This inspection was completed on 21 March 2018 and was unannounced.Creedy House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Creedy House is a large, detached premises situated in a residential area in Littlestone-On-Sea. The service was divided into two areas: The House which accommodated people requiring nursing as their primary need and The Lodge where people living with dementia had their bedrooms.
There was a manager at the service, who was in the process of applying to be registered 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.
At our last inspection we recommended that the provider ensured that quality and safety checks included observation of staff practice to see that it reflects care plan guidance and consistently minimises risks to people. At this inspection we found that these had not been implemented. Risks had been identified, however, action had not always been taken to minimise the risk from occurring. People had fallen and displayed behaviour that challenged. Although the manager had identified these as risks, there was a lack of guidance for staff regarding how to support people to prevent these from occurring. Incidents had not always been appropriately documented or analysed to look at the reason why they occurred.
One person had displayed behaviour that challenged and an identified reason for this was a possible urine infection. Staff had not tested the person’s urine to see if this was the reason for their behaviour and if they required antibiotics. Some people had Deprivation of Liberty Safeguards (DoLS) in place, and conditions on these DoLS, had not always been complied with. Staff did not always work consistently across organisations, meaning necessary referrals to healthcare professionals were not always made. Other health care needs such as pressure areas, support with catheter care and diabetes were managed well.
At our previous inspection we recommended that the provider introduced a dependency tool to calculate the number of staff required to support people. Although this had been introduced the manager was unable to show us how the number of staff required had been calculated. People and their relatives told us they sometimes had to wait to receive support. Staff were busy and although we observed some kind and caring interactions, staff were task focused. Some staff did not treat people respectfully and we observed staff moving people in wheelchairs abruptly, without telling them what was about to happen.
At our last two inspections we identified that recruitment checks were not always completed and staff had not been recruited safely. At our last inspection we made a recommendation for the provider to consider using a recruitment checklist to ensure that all areas were addressed for every applicant. This had been introduced and staff were recruited safely.
At our last inspection we highlighted that there were no pictorial menus available for people living with dementia. Pictorial menus could assist people with dementia to make meaningful choices about what they wanted to eat. These were not seen to be in place during the inspection. People had enough to eat and drink and when they required specialist diets, were supported to eat and drink safely.
At our previous inspection we recommended that the provider increased oversight of the service’s complaints process to ensure it was suitably robust. Although improvements had been made the manager did not record all actions taken as a result of a complaint which impacted on learning from them in the future.
Checks and audits were completed by a representative of the provider and the manager, however, these had not identified the issues we found during this inspection. People, their relatives, staff and other stakeholders had been asked their views on the service. Responses had been collated, however, some areas of improvement, such as a lack of staffing at weekends had not been addressed. The provider had failed to meet all of their regulatory requirements as there had not been a registered manager at the service for over two years.
The manager had worked with other organisations, including the local safeguarding team when incidents had occurred at the service. We spoke with staff and although they knew about different types of abuse and how to whistleblow they did not always recognise that incidents between people could also be types of abuse.
There was an activities co-ordinator in place at the service, however, the manager told us that they wanted to develop the activities on offer at the service. They recognised that this was an area for improvement.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider’s vision included, to, ‘Build confidence and promote an independent lifestyle for all of our residents.’ Staff and the manager shared this view of the service and people and their relatives had been involved in planning their care. People’s care plans contained information regarding how they wanted to be supported. There were plans in place regarding how people wanted to be supported at the end of their lives.
Medicines were now managed safely, and people received all of their medicines and creams as required. Staff had received training and told us they felt well supported by their line manager.
The service was clean and people were protected from the spread of infection. Checks had been completed on the environment to ensure it was safe. The service had been adapted to meet people’s needs and there was additional signage in place to assist people living with dementia.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The manager had submitted notifications in an appropriate and timely manner and in line with guidance. The manager had displayed the rating from our last inspection in the entrance hall of the service and the provider had ensured that the rating was displayed on their website.
You can see what action we told the provider to take at the back of the full version of the report.