Crowley Care Homes Ltd - St Annes Care Home Also known as St Annes Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the legal regulations in relation to safe care and treatment and the premises and equipment being unsafe. The provider had not always ensured staff followed safeguarding policies and procedures. The provider did not always assess or mitigate risks to people’s health and safety. Care plans and risk assessments in place for people were not always detailed or accurate. The provider was not ensuring the environment at the service was safe. Staff were not always recruited safely, we identified gaps in recruitment records during this assessment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care plans and risk assessments were not consistently updated with accurate information when people’s needs changed. Therefore, improvements in people’s experiences could not be demonstrated. Care plans did not demonstrate known risks had been fully reviewed and assessed to enable learning and improvements to people’s care to be made.

Staff told us people’s care plans and risk assessments were reviewed and updated following incidents and accidents. However, during the onsite inspection one person was observed using the stairs independently and staff confirmed it was unsafe for them to do this unsupported. Staff told us this was a known risk for the person, but no risk assessment or care plan was in place. We discussed this with the management team who immediately implemented a risk assessment and care plan. Staff also told us the management team discussed any lessons learned during regular handover meetings. However, handover records reviewed during the assessment did not contain any recorded discussions about people’s care needs.

Accidents and incidents were reviewed by the management team. However, records lacked enough detail to enable analysis and learning to take place. For example, the lessons learned log for 2024 did not contain the names of people affected by incidents and accidents. This meant staff could not review patterns and trends relating to specific people. Following the assessment the provider implemented a detailed log to enable oversight and analysis of accidents and incidents.

People’s relatives in the main told us they had confidence in the management team to deal with any referrals. One person’s relative said, “Yes I do feel that [person] is referred to social and health care professionals.”

Staff told us they were supported by the management team to ensure people were safely admitted to the home and had access to other services when needed. Staff told us they supported people to access the GP and community nurses and other referrals were completed by the management team. Staff told us communication from the management team about people’s contact with other services was good.

The provider worked well with other services for the benefit of people. A recent assessment of the service undertaken by the local authority found that people were confident they would be supported to access other services should they require it.

Policies and procedures were in place to support safe transition between services. However, care plans and risk assessments did not contain the information required to ensure all services involved in people’s care had access to accurate records.

Not everyone living at the service felt safe. A safeguarding alert was raised with the local authority as a result of some of the feedback we received from people.

Staff told us they had received training in safeguarding adults and knew where the safeguarding policy was. They were able to explain how they would report any safeguarding concerns. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Although staff had received training in MCA and DoLS, not all staff we spoke with had sufficient knowledge about their responsibilities under this legislation. There was a risk people would not receive their support in line with the requirements of the MCA.

During the inspection we observed staff treating people with kindness and respect.

The provider had not always ensured staff followed safeguarding policies and procedures. This meant incidents had not always been investigated or steps taken to mitigate future risk. Not all incidents had been reported to the local authority safeguarding team as required. Allegations and incidents of abuse had not been appropriately recorded in the provider’s safeguarding log. Safeguarding records lacked the detail required to ensure people were protected from abuse. Following the assessment a detailed safeguarding log was implemented.

Although people and their relatives did not raise any concerns about the management of risk in the service. We found that people had been placed at risk of harm by a failure to assess and monitor risk and have suitable plans in place to manage people’s known risks. For example, one person living with diabetes did not have their needs assessed or their diabetes monitored and managed safely. Records of blood glucose level checks and insulin administration provided indicated the person’s blood glucose levels were outside the identified safe range on several occasions and there was no record this was escalated to a health care professional.

Care plans and risk assessments did not contain the information staff required to ensure people’s risks were managed and safe support provided. However, staff knew people well and worked with people in a positive way to support them and reduce risks to their safety.

People were not always supported to mitigate known risks. During the inspection one person was observed using the stairs without staff support. The inspector alerted staff, who confirmed the person required support and it was unsafe for them to do this.

Risks to people were not always adequately assessed. Care plans and risk assessments did not always contain current, detailed information about people’s needs in relation to mobility, nutrition, falls, pressure ulcer prevention and specific health needs. For example, one person’s diabetes care plan and risk assessment contained inconsistent information about safe blood glucose levels and when escalation to a health care professional was required. This meant staff did not have access to the information they needed to support people in a safe way and mitigate risks to their safety and well being.

We found concerns with the quality of the home environment that may have negatively affected people’s experience of living at the service. For example, we identified multiple items of furniture in people’s bedrooms which required repair and carpets that required replacing. The provider took prompt action to repair and replace items following our feedback.

The provider acknowledged the findings of the inspection in relation to environmental safety and began to implement the actions required to make improvements.

During the inspection we saw several environmental concerns that posed a risk to people. For example, people were at risk of harm due to most free-standing wardrobes not being secured to walls. There was an increased risk that people could be injured by temporary fencing and other unsafe areas in the garden. There were multiple trip hazards in the home caused by extremely worn carpets, rugs, wires attached to sensor mats, and protruding extension lead wires. The provider had not ensure people were living in a safe environment. In response to feedback the provider ensured all wardrobes were secured to walls. Following the assessment the temporary fencing and worn carpets and rugs were replaced.

Systems to ensure the safety of the premises and quality of service delivery were not implemented or accurately completed. The registered manager informed us no full health and safety inspection of the service had been undertaken since 2021. Environmental risk assessments were ineffective as they did not indicate the level of risk to people. Health and safety checks that were in place were ineffective, for example, weekly bedroom checks had not identified concerns that were found during the inspection. The fire service had recently undertaken a fire safety inspection at the service and had identified shortfalls in fire safety. At the time of the inspection the provider was working on an action plan to complete the improvements required to fire safety in the specified timeframe. Following the assessment the provider carried out more detailed environmental risk assessments and arranged for a full environmental health and safety assessment to be completed.

We received mixed feedback about the availability of staff to meet people’s needs. One person’s relative said, “There could always be more, and the quality of care could be better.” However other people felt there were enough staff, with one person’s relative saying, “I would probably say that they have [enough staff], they have 22 rooms, I never see any less than 4 or 5. Appears to be quite a few around.”

Staff we spoke with provided mixed feedback about staffing levels in the home. Staff who worked in the day felt there were enough staff on duty, however some staff who worked overnight thought more staff were needed to ensure people received the care they required. Staff told us they received regular supervision with senior staff. One member of staff said, “These are useful, gives a specified time to talk and put forward suggestions.

During the onsite inspection we saw staff were generally available to meet people’s needs and people’s call bells were answered promptly. However, we were concerned about one person using the stairs to the fire escape without staff being aware, despite this being a known risk.

Staff were not always recruited safely. We reviewed staff recruitment records and found gaps and inconsistencies in information that was required to ensure safe recruitment. For example, one member of staff did not have a full employment history recorded. Rotas reviewed for a four-week period showed consistent staffing levels. However, as no system was in place to assess the number of staff required, the provider could not be assured the staffing levels were adequate to safely meet the needs of people living in the home. Not all staff had received the training they required to provide safe care. Staff were required to support people to move using a range of moving and handling equipment. They had received theory training in moving and handling people, but no training had been provided to teach staff how to practically support people to move in a safe way. There was also no record that staff’s competency to support people to move in a safe way had been assessed. The provider could not be assured that staff had the necessary skills to provide people with safe support. In response to our feedback the provider arranged for staff to receive practical manual handling training. Staff had received a range of other training to equip them to undertake their role, including first aid, dementia care and oral healthcare.

Although people did not raise any concerns about the cleanliness of the home, our onsite inspection identified several environmental infection prevention and control concerns.

Staff told us they had received training in infection prevention and control, however not all staff worked effectively to mitigate the risk of infection. For example, care staff providing personal care to people were entering the kitchen to wash their hands and had to walk through the kitchen to collect medicines that were stored in a fridge in the kitchen. We observed one member of staff enter the kitchen with no apron on during the inspection. Staff were able to describe effective prevention control measures and told us there was a plentiful supply of personal protective equipment (PPE). One member of staff said, “We need to wash our hands before a task and after a task, and use the equipment provided; PPE, and dispose of this after the task.”

During the inspection we identified several infection prevention control risks related to the environment. For example, the provider had failed make improvements to the kitchen in a timely manner following an inspection by an environmental health officer. We saw several areas of the kitchen remained in a poor state of repair which made them difficult to clean and mitigate food hygiene risks. Countertops remained chipped, floor tiles were cracked, work tops were worn and the net screen to prevent flies entering the kitchen was broken. The kitchen had been in a state of disrepair for a significant period of time and people could not be assured their food was prepared in an environment that met food hygiene requirements. Following the assessment the kitchen was refurbished and has now been awarded a ‘Very Good’ rating by the Food Standards Agency. Some areas of the home and equipment were visibly dirty, stained or rusty. For example, items in bathrooms were rusty, including shelving, toilet roll holders and radiators. We saw unclean crash mats were located under people's beds, and one person’s bed frame was stained. These items posed a risk of cross contamination.

The provider had not implemented effective processes to protect people from the risk of infection. A Legionella risk assessment was conducted on the 1 August 2023 to assess the risk to life from Legionella Bacteria. Actions required because of the risk assessment had not been correctly implemented which meant people continued to be at risk of becoming seriously unwell due to exposure to legionella bacteria. As a result of our feedback the provider acted promptly to ensure appropriate monitoring was in place.

People told us staff provided them with the support they needed to take their medicines and they received their medicines as prescribed.

Staff had received training in medicines administration and were able to describe how they administered people’s medicines in a safe way. They were knowledgeable about how to support people who were prescribed medicines on an as required basis and described the protocols that were in place to support this.

People’s care plans contained a list of prescribed medicines. However, the medicines listed did not always match the information on people’s medicines administration charts (MARs). Staff had received training in medicines administration and had their competency assessed. Staff consistently signed people’s medicines administration record charts (MAR) to confirm they had administered people’s medicines as prescribed.