Crowstone House

Updated 1 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Crowstone House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Crowstone House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with 2 people who used the service and 9 relatives about their experience of the care provided.

We spoke with 9 members of staff including the registered manager, deputy manager, unit manager, care team leaders, care staff and the housekeeper. We also received feedback from 5 healthcare professionals who have regular contact with the service.

We reviewed a range of records. This included 5 people’s care plans, 5 people’s medicines records, 3 staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service.

Updated 1 March 2023

About the service

Crowstone House is a residential care home providing personal care to up to 54 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 45 people using the service.

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

The provider did not have robust systems in place to assess and monitor risks to people’s health and safety. Risks within people's living environment were not always identified or adequately managed in order to keep people safe from harm. The provider’s processes for monitoring the quality and safety of the service were not always effective in highlighting and addressing concerns.

The provider had not always ensured all relevant recruitment checks were completed for new staff. We have made a recommendation about the safe recruitment of staff. The provider had recently increased staffing levels in the service. However, we found the deployment of staff did not always fully meet people’s needs.

The provider had processes in place to manage people’s medicines. However, some guidance did not reflect how medicines were being administered.

Staff were aware of how to report safeguarding concerns and the provider had sent notifications and shared information with the relevant authorities when appropriate. People and relatives told us they knew who to speak to if they had any concerns or complaints.

The provider had safe infection prevention and control processes in place and visitors were welcomed into the service. Relatives were encouraged to give feedback and spoke positively about the approachability and availability of the management team. Staff had received an induction and relevant training and told us they felt valued and supported in their roles.

People were encouraged to maintain their independence and the provider worked alongside other healthcare professionals to support people’s health needs. People and relatives told us staff were generally kind and caring and were respectful of people’s privacy. 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

The last rating for this service was outstanding (published January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the number of people having falls in the service and the number of staff available to support people. The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined 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 have found evidence the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report. The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to the management of risks to people’s health and safety and the oversight of the service 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 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.