Archived: Creswick House

Creswick House is a care home providing personal care and support for up to 14 people with a learning disability, autistic people including mental and/or physical healthcare support needs. At the time of the inspection, there were nine people living at the service. The service was split into two units, with the first floor accommodating three people, and the ground floor unit the remaining six. The ground floor unit offered care and support to people requiring care on one level, to aid mobility and physical healthcare needs. Those people living on the first floor were more independent. Each unit had its own main entrance, and designated staff teams on each shift.

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

People were not always supported by sufficient numbers of suitably trained staff. There were concerns identified in relation to the management of people’s medicines. Staff were not consistently implementing safeguarding training and procedures into their practice. This did not demonstrate that incidents effecting people’s safety and well-being were being addressed appropriately and shared as required with CQC and the local authority safeguarding team.

Risks posed to people, for example in relation to the condition of the environment, which needed to be cleaned and repaired, and the prevention of the spread of infection were not well managed. Improvements to the condition of the care environment were required. Such shortfalls were not being identified through audits and checks in place, to ensure people received consistently safe standards of care and support.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well-led, the service was able not able to fully demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

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 Good (published 23 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the standards of care and support being provided to people living at the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to Inadequate.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Creswick House on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from risk of harm and abuse, staffing and good governance at this inspection.

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.

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.

Following the inspection, the provider made a decision to close the service. The local authority and provider supported people to find alternative residential care homes and the service was de-registered from CQC on 15 November 2021.

Creswick House is a residential care home that provides care and support for up to 14 people with a learning disability and/or mental health needs. Seven people were living in the home at the time of this inspection.

People’s experience of using this service:

The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people who used the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. The manager confirmed that robust recruitment procedures were followed.

Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People who used the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were supported to choose what they wanted from the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Staff treated people with kindness, respect and compassion. People also received emotional support when needed. People were involved in planning the care and support they received and were supported to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

People we spoke with told us the new manager was very supportive and well liked. The new manager had applied to become registered with the Care Quality Commission (CQC). CQC’s other registration requirements were met and complied with and effective quality assurance procedures were in place.

Rating at last inspection:

At our last inspection (report published 26 July 2016) all the key questions were rated Good and the service was rated as Good overall. This rating has not changed and the service remains Good.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

Creswick House provides accommodation, care and support for up to 14 people living with a learning disability and or mental health needs. At the time of our inspection there were eight people living in the home. The home was divided into two different units. The upstairs of the home was for people with more complex needs who required one to one support.

The registered manager had been in post since 2003. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Staff had an in-depth knowledge of people’s care needs and were able to describe how they would protect people from harm. Staff were aware of what would constitute a safeguarding issue and how to raise this. Where risks had been identified with regards to a persons health, these were safely managed. The storage and administration of medicines was safe and there were robust checks in place to ensure that staff were competent in the administration of medicines.

Staff were recruited in to their roles after satisfactory employment checks had been carried out to ensure that only staff suitable to work in the home were employed. there were enough staff employed at the home to meet the needs of the people living at the home. Staff completed a comprehensive induction process and received subsequent training updates relevant to their role. Staff were well supported.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find the manager and staff were knowledgeable about when a request for a DoLS should be submitted but mental capacity assessments were not in place before best interests decisions were made for people.

People’s nutritional needs were being met and appropriate advice and support had been sought from professionals such as the GP, speech and language therapist and occupational therapists to inform the care plans of people. The care that was provided was person-centred and care plans reflected this. People were encouraged to be as independent as possible and regular one to one staff support was in place to support this.

A complaints procedure was in place and people who lived in the home had access to a copy of the complaints procedure. This was written in an easy read format.

Staff felt well supported by the management team and were able to speak openly about their suggestions for service improvements. There were regular audits carried out to ensure that the service being provided was safe and effective. The registered manager had reported notifiable events to the CQC as required.

We noted that people gave consent before staff provided any care or support. The care workers used different communication methods to ensure people understood what was being said to them.

Care and support plans were detailed, up to date and person-centred. Appropriate risk assessments had been completed and were reviewed on a regular basis. People undertook different activities during the day, according to their needs and preferences.

There were appropriate arrangements in place for the management of medicines. This included checking processes to make sure the administration of medicines was safe.

We noted that staff were suitably qualified and skilled. We reviewed five weeks' of staffing rotas and noted that staffing numbers met those identified as required by the provider.

The provider had a complaints policy and procedure and this was readily available to people who used the service in an 'easy read' format. We saw evidence that staff supported people if they wished to complain or raise a concern.

The staff were noted to be carrying out the care and support required as stated in the care plans we looked at. We noted that specialist advice was being used and that the documented care plans were specifically written to meet the individual needs of each person.

During this visit we were given examples of the way people were safeguarded and how the home had worked with the local authority safeguarding team. The staff members had been trained and understood the need to ensure the people living at Creswick House were safeguarded from abuse.

We noted that staff were trained and supervised on a day to day basis but that documented one to one supervisions and annual appraisals were not timely with some staff being overdue by six months or more. However the manager was aware of the concern and was planning to catch up with those outstanding.

This home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and senior management audits were in place and records were available.