Archived: Croxley House

Updated 25 May 2021

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 Care Act 2014.

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 team consisted of two inspectors and one 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

Croxley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave five minutes notice so we could clarify the services COVID-19 Personal Protective Equipment (PPE) practice for visiting professionals and identify persons who were shielding so we could respond accordingly.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us following the transitional monitoring assessment. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and 12 relatives about their experience of the care provided. We spoke with seven members of staff including the nominated individual, registered manager, senior care workers, care workers and the chef. We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 25 May 2021

About the service

Croxley House is a residential care home providing personal and nursing care to 22 people at the time of the inspection. The service can support up to 33 people.

Croxley House consisted of two floors. The ground floor had living facilities which included staff office space, the kitchen, dining rooms, living rooms and people's individual bedrooms, all of which had a toilet attached. The second floor was made up of all bedrooms.

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

People were at significant risk of harm in relation to poor manual handling and support with meeting nutritional needs. Risk assessments and care plans did not identify people’s up to date support needs and staff were inconsistent with their knowledge of what support people needed.

Where safeguarding risks had been identified in the past, the registered manager and staff team had not learnt from this and implemented changes to protect people.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice

The staff did not have adequate training and knowledge of processes. For example, in the event of a fire staff could not confidently tell us what they would do. The service did not have a dedicated person responsible for this.

Records showed there was a risk of people not being supported at night in the event of an emergency. Night spot checks had not been carried out by the management team.

Overall, the service had processes in place for infection prevention control. Although we observed some staff in the home not wearing the correct Personal Protective Equipment (PPE).

The registered manager did not lead effectively, and this put people at risk of harm. Quality audits completed were not robust and did not find areas where significant improvement was needed.

Relatives we spoke with were happy with the overall support their family member was receiving.

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 requires improvement (published 26 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staff training, meeting nutritional needs and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

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 changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to unsafe moving and handling, risk to people whilst eating and drinking, lack of staff training and governance practices 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.