We undertook this inspection to review compliance with the essential standards where we had previously served warning notices. As a result of our inspection on 16 and 19 May 2014, we served five warning notices and three compliance actions. We served the warning notices on 16 June 2014 and required the provider to achieve compliance by 4 July 2014. We agreed with the provider to extend this deadline for Regulations 9 (Care and welfare) and 10 (Assessing and monitoring the quality of care) of the Health and Social Care Act 2008, to 11 and 14 July 2014 respectively. The provider, Greensleeves Homes Trust Limited, sent us their action plan and advised us they had achieved compliance in the areas where we had served warning notices on 15 July 2014.
We visited St Cross Grange on 15 and 19 August 2014. Our inspection team included a pharmacist and a specialist advisor. We reviewed 12 people's care records and spoke with the new manager and 12 staff members. We also spoke with four people using the service or their relatives and two health and social care professionals.
We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The staff and managers had received further training in procedures for safeguarding vulnerable adults and appropriate referrals had been undertaken since our last visit. Further training on Hampshire County Council's specific safeguarding practices was booked.
Systems for recording accidents and incidents were in place and some trend analysis had been undertaken. Further work was planned to implement an audit system to promote continuous learning and development.
The management of medicines had improved since our last visit, with more accurate administration and more suitable storage arrangements. There were aspects of medicine handling which were not safe however and still needed to be addressed.
Recruitment procedures had been reviewed and a robust system was in place to check that recruits were safe and suitable to work at the home.
Although improvements had been made to the safety of the service, we have asked the provider to tell us what they are going to do to continue with their safety improvement plan in relation to medicines managements.
Is the service effective?
We found that people's health and care needs were assessed and were reviewed more regularly. Specialist advice had been sought and followed and the service collaborated effectively with health and social care services. Analytical tools were applied correctly to assess people's care needs. Care was personalised and people were provided with the correct equipment.
Further work is required to develop personalised behaviour and emotional support plans and to ensure people on specific diets have dietary care plans and are offered appropriate choices. We have asked the provider to tell us what they are going to do to continue with their improvement plan in relation to care planning and risk assessments.
Is the service caring?
We observed staff interaction with people who lived at the home and saw this was caring, compassionate and kind. Staff were attentive and spoke with people in a friendly and appropriate way. People told us they were happy living at the home.
Is the service responsive?
We received positive feedback from staff and relatives that the new manager of the service responded to their concerns appropriately and in a timely way. Communication had improved in the home which meant staff sought medical advice promptly when people's health deteriorated.
Care plans were not always updated to reflect people's changing needs, but this had improved since our last visit.
Is the service well led?
Since our last visit the provider had employed a new manager for the home and had implemented an extensive improvement plan. The plan included the recruitment of additional care and managerial staff, which was still underway when we visited. Without the full complement of staff, there had been delay in completing and embedding some improvements within the service.
The new manager had a clear understanding of the changes that were required, what to prioritise and how to lead and support the staff team. Staff recognised that improvements were taking place. A clear management structure was planned for the service, with allocated responsibilities and management support.