Cressington Court Care Home

Cressington Court Care Home is a residential care home providing personal care to 43 people, including people living with dementia and physical disabilities. The service can support up to 53 people. The service is a domestic style property and accommodation is over two floors.

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

At this inspection we identified concerns with the management of risk, care planning, the management of medicines and governance.

Risk was not always effectively mitigated. Care plans reviewed were not updated following reviews by professionals and changes to peoples care needs. Advice and guidance from professionals had not always been acted upon or implemented and care plan reviews were inconsistent.

Medicines were not always managed safely. There was a high volume of medication errors being reported and a number of actions identified following quality audits. Covert medications were not being administered safely for a person and the covert care plan was not being followed.

The governance arrangements in place were not robust and records were not always adequately maintained. There were gaps in auditing, and some audits were not effective. The audits for the medicines and the environment had failed to identify the issues found during the inspection.

There were systems in place to determine safe staffing levels. People and their relatives told us staff were kind, caring and respectful. The majority of people we spoke with felt there were enough staff on duty to support people's needs. Mixed feedback was received regarding agency staff, the provider was open and transparent regarding the barriers they were facing with regards to

recruitment of staff.

People received support from a range of health and social care professionals including dieticians; social workers, community nurses, community mental health teams, speech and language therapy and their local GP.

The culture of the service was open and transparent. The acting manager and CEO engaged with the inspection positively and were committed to making any necessary improvements.

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 and update.

The last rating for this service was Requires improvement (published 10 October 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the domains of 'safe’, effective, ‘caring’, 'responsive' and' well-led’.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cressington Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

At this inspection we found breaches of regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to the failure to ensure people received safe care and treatment and a failure to ensure the service was always governed and managed adequately.

You can see what action we have asked the provider to take at the end of this full 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.

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for the service has remained at requires improvement based on the findings of this inspection.

Cressington Court Care Home is a residential care home providing personal care to 18 people, including people living with dementia and physical disabilities. The service can support up to 56 people. The service is a domestic style property and accommodation is over two floors. At the time of the inspection only one floor was in use.

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

There had been improvements in the home since the last inspection. Risks to people were assessed and appropriate plans were in place to keep people safe. Risk plans provided staff with more detailed guidance on how to support people safely. However, further improvements were needed to ensure all plans were person-centred and reflected individual needs.

Medicines management had improved since the last inspection, however there were still concerns with some aspects of safe administration of medicines. People did not always have their medicines administered safely in line with the prescriber’s guidelines. Audits did not identify these concerns. The provider updated their audits during the inspection, and we were assured these would identify similar concerns in the future.

Governance processes had improved and there was better oversight from managers at the home. However, further improvements were needed to ensure records were completed accurately and updated in a timely manner.

Accidents and incidents were recorded, and appropriate actions were taken to ensure people were safe. We could see reviews of these incidents had been implemented since the last inspection. However, further improvement was needed to ensure patterns, trends and themes were identified and effectively used to improve the safety of the service.

Recruitment procedures had improved, and staff were recruited safely. There were enough staff to meet people's needs. Staff told us things had improved at the home. Staff were positive about the support they received from the managers, and from the provider. Staff told us they felt there was more responsive action taken by management when they raised concerns.

Infection control procedures were in place and followed by staff. Staff wore appropriate PPE and the home was clean throughout. Visiting was safe and followed current guidance.

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.

Care plans had been updated since the last inspection and showed a clear improvement in the planning of person-centred care. There was more information to guide staff in supporting people safely and in line with their preferences. Staff knew people well and treated them with compassion and respect.

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 inadequate (published 25th May 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made to some aspects of the service, however the provider still remained in breach of some regulations.

This service has been in Special Measures since 25th May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Due to concerns found at the last inspection the provider voluntarily applied to cancel the regulated activity for treatment of disease, disorder and injury and no longer admit people with nursing needs. The CQC placed a restriction on the provider’s admissions after the last inspection which is still in place. This means the provider must seek the approval of the CQC before taking new admissions to ensure this is managed safely.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end 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 COVID-19 and other infection outbreaks effectively.

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 and will take further action if needed.

We have identified breaches in relation to safe management of medicines and 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 meet with the provider following this report being published to discuss how they will make changes to ensure they continue to improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cressington Court is a residential care home providing personal and nursing care to up to 56 people. The service provides support to people who live with physical disabilities and dementia across two units. At the time of our inspection there were 47 people using the service.

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

People were not always protected from serious harm because staff did not always ensure they received care and treatment in a safe and effective way. People did not always receive their medicines as prescribed. Staff did not always effectively safeguard people or act on recommendations made by safeguarding professionals to reduce risks identified. Accidents and incidents were not effectively managed to prevent further incidents and lessons were not always learnt. We found safety concerns in relation to the environment and infection control. During the inspection the provider acted on our concerns about the environment and improvements were made.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s needs were not effectively assessed or reviewed and their care was not always planned in line with best practice guidance. Staff did not always have the skills and experience to provide safe, responsive and effective care and treatment. The provider was highly reliant on the use of agency workers and this meant people did not receive consistent care.

People were not always treated with kindness, respect or compassion because a number of agency staff deployed failed to understand the needs and preferences of people they supported. We received mixed feedback from people who lived at the service and their representatives about staffs’ approach and knowledge of their needs. People were not always involved in the care planning process or when decisions were made about their care and treatment.

People were not always supported in a person-centred way. Staff lacked understanding about people’s preferences and life experiences this meant they had been unable to build meaningful relationships. Staff did not have the skills or experience to effectively support people at the end of life. People were not always supported to make informed decisions about end of life care in a person-centred or timely way.

The service was not well-led. The registered manager and provider failed to carry out their regulatory responsibilities. Quality assurance processes were ineffective, this meant serious risk of harm was not suitably acted on. During the inspection the senior management team and nominated individual worked in partnership with us and social care commissioners to ensure immediate actions were taken to mitigate the failures highlighted in this report.

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 09 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and clinical care. A decision was made for us to inspect and examine 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 undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services across Merseyside. To understand the experience of social care Providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

You can see what action we have asked the provider to take at the end of this full report.

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment, environment safety, staffing, governance, safeguarding adults, nutrition and hydration, medicines and person-centred care at this inspection.

We originally took action to propose to cancel the providers registration in response to the concerns found. Due to action taken by the provider to reduce the risk of harm to people we have decided to withdraw the action to cancel the provider. Please see the action we have asked the provider to take at the back 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The home was clean and hygienic. Regular cleaning was carried out by staff throughout the day and cleaning schedules had been reviewed and enhanced in response to COVID-19.

The provider had safe systems in place to facilitate and support visiting at the home in line with the national guidance.

Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant guidance. Staff were wearing the required levels of PPE during our inspection.

The provider had an effective testing process in place, ensuring staff and people living at the home were tested regularly for COVID-19 in line with the national guidance.

The provider had systems in place to ensure it was meeting the COVID-19 vaccination requirements for staff and people visiting the service.

Cressington Court Care Home is a residential care home providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. The service is registered to support up to 56 people.

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

People told us they felt safe living at the home and there were enough staff to support them. One person told us staff quickly responded to their alarm and said, “This makes me feel really safe and less vulnerable.” Systems were in place to protect people from abuse and new staff were safely recruited.

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.

People’s needs were effectively assessed before they were supported by the home and staff worked effectively with other healthcare professionals to ensure people’s health and wellbeing was maintained. Feedback about the food and drink at the home was positive. One person said, “Food is good, especially the Sunday Roast.”

People gave us positive feedback about the staff at the home and staff knew the people they were supporting well. One relative said, “Really pleased with the improvements at the home, [Relative] has made great progress and the staff have supported [Relative] brilliantly.”

People’s care plans were person-centred and gave staff the information they needed to support them. There was a good range of activities on offer to people living at the home.

There was a kind and caring culture amongst staff at the home, which was a significant improvement from our last inspection.

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 inadequate (published 28 March 2019), there were multiple breaches of regulation and the service was placed into Special Measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. During this inspection the provider demonstrated that improvements have been made and was no longer in breach of regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At the last inspection the safe, effective, caring and well-led domains were rated as inadequate. At this inspection these domains have now improved to requires improvement. We noted the provider had made significant improvements since our last inspection. However, in order to achieve a rating of good the provider needs to demonstrate those improvements have been fully embedded and sustained.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cressington Court Care Home is a care home that was providing personal and nursing care to 44 people at the time of the inspection. It is registered to provide a service to older people who may be living with dementia and/or physical disabilities.

People’s experience of using this service:

People were not always treated with care and compassion and were sometimes left in undignified situations.

The service was not acting in line with the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. This meant that people were at risk of having their liberty unlawfully restricted and inappropriate decisions could be made on a person’s behalf if they lacked capacity to make the decision for themselves.

Risk assessment and management was poor. Medicines were not always administered safely and in line with best practice and any prescriber instructions. The premises were not kept safe.

Standards of cleanliness were poor and infection prevention and control was not always well-managed.

The service did not have robust and effective processes in place to protect people from abuse or investigate and act on allegations or evidence of abuse.

The service did not ensure staff were sufficiently trained, supervised and appraised in their roles. It also failed to ensure that staff of good character and with suitable competence, skills and experience were employed.

The service did not have robust and effective systems in place to monitor, assess and improve the safety and quality of service being provided. People’s personal information, such as care records, was not stored securely. Contemporaneous records of people’s care were not kept up-to-date. The service failed to notify CQC of incidents which occurred at the service, as required.

You can see more information in the Detailed Findings below.

Rating at last inspection:

This was our first inspection of the service since the provider acquired it in December 2017.

Why we inspected:

This was a planned comprehensive inspection.

Follow up:

Following the inspection we arranged to meet with the provider and the local authority to discuss the concerns we identified and seek reassurance as to how the provider would deliver the required improvements.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve;

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made; and

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.