Background to this inspection
Updated
4 September 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by one inspector, an ‘Expert by Experience’ and a ‘Specialist Advisor’. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service and a specialist advisor is a person who has professional experience and knowledge of the care which is being provided.
Service and service type:
Cromwell Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with CQC. This means that they and the registered provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
The inspection was unannounced.
What we did:
Before the inspection we reviewed the information we held about the service. This included any statutory notifications sent to us by the registered provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted local commissioners of the service to gain their views. We used the information the provider sent us in the ‘provider information return’. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to formulate a ‘planning tool’; this helped us to identify key areas we needed to focus on during the inspection.
During the inspection we spoke with the registered manager, five members of staff, one kitchen chef, six people who were living at Cromwell Court and five relatives who were visiting at the time of the inspection.
We also looked at care records belonging to five people, three staff recruitment files, medication records, and other records and documentation relating to the management and quality monitoring of the service.
In addition, a Short Observational Framework for Inspection (SOFI) tool was used. SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.
Updated
4 September 2019
About the service:
Cromwell Court is a two-storey purpose-built building that is situated in the centre of Warrington. Cromwell Court is registered to provide personal care for up 67 older people, some of who are living with dementia.
Accommodation can be found across four separate units, each of which have separate adapted facilities. At the time of our inspection, 31 people were living across two of the ground floor units.
People’s experience of using this service and what we found:
People's level of risk was established from the outset, however some people did not have the relevant risk assessments in place and not all risks were effectively recorded or monitored.
Quality assurance measures were in place however these were not always effective. We identified a number of concerns during the course of the inspection in relation to the quality and safety of care people received.
Medication processes were in place; although it was identified that some areas of practice could be improved to ensure people received a safe level of care.
At the time of the inspection there was no activities co-ordinator in post; however, this area of responsive care had improved since the last inspection.
Complaints processes had improved since the last inspection. Complaints were recorded, regularly reviewed and monitored.
Staffing levels were analysed and assessed in relation to the dependency support needs of people who were living at Cromwell Court. Pre-employment checks were carried out and people received care by staff who had been appropriately recruited.
Staff were supported with training, learning and development opportunities. Staff received regular supervision and told us they felt supported on a day to day basis.
Safeguarding and whistleblowing procedures were in place. Staff received appropriate training and understood the importance of keeping people safe.
People and relatives told us that staff provided care in a dignified, respectful and compassionate manner.
A person-centred approach to care was provided. Care records contained person-centred information and we observed staff providing care and support that was tailored around the needs of people living at Cromwell Court.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was requires improvement (published 14 August 2018) as we identified a breach 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, however the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected:
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches of regulation in relation to safe care and treatment people received and good 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 from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.