Archived: Cressington Court Care Home

Cressington Court is situated in a suburb in south Liverpool close to transport routes. The home provides a service for up to 56 people who have a range of care needs. The home was purpose built and all accommodation is provided on two floors. The home is located in a residential area of Liverpool close to public transport routes and local amenities. At the time of our inspection there were 38 people living in the home, 23 of whom received nursing care at the service.

This inspection was prompted following the receipt of information from the Local Authority which raised concerns for the safety, comfort and welfare of people living at Cressington Court. These concerns related primarily to issues around the administration of people’s medication and the management structure at the service. The purpose of this inspection was to check if the provider was managing risks to people effectively and to ensure that people were safe.

There was no registered manager within the service. The previous registered manager had recently changed roles to become the clinical lead. 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.

When we carried out an inspection of Cressington Court in May 2017, we identified breaches of legal requirements and the service was rated as, ‘Requires improvement.’ We found that people were not protected against the risks associated with unsafe administration of medication and that the service did not work in accordance with the principles of the Mental Capacity Act 2005. We also found that there was no effective oversight of the service. We asked the provider to take action to make improvements. On this inspection, we found that sufficient action had not been taken and the provider remained in breach of regulations. The concerns we identified are being followed up and we will report on any action when it is complete.

We found that medicines were not managed safely within the home. People were not always given their medication when they needed them or as directed by their doctor. We identified examples of missed medication and of people being given the incorrect dose of medication. The support plans in place for people who had their medicines administered into a stomach tube lacked detail.

We found that the environment was not always adequately maintained in order to ensure people's safety and wellbeing. We identified issues with infection control at the service and observed poor hygiene practices by staff at the home.

Fire alarm and equipment checks were not completed regularly. This meant that faults were not identified promptly. We saw that fire exits were blocked with items of furniture which compromised the safety and security of people using the service.

Accidents and incidents were not consistently analysed and reviewed at the service. This meant that audits had failed to identify that appropriate action had not been taken to refer one person to the podiatry service following the identification of pressure ulcers. We found the provider’s response to incidents and accidents varied and their reporting procedures to the Local Authority were inconsistent.

The service did not always operate within the principles of the Mental Capacity Act 2005 (MCA). We found that some capacity assessments were generic and not linked to key individual decisions. The service had not applied for Deprivation of Liberty authorisations for everyone who needed them. Some people were at risk of being restricted unlawfully.

At the time of the inspection, there was no registered manager in post. We found the management structure at Cressington Court to be ineffective, in terms of assessing and monitoring the quality and safety of services provided and mitigating risk to the health, safety and welfare of people receiving care.

We found that staff assessed risk to people but information was not always updated or reviewed regularly. This appeared to correlate to periods of absence of the last registered manager. There were no effective contingency arrangements in place to manage this review process in their absence.

There was no evidence that the service had made the necessary changes identified at our last inspection in May 2017. There continued to be a lack of effective audit systems and processes to check the quality and safety of the service.

People’s personal information was not stored securely within the home which meant that people's confidentiality was not maintained.

The was a lack of systems in place to seek feedback from people.

The provider had not always notified the Care Quality Commission (CQC) of events and incidents that occurred within the home in accordance with our statutory requirements. This meant that CQC were unable to monitor risks and information regarding Cressington Court.

There were limited activities available to people living at Cressington Court. People told us they “could do with some more entertainment.” We have made a recommendation regarding this.

There were sufficient numbers of staff to meet people’s needs however we found there was a recent reliance on agency staff. The provider had taken appropriate steps to address this.

Staff had received training however the registered provider's records showed that this was not always up-to date or consistent. For example over 50% of care staff had not received training in safeguarding vulnerable people or the MCA. Nevertheless, the majority of care staff had achieved NVQ level qualifications and appeared to have the necessary skills and knowledge to support people safely.

The provider had systems and processes in place to ensure that staff who worked at the service were recruited safely.

Staff told us they were assisted in their role through supervisions and appraisals however there was no documented evidence of this. Staff described the provider as, "supportive and approachable” and felt well supported within their roles.

People told us they were given choice regarding meals. Staff knew, and catered to, people’s individual dietary needs and preferences. Specialist diets were catered for including diabetic and liquidised diets and we saw people's preferences being met.

The majority of people we spoke with were complimentary about the staff and the service in general. People told us they liked the staff who supported them.

We observed interactions between staff and people living in the home to be warm and familiar. However, although we found that staff were caring towards people living in the home, the provider had not addressed risks identified during the last inspection and this does not demonstrate a caring approach.

Through discussions with staff, we found that they knew people they were caring for well, including their needs and preferences. Care plans contained good information regarding people's preferences, likes and dislikes. This ensured that staff had access to relevant information on how to support people.

People had access to a complaints procedure which provided relevant contact details should people wish to make a complaint.

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.

• 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.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Cressington Court is situated in a suburb in south Liverpool close to transport routes. The home provides a service for up to 56 older people. It was purpose built and all accommodation is provided on two floors. The home is fully accessible and is fitted with aids and adaptations to meet people's needs. There were 44 people living at the home at the time of our inspection.

We completed a comprehensive inspection of Cressington Court in November 2015. We found that the provider was in breach of regulations with regard to consent and good governance. The service was rated as ‘requires improvement.

The home did not have a registered manager in post. The last manager had resigned from her position in January 2017 and the provider had not yet recruited another manager to the 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.

We viewed medicine administration records (MARs) and found that they were not always fully completed as there were some gaps in the recording of medicines administered. Stock balance checks of boxed medicines were not routinely undertaken.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

Safety checks of the environment and equipment were completed regularly.

There were enough staff on duty to provide care and support to people living in the home.

The provider had robust recruitment procedures to ensure staff were suitable to work with vulnerable adults.

Staff worked with health and social care professionals to make sure people received the care and support they needed.

Staff were trained to ensure that they had the appropriate skills and knowledge to meet people’s needs. They were well supported by the registered manager.

Staff sought the consent of people before providing care and support. The principles of the Mental Capacity Act were not always adhered to when seeking and recording people’s consent to their care and treatment. For example a person was given their medication covertly (hidden in food or drinks) and the relevant people had not been a part of the best interest decision making process.

People told us they liked the food and were able to choose what they wanted to eat.

People told us the staff had a good understanding of their care needs. People’s individual needs and preferences were respected by staff.

People at the home told us they were listened to and their views taken into account when deciding how to spend their day.

People told us staff were kind, polite and maintained their privacy and dignity. We observed positive interaction between the staff and people they supported.

Care plans provided information to inform staff about people's support needs, routines and preferences.

A programme of activities was available for people living at the home to participate in.

A process for managing complaints was in place. People we spoke with knew how to raise a concern or make a complaint.

The service had no registered manager. Feedback from people, relatives and staff was complimentary regarding the clinical lead nurse, operations manager and owner’s leadership and management of the home. However, audits had not been completed regularly and had not identified the medication errors we found.

You can see what action we told the provider to take at the back of the full version of this report.