacity to make decisions. We also found appropriate action had been taken by staff to ensure people at risk of a pressure sore, and a person with a pressure sore received the care and treatment they needed.