Archived: Cromwell House Residential Care Home

Following the last inspection in September 2016, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘safe’ to at least good.

Cromwell House provides care for one individual with a learning disability in one adapted building. Cromwell House 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. At the time of our inspection the registered manager, who was also the provider was in the process of ‘stepping back’ from the day to day running of Cromwell House. Their deputy manager was in the process of registering as manager. 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.

There were effective staff recruitment and selection processes in place. A member of staff had been employed since our last inspection and the recruitment process had been robust. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication between staff at the service.

People were safe. Staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf. Staff ensured infection control procedures were in place. People’s individual needs were met by the adaptation, design and decoration of the premises.

Care files were personalised to reflect people’s personal preferences. The service adopted informal methods when seeking people's views. This was through regular family contact, via phone calls and visits. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. The organisation’s visions and values centred around the people they supported, which ensured their equality, diversity and human rights were respected.

A number of effective methods were used to assess the quality and safety of the service people received and make continuous improvements.

Cromwell House is registered to provide care and support without nursing for one person with learning disabilities.

The registered manager is also the director of the limited company who is the provider of this service. He usually visits the service weekly, and has delegated the day to day running of the service to the assistant manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the registered manager was not available and subsequently was out of the country for a number of weeks. They did not inform CQC about this absence.

We found there had been improvements in the way staff recorded how they worked with people and how they monitored their wellbeing and incidents. There were also improvements in the way risks were being managed which helped to ensure people’s safety as well as the safety of staff, when out in public. Training had been completed to ensure staff had the right skills to work with people with complex needs. This included positive interventions, safe holding and working with people with autism.

We found the staffing arrangements at night did not keep people or staff safe. The arrangements were for one member of staff to provide sleep-in cover. Although the provider had been commissioned to provide an on-call system, staff were doing this on a ‘good-will basis’. For example no staff were rostered or paid to provide on-call back up in an emergency. This meant the systems were not robust if there was an event where people were distressed and needed more than one staff member. Since the inspection took place we have been assured by the provider that there was now an on call system in place. He told us he was always available to provide support.

Records had improved since the last inspection, although some care plan details did require updating, which the assistant manager was addressing. There were clearer guidelines about how best to support people. These had been developed by a specialist from Somerset County Council following a safeguarding incident in relation to managing one person’s behaviour when out in public. It included looking at trigger points and positive intervention strategies for staff.

Staff said they had benefitted from additional training and clearer guidelines. They said they all knew people’s needs and worked well as a team to support people to do things they enjoyed and were meaningful. Staff were knowledgeable and talked about people with compassion and genuine kindness. It was clear people were at the heart of how the core staff worked and planned activities.

People’s medicines were well managed and staff knew when and why they might consider additional medicines when a person may require this to relieve agitation and help them stay calm.

People were protected because staff understood how and when to report any abuse. Monies were well managed with clear systems for recording when and how people’s personal monies were being spent. We did find one out of three recruitment files did not have a copy of checks being done to ensure they were suitable to work with vulnerable people. The assistant manager said they were sure these were in place but had not been filed.

Audits were being completed to ensure the environment and the way the service was being run was safe and effective, although these had failed to pick up on a number of areas we identified during the inspection.

We found one breach of 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 this report.

This visit took place unannounced and we met two staff and the person living in the home. Cromwell House provides bespoke care and support for a single person, with complex communication needs. Much of our inspection findings were based on our observations and talking with the person and staff supporting them. We found staffing arrangements had been reviewed and meant the person had good levels of support and care, which corresponded with their planned care package.

Staff anticipated the person's needs very well and promoted an inclusive atmosphere that was free from restrictions but was managed safely. This meant the person was able to express themselves and live their life as they chose to. The person proudly showed us around their home pointing out their own artwork and other things which were important to them. We saw another example of how their independence and choices were supported, they said they had told staff they wanted to get their 'Weekly' magazine. As we left the home, we saw everyone getting into the vehicle which they now had access to every day .

We found the provider was compliant in the two outcomes we looked at. The care and welfare of people who used the service and staffing.

In this report we use the term 'manager' to refer to the person in day to day charge of the home. This is not the same person as the registered manager, who is also one of the owners of the care home.

The staff knew the individual very well and were well able to anticipate the person's needs to provide the support that they required. When the person became anxious or unsettled they could physically damage fixtures and fittings or hurt people. Staff were seeking to create a homely atmosphere whilst also taking care to ensure the environment is maintained in such a way as to minimise any potential damage. Staff were skilled in anticipating when the person was becoming anxious and at diffusing situations.

One member of staff told us "I chose to return back to Cromwell House when it re-opened." When asked if they liked living at Cromwell House the person responded "Yes".