Crowstone House

Crowstone House is a residential care home providing personal care to up to 54 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 45 people using the service.

People’s experience of using this service and what we found

The provider did not have robust systems in place to assess and monitor risks to people’s health and safety. Risks within people's living environment were not always identified or adequately managed in order to keep people safe from harm. The provider’s processes for monitoring the quality and safety of the service were not always effective in highlighting and addressing concerns.

The provider had not always ensured all relevant recruitment checks were completed for new staff. We have made a recommendation about the safe recruitment of staff. The provider had recently increased staffing levels in the service. However, we found the deployment of staff did not always fully meet people’s needs.

The provider had processes in place to manage people’s medicines. However, some guidance did not reflect how medicines were being administered.

Staff were aware of how to report safeguarding concerns and the provider had sent notifications and shared information with the relevant authorities when appropriate. People and relatives told us they knew who to speak to if they had any concerns or complaints.

The provider had safe infection prevention and control processes in place and visitors were welcomed into the service. Relatives were encouraged to give feedback and spoke positively about the approachability and availability of the management team. Staff had received an induction and relevant training and told us they felt valued and supported in their roles.

People were encouraged to maintain their independence and the provider worked alongside other healthcare professionals to support people’s health needs. People and relatives told us staff were generally kind and caring and were respectful of people’s privacy. 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

The last rating for this service was outstanding (published January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the number of people having falls in the service and the number of staff available to support people. The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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.

We have found evidence the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report. The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to the management of risks to people’s health and safety and the oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Crowstone House is a ‘care home’. People in care homes receive accommodation and 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 is registered to care for up to 54 older people, some of whom may be living with dementia, a physical disability and/or a sensory impairment. There were 48 people living in the service when we inspected.

There was a registered manager in post. 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.

People were consistently cared for by kind, caring, respectful and compassionate staff. They told us that they felt they mattered and that staff always listened to them and helped them in any way they could. Staff were passionate about their role and had an exceptionally good knowledge about the people they cared for. People and their relatives said that staff, ‘went the extra mile’ and, ‘go out of their way’ to ensure that people had the most pleasant experience of care. Staff were described as, ‘absolutely marvellous’ and, ‘kind and compassionate’. People and their relatives were kept actively involved in making decisions about their care. Advocacy services were available if people needed them. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People always received excellent personalised care that was tailored to their individual needs. Staff cared for each person as an individual and knew them really well. The service promoted the importance of engagement and linking people to their community, people were extremely positive about their lives and told us about their trips to the theatre, the seafront, the dementia awareness festival, local church groups and to local cafes. People told us they made good friends and one relative said their loved one had a better social life since moving into Crowstone House. Everyone we spoke with praised the service and staff. They could not speak highly enough of the care and support they received.

People were encouraged to maintain personal relationships. Their families were able to share meals with them if they wished. People had the use of technology such as mobile phones and email systems and one person had used a tablet computer. Where people had never used technology before the service supported them to learn and link with their families which increased their wellbeing exponentially. A satellite television service had been ordered to offer people a wider choice of TV programmes.

People and relatives spoke confidently about how the service listened to them and felt concerns and complaints, no matter how small, were acted upon and resolved to their satisfaction. The service learnt from complaints and made changes to ensure that people received an improved service. People had plans in place for their end of life care and staff knew how to support people’s families at these times.

There was a wonderful personal relationship between staff, people and their loved ones. People and their families had confidence in the registered manager and staff. People consistently told us they would recommend Crowstone House to others as the care was exceptionally good. People's relatives felt they could talk with any of the staff and that they all knew exactly how to care for their loved one.

Staff felt valued and supported by management and by each other and ensured that people’s needs and preferences were at the forefront of what they did. The service worked really well with other professionals and was highly rated by them. The provider operated an award system and Crowstone House won the award for excellence in 2016 and the registered manager won the award for excellence in 2017. And it was easy to see why they had received these awards; there was a feeling of calm and confidence amongst staff which gave people a sense of wellbeing. People benefit from an outstanding, ever improving service.

The service had effective and inclusive quality assurance systems and processes in place which highlighted any improvements needed. The system fully involved people and the actions taken by the service showed that all staff and management were quick to make the improvements. The registered manager felt strongly that the only way to continually improve the service for people was to ensure that they were at the heart of it all.

People were protected from the risk of harm by the systems, processes and practices in the service. Staff knew how to protect people and had been well trained. They knew what to do in an emergency and how to support people with mobility issues. The registered manager ensured that the right calibre of staff were recruited and retained, they were well trained and supervised and demonstrated excellent communication and teamwork.

There were plenty of staff working at all times to ensure people’s needs were fully met. People received their medication safely as prescribed and the records were of a good clear standard. Staff had been trained in the prevention of infection and there were sufficient domestic staff employed to ensure the service was clean. The environment was well maintained, kept clean and was safe and hygienic.

People’s care and support needs had been holistically assessed to ensure that all of their diverse needs could be met. People and their families had been fully involved in the process and the care plans were kept continually under review to enable staff to care for them correctly. Staff knew people well, were well trained and demonstrated the skills, knowledge and experience to care for people effectively. Where people found it difficult to communicate their needs, staff used a variety of methods of communicating with them to ensure their needs were met.

It was clear throughout our inspection and from the many people, relatives, staff and professionals we spoke with that the service was run for the people they cared for and that all the processes and systems in the service governed by management supported an inclusive person centred culture that allowed people to access their community, live full lives and really engage with each other, with their relatives and staff in a way that brought happiness to everyone in the service.

People were appropriately supported where they needed help with meals and drinks. They were involved in menu planning and had the choice from a range of home cooked food each day. The cook accommodated people’s individual preferences and had prepared meals to order to ensure that people had sufficient, appetising food that suited their taste. Staff ensured people’s healthcare needs were met and worked well in partnership with other professionals to ensure that people received the best possible healthcare.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. People were supported to maintain their independence whilst staff ensured they were kept safe by minimising risks. Where people were deprived of their liberty for safety reasons the service had completed the appropriate forms and had authorisations in place to do so. Where bedrails were used as a form of restraint to prevent a person from falling out of their bed, the service had carried out appropriate assessments in line with legislation.

Further information is in the detailed findings below.

Crowstone House is registered to provide accommodation and personal care without nursing for up to 54 persons who may be living with dementia. There were 48 people living in the service on the day of our inspection.

There was a registered manager in post. 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.

At our last inspection in September 2015 we had concerns about staffing levels and medication storage. At this inspection we found that staffing levels and medication storage had improved and that people were cared for and supported by sufficient numbers of staff.

You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Crowstone House on our website at www.cqc.org.uk

We saw that people's care needs were assessed. Care plans were in place so that staff would know about people's care needs. Risks associated with people's care was minimised as far as possible through risk assessments being undertaken to keep people safe. The service was caring and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed. Staff had a good knowledge of people's individual needs and offered them appropriate support. People had opportunities for activity and occupation.

People told us that they enjoyed the food provided at Crowstone House. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

People told us that they felt safe and secure living in Crowstone House. The home had a friendly, welcoming and caring atmosphere. We saw that staff had been trained to understand different types of abuse and to report and act upon any concerns they had about people's care and welfare.

People had access to sufficient levels of equipment to assist in meeting their needs. Equipment in use was kept in good condition and well maintained to ensure people's safety.

Staff were supported to be effective in their role through good levels of initial induction, training and on-going supervision.

Overall we found Crowstone House to be a caring, effective, responsive, safe and well led service.

We found that people were treated with respect and dignity was promoted through dignity champions. Staff made pledges on the dignity tree for everyone to see how they individually would promote dignity within the service.

People told us that they experienced care, treatment and support that met their needs and protected their rights. Care plans were up to date and informative for staff to follow.

Staff were well trained in care and were aware of the needs of people living with dementia. Staff told us they were well supported by management and were happy to work at this establishment.