Cravenside Home for Older People

Cravenside Home for Older People is a care home providing accommodation and personal care. It can accommodate 46 older people. The accommodation is provided over two floors. The home is divided into four areas known as, Rose Lane, Lily Lane, Poppy Lane and Daisy Lane. Some people using the service are living with dementia. At the time of the inspection 34 people were living at the home.

People’s experience of using this service and what we found People told us they felt comfortable and safe living in the home. The registered manager and staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. Systems were in place to ensure lessons were learnt from any incidents and the management team understood their responsibility to be open and honest when something went wrong.

There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. The provider operated an appropriate recruitment procedure. Following the inspection, the procedures were further strengthened to ensure all relevant information was obtained prior to staff working in the home. People received their medicines safely and on time. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The home was clean in all areas seen and staff followed safe infection control practices.

The management team and staff had addressed the shortfalls found at the last inspection. The provider had systems to check the quality of the service and to monitor staff practice. People's views were sought about the service and acted on. People were involved in decisions about their care and support. The registered manager and staff worked with external professionals to ensure people received prompt and coordinated care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was requires improvement (published 4 June 2019). Two breaches of the regulations were identified in respect to the cleanliness of the home and the quality assurance procedures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on the previous breaches of the regulations. We therefore 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.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cravenside Home for Older People on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: The home had made some improvements with regards to the management of medicines. However, we found there were further improvements needed to ensure medication was stored safely. We made a recommendation about this.

The home was tired looking and required re-decoration. The environment had not been adapted to suit the needs of people living in the home. There were re-decoration works taking place at the time of the inspection. The manager told us these concerns had been addressed in the refurbishment plans.

The home also looked ‘dirty’ in places. We found some kitchen areas needed a thorough clean. Some areas of the home had dirty looking carpets. The home was in the process of a complete re-furbishment, with carpets due to be replaced.

There were risk assessments in place for people, with measures identified to mitigate those risks. However, we found potentially dangerous products, such as cleaning products, stored unsecurely around the home. This posed a risk to people.

During the inspection we found key coded doors left on the latch, making them unsecured. The front door was also unsecured on one occasion. The manager told us this was due to builders coming in and out of the home. A thorough risk assessment was in place for these works, however, we found there needed to be more management oversight of the risks.

We received mixed feedback from healthcare professionals. Some felt communication with the home was poor, and records were not always available to provide the right support for people. One healthcare professional felt the home communicated well, informed them of all appropriate information and staff were ”great” at following advice given.

People knew who the manager was and felt able to raise any concerns with them. Although there were systems in pace to monitor the quality and safety of the service, we found these were not always effective and in need of improvement.

Staff were supported in their role and had access to relevant training to help ensure they had the necessary skills to meet people's needs.

Sufficient numbers of staff were employed to meet people’s needs. Staff were caring and always promoted people’s dignity and independence.

A system was in place to monitor applications and authorisations to deprive people of their liberty and any conditions attached to them. Consent to care and treatment was sought and recorded in line with the principles of the Mental Capacity Act. Staff supported people in the least restrictive way possible.

Care plans did not always reflect people’s needs or personal preferences. However, we found people received personalised care responsive to their needs.

People and relatives told us they felt safe living in the home. Safeguarding procedures were followed, and incidents were raised with the appropriate professionals.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people's dietary needs and people told us they enjoyed the food available to them. People could enjoy snacks throughout the day, and were able to choose alternative meals if they did not like what was on the menu.

Rating at last inspection: Requires improvement (Report published 08 May 2019)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Please see action we told the provider to take towards the end of the report.

Follow up: This is the second consecutive time the service has been rated as requires improvement. We will seek an action plan from the provider to gain assurance appropriate measures are put in place to address concerns. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Cravenside Home for Older People 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 home is registered to provide accommodation and personal care for up to a maximum of 46 people. The home is divided into six areas known as Valley Close, Dean Close, Glen Close, Marls Close Stanley Close and Dale Close. Dean and Glen Close provides care for older people living with dementia and all other areas provide support for older people with personal care needs. At time of the inspection there were 43 people accommodated in the home.

The service was managed by a 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 the last inspection, in April 2016 the service was rated as good. At this inspection, the rating had deteriorated to ‘Requires improvement’. We found one breach of the regulations in respect to the management of medicines. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation about strengthening the auditing systems.

People told us they felt safe and secure in the home. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. People and staff spoken with expressed concerns about the level of staffing in the home. The registered manager used an assessment tool to monitor the level of staffing and there had been an increase in staff hours since our last visit. The registered manager agreed to continue to monitor the staffing levels closely. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

The premises and equipment were appropriately maintained and we noted safety checks were carried out on a regular basis. Staff understood best practice for reducing the risk of infection and audits were carried out to ensure the environment was clean and safe. Risks to people’s health and safety had been identified, assessed and recorded. However, people’s medicines had not always been managed safely.

People’s capacity to make decisions had been considered during the support planning process. However, staff had not reviewed people’s capacity as part of the reviews of people’s support plans and there was no information in one person’s plan about the best interests decision to administer their medicines covertly. The registered manager assured us this matter would be addressed immediately.

Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and they were up to date with the provider's mandatory training.

There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. Some people living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Support plans and risk assessments provided guidance for staff on how to meet people’s needs and preferences. However, we found one person’s support plan contained very brief information about their needs and preferences. Following our intervention, the plan was updated during the inspection.

People were given the opportunity to participate in social activities both inside and outside the home. People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon. Where people received end of life care this was planned and provided sensitively.

There were systems in place to monitor the quality of the service, which included seeking feedback from people, relatives and staff. However, the quality monitoring systems had not identified the shortfalls found during the inspection.

Cravenside Home for Older People is registered to provide accommodation and personal care for up to 45 older people. The home is located close to Barnoldswick town centre and is set in its own grounds. Accommodation is provided on two floors linked by a passenger lift and stairs. The home has six separate units known as Dean Close, Glen Close, Dale Close, Stanley Close, Marles Close and Valley Close. Dean Close and Glen Close provided care for older people living with dementia.

The service was managed by a 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 the last inspection on 15 and 16 October 2014 we asked the provider to make improvements to the management of medication, the maintenance of records and the quality assurance systems. Following the inspection the provider sent us an action plan which set out what action they intended to take to improve the service.

During this inspection, we found the necessary improvements had been made in order to meet the regulations. However, we have made a recommendation about improving people’s mealtime experiences.

People told us they were happy living in the home and felt safe using the service. Staff were aware of the signs and indicators of abuse and they knew how to recognise and escalate any concerns. Risks to people had been identified, assessed and managed safely. There were sufficient numbers of staff deployed to meet people’s needs and the service followed safe recruitment practices. People’s medicines were managed safely and were administered by trained staff.

Staff were trained in all essential areas and new staff completed a thorough induction programme which included the care certificate. This helped to ensure the staff team had a good balance of skills and knowledge to meet the needs of people living in the home. Staff were well supported by the management team and received regular supervision and an annual appraisal of their work performance.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves.

People were supported to eat and drink and their nutritional and hydration needs were assessed. However, whilst we observed some good practice over lunchtime, we received mixed comments about the quality of the food and noted the food was not always served in a way which respected people’s choices and dignity at breakfast.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure their wishes and preferences were met. Staff worked with healthcare professionals to obtain specialist advice about people’s care and treatment.

People and staff had developed positive, caring relationships. People were encouraged to express their views and be involved in their care. People’s privacy and dignity was respected. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives.

People were provided with a range of activities which met their needs and preferences. People told us they were aware of how to raise complaints if they needed to. We saw that complaints were responded to appropriately.

People, relatives and staff spoken with had confidence in the registered manager and felt the home was well managed. We found there were systems in place to assess and monitor the quality of the service, which included feedback from people using the service.

People's care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments. People told us they had discussed their needs with staff and had been involved in the reviews of their care. We saw people had signed their care plans wherever possible to indicate their participation and agreement.

People were provided with a variety of suitable and nutritious meals. People were given a choice each mealtime and drinks and snacks were served throughout the day as well as other times on request.

Staff were provided with appropriate training opportunities and received regular supervision. All staff spoken with told us they were well supported in their role and they enjoyed their work.

There were effective systems in place to monitor and assess the quality of the service. People were asked their opinion of the service on an ongoing basis and were given feedback about the action taken in response to any suggestions.

People's care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments and daily care records.

At the time of our visit, work was ongoing on the refurbishment of the home. People had been consulted about the work and they were very pleased with the newly refurbished areas. People told us the home was comfortable, warm and well maintained.

People spoken with said there was a sufficient number of staff on duty and made positive comments about the approach taken by staff.

We found there were effective systems in place to monitor and assess the quality of the service, which included gathering the views of people living in the home.