Cromwell House (West Bromwich)

Vestige Healthcare (West Bromwich) is a residential care home providing personal and nursing care, treatment of disease disorder and injury and diagnostic and screening procedures. People living at the home have a mental health diagnosis and are aged 18 and over. Some people also had a learning disability or autism. The service can accommodate 14 people, at the time of inspection, nine people were living in the home.

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

Improvements had been made since the last inspection but there were still some areas that required improvement. A new audits system was being implemented but had not yet been used. Medicines records were not always accurate or up to date. Care plans and risk assessments had been reviewed and updated, however we found some information was not always consistent.

People, relatives and staff expressed confidence in the manager. Safeguarding processes were in place to report concerns to relevant professionals. There were enough staff to keep people safe.

We were assured the home had good infection control practice relating to COVID-19. Risks to people had been assessed and mitigated.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care and setting maximises people’s choice, control and independence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 November 2019) and there were two breaches of regulation. At this inspection we found improvements had been made however the provider were still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We inspected other services owned by the provider and concerns were identified. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vestige Healthcare (West Bromwich) on our website at www.cqc.org.uk.

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 will continue to monitor the service.

We have identified breaches in relation to governance 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People told us they were happy living at the home and felt safe. Individualised care plans were in place. Following our inspection, the provider made improvements to the care records to ensure they contained detailed information about risks associated with people’s care and details of how staff should identify and manage them. People were supported by staff who knew them well and who recognised the risks to people’s health, safety and well-being. The provider already had plans in place to implement a new risk assessment system. Staff understood how to identify, and report abuse, and recruitment processes included checks to ensure only appropriate people were employed to work with people at the service.

People received their medicines when they required them from suitably trained staff. The registered manager completed regular checks to ensure people received the correct medicines and they were administered safely. The service was clean, and staff understood how to maintain good infection control practice.

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. However, the provider’s systems did not always support this practice. Staff knew to ask people for consent before supporting them but people who lacked capacity to make certain decisions did not always have clear assessments in place that were decision specific to demonstrate compliance with the Mental Capacity Act 2005. People were supported to access healthcare professionals regarding any health and welfare concerns. Meals were prepared which met people’s nutritional needs and preferences.

Staff were caring and supported people with empathy and compassion. Staff provided reassurance to people if they became anxious. People were supported to learn new skills to increase their independence.

People were involved in planning their care with support to ensure their needs were met in accordance with their needs and preferences. They had access to activities relevant to their interests and hobbies. A complaints procedure was available, and people understood how to raise concerns.

The registered manager completed audit checks to make sure the care provided was in accordance with the provider’s expectations, however, these did not always identify the lack of information in care records to support staff in meeting people’s needs. The registered manager had not always informed us of notifiable incidents such as police being contacted to demonstrate risks to people’s health and safety had been identified and managed.

For more details, please see the full report which is on the CQC website www.cqc.org.uk.

Rating at last inspection

The last rating for this service was Good (report published 2 March 2019).

Enforcement

We have identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance. We identified one breach of the Care Quality Commission (registration) Regulations 2009 relating to notifications of other incidents.

Why we inspected

We inspected this service following concerns identified at inspection of another location owned by the provider.

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 Camino Healthcare West Bromwich Cromwell House on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cromwell House is a care home with nursing, which can accommodate up to 14 people between two on-site buildings, one being an independent living service. At the time of our inspection 13 people were using the service. These included people with mental health difficulties.

At our last inspection in January 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 10 December 2018 and was unannounced.

There was a registered manager in post who was there at the time of the inspection. 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 continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to and follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to people. People received medicines as required.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People could speak openly with staff and understood how to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the registered manager. We were provided with information about the service where required.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were given appropriately.

People told us that they were kept safe.

We observed there were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs.

People told us that they were able to raise any concerns they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and used a variety of communication methods to establish their consent and/or understanding.

People were supported to take sufficient food and drinks and their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision allowing staff to understand their roles and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager a high level of support.

Notifications were sent to us as required.

People told us and we saw that that people's views were sought and acted upon. Staff spoken to was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One relative said 'I have seen X's care plan and attended care reviews'

All staff spoken to were able to tell us about people's needs and records seen confirmed the that staff were knowledgeable about the people they cared for. We saw positive interactions between staff and people that lived at the home. One person said, 'I talk a lot to my keyworker and we are planning for my future.'

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. One person told us, 'Staff are friendly and helpful.' Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

Medicines were prescribed and given appropriately to the people who used the services.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

The people who lived at the home had mental health care needs. People told us about their experiences, we looked at records and observed staff caring for them. Staff was able to tell us about people's needs so that they received care in a way that they preferred. Relatives told us they were kept informed about their relative's health so they felt involved in their care. One relative said 'It's a nice clean place and they seem to have everything in order.'

We saw that systems were in place to keep people safe from harm. A relative told us 'Staff are friendly and helpful.' Staff received a range of training to support the people who lived in the home. There were systems in place to monitor how the home was run, to ensure people received a quality service.