Crowley Care Homes Ltd - St Annes Care Home Also known as St Annes Care Home

Crowley Care Homes Limited- St Annes Care Home is a residential care home providing personal care to 21 older adults who may be living with dementia, a sensory impairment or a physical disability at the time of the inspection. The service can support up to 22 people. The service is split across two floors and people have their own bedrooms and share facilities such as a lounge, garden and bathrooms.

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

People were not always supported in a person-centred way and the provider had not identified shortfalls at the service and how these could be improved. One relative told us, ‘‘I am disappointed in the care that [family member] receives. It does not need to be luxury, but the basics should be right.’’

Audits completed by the provider and management team were not effective in identifying where improvements needed to be made. This included areas such as supporting people to communicate or have a clean and comfortable home. The provider had failed to learn and improve from previous inspections and the service continued to be rated requires improvement for the sixth time. We could not be assured that the provider would be able to implement and sustain improvements.

The culture of the service was negative as people were not being empowered to achieve positive outcomes and continued to receive a service where improvements needed to be made. People and relatives were not being supported to feed back about the service or be involved in decisions about their care and support. We have made a recommendation that the service improves the way they collect feedback from people and relatives.

The service was not kept clean and this placed people at the risk of infection. The furniture provided for people was old and worn which could also pose an infection control risk. Not all safety measures were taken regarding protecting people from the risk of infection of COVID-19.

People were not supported in line with the Accessible Information Standard (AIS) meaning that they were unable to communicate effectively and feed back about their care. The service had not been adapted to support people living with dementia to orientate to the best of their ability. People’s living environment was not maintained to a good standard. It was not clear how people who chose to spend time away from communal areas were having their personal preferences met.

People were kept safe by a staff team who were trained to understand safeguarding and how to report concerns. Risks to people with regards to their daily living were assessed and updated regularly. There were enough suitably trained and skilled staff to support people safely. People were supported safely with their medicines. Incidents and accidents were reviewed for lessons learned and shared with the staff team.

Staff treated people with kindness and respect and knew them well. The manager had adapted people’s care plans to focus on their likes, dislikes and preferences. Feedback about activities which had been provided by the previous activities’ coordinator was mostly positive, and the manager was recruiting into this role. Complaints were responded to appropriately. People received kind and compassionate care at the end of their life.

The new manager was working hard to put improvements in place and feedback about them was positive. They and the provider responded during and after the inspection to show us that action was being taken to put improvements in place.

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 requires improvement (published 11 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service (published 11 March 2020). Whilst no breaches of legal requirements were found, we made two recommendations to guide improvements at the service and rated the service as requires improvement.

We undertook this focused inspection to check they had made these improvements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those recommendations.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crowley Care Homes Limited- St Annes on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment (infection control), person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider to discuss how they plan to make and sustain improvements. 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.

St Anne’s is a residential care home that provides personal care to up to 20 people aged 65 and over. On the day of the inspection they were providing a service to 19 people, one of whom was in hospital.

People’s experience of using this service:

Risk assessments were in place where a need had been identified in most instances, However, we found a care related risk to one person had not been assessed and no care plan had been developed to guide staff in relation to it.

We also found one risk in relation to the building work being carried out at the service had not been identified or addressed. This was resolved during the inspection.

People’s care plans were personalised to give guidance to staff on how to support people effectively. However, we found staff did not always take immediate action to respond to people when they asked for help.

People had enough to eat and drink, although, for some people who did not eat meat, options were limited and not offered routinely alongside meals for meat eaters. People were supported to attend healthcare appointments and seek medical care when needed. People’s medicines were managed and administered safely by staff who were trained and assessed as competent to do so.

The premises were undergoing construction work to create more communal space at the time of the inspection. People living at the service said they were looking forward to the improvements being completed and had not felt unduly inconvenienced by the building work. At the time of the inspection, refurbishments to the existing premises had been put on hold and some of the décor and furnishings required redecoration or replacement. Some of the issues identified could have presented an infection control risk. After the inspection, the provider confirmed that work to address some of the outstanding refurbishment had started.

There were enough staff to meet people’s needs during the inspection and we saw some improved engagement between staff and people using the service. Activities and events were provided more frequently, and people enjoyed opportunities to take part in community groups.

People and their relatives gave positive feedback about their experiences of living at St Anne’s. They told us staff were kind and provided them with care that upheld their dignity. They were involved in discussions about their care and in developing their care plans.

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.

The quality manager was continuing to develop systems and processes to support improvements at the service. They were also working with staff to develop a more person- centred culture within the service, and staff were receiving supervision, guidance, support and training to drive these improvements.

Although improved since the last inspection, the governance systems in place did not pick up some issues identified on the inspection. It became clear during the inspection that the current management structure did not ensure strong management oversight of the service. Following the inspection, the provider informed us of changes to the management structure to support the necessary improvements to the service.

We made a recommendation in relation to providing more choice of meals to people who had specific dietary preferences. We made a second recommendation that the provider considered the accessible information standards and associated guidance and took action to update their practice accordingly.

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 requires improvement with an inadequate rating in ‘Responsive’ (published on 7 August 2019). There were two breaches of the Regulations. At this inspection, some improvements had been made and the provider was no longer in breach of Regulations. However, there was more work to be done to raise the overall rating for the service. Therefore, although the service is moving in a much more positive direction, the overall rating remains ‘requires improvement’.

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up

We will speak with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service:

The registered manager was working with the provider and the quality manager to develop a person- centred culture within the service. However, the outcomes for people did not fully reflect this and more work was needed to embed this way of thinking within the team.

Although there were enough staff to meet people’s physical needs during the inspection, we have recommended the provider consider again whether they have enough staff to meet people’s social, emotional and psychological needs.

The premises were undergoing refurbishment at the time of the inspection and some building work was planned for the near future. We have recommended that the provider uses this opportunity to consider current good practice guidance in relation to creating an environment that is more suitable for the needs of the people using the service.

People gave mixed feedback about their experiences of living at St Anne’s. People told us staff were caring. However, many people felt there was not enough to do, and that staff did not spend time talking to them. We observed that staff were kind but were task focussed in their approach to care.

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.

The provider had governance systems in place and the Quality Manager was developing these to support improvements at the service. We have recommended that they look at how they can improve these to include monitoring of staff practice, as well as records.

People’s care plans were personalised to give guidance to staff on how to support people effectively. However, we found staff did not always follow this guidance. People and their relatives were involved in discussions about their care and in developing their care plans.

Staff were knowledgeable about safeguarding people from avoidable harm and how to report their concerns internally and externally to local safeguarding authorities.

People’s dignity and privacy was promoted and respected by staff, although they were not supported to maintain their independence. People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.

Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider. This was to develop their skills and knowledge but some staff struggled to explain what they had learned from aspects of their training.

We made recommendations in relation to promoting person centred practices and supporting the needs of people with sensory loss. We also made recommendations about ensuring staff understand how to prevent all types of abuse and meet peoples social and emotional needs. We have made a recommendation around using observations of practice to improve the quality of 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 last rating for this service was requires improvement (published on 17 July 2018) and there were multiple breaches of the regulations. At this inspection, although improvements in some areas had been made, there was more work to be done to raise the overall rating for the service. Therefore, the rating remained ‘requires improvement’. This was the fourth consecutive inspection where the service has been rated as ‘requires improvement’.

Why we inspected:

This was a scheduled inspection based on the previous rating.

Enforcement:

We have identified breaches in two regulations in relation to providing care that met people's individual needs and preferences and ensuring good management of the service which utilised quality assurance processes to improve practice.

Please see the action we have told the provider to take at the end of this report. 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 speak with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Crowley Care Homes Ltd - St Anne's 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.

Crowley Care Homes Ltd - St Anne's care home accommodates up to 19 people in one adapted building. The home supports people who require nursing and personal care; some of whom may be living with dementia.

This is the third time we have inspected this provider. We previously inspected the home in February 2016 and rated it as 'Requires improvement'. We identified two breaches under the Health and Social Care Act and issued the provider with a fixed penalty notice because they had failed to notify us of the deaths of people using the service. This is an expected requirement for all providers. Following this inspection, we carried out a further inspection in May 2017 and rated the provider as ‘Requires improvement for the second time. In this inspection we identified a further five breaches under the Health and Social Care Act and issued a further two fixed penalty notices because the provider had failed to display their rating within the home and on the provider’s website as they are legally required to do. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions for safe, responsive and well-led to at least a rating of good.

At this inspection we found that the service had made some improvements and five breaches identified in the last two inspections had been addressed. We did however find a continued breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because there was a continued lack of provider oversight of the service which meant that the service was unable to maintain care standards. This was because there was a lack of accountability when audits were undertaken which meant that the registered manager did not identify when the standards in the home were in breach of regulations and the provider had not identified this failing.

We also found that the cleanliness of the home did not meet with the expected standards and there was therefore a new breach identified under Regulation 15: Premises and equipment.

The service had a registered manager in place. 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. The registered manager did not have a robust auditing process which could ensure that processes were being followed by staff and that the service provided was fit for purpose.

Cleanliness and infection control procedures were not always followed which meant that people were left at risk of acquired infection.

Staffing levels were sufficient to provide the level of care required to keep people safe from avoidable harm. There was also a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service. Staff demonstrated a good understanding of their roles and responsibilities and regular checks were undertaken to help ensure on-going competency of care staff.

The provider and staff followed the local authority policy and guidance when dealing with safeguarding people from harm and demonstrated a good understanding of safeguarding issues. 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.

Confidentiality was respected and independence was promoted. 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. Communication with relatives was on-going throughout the duration of their relative's involvement with the service. Comments and feedback was encouraged formally and informally and there was a complaints policy in place.

People were supported to eat and drink enough to maintain a balanced diet and risk assessments were in place and were regularly reviewed and updated. The service was flexible and responsive to people's changing needs, desires and circumstances.

The service demonstrated a commitment to staff training, which was on-going and regular refreshers were undertaken. Staff were trained to administer medicines safely and had undertaken further training to ensure they could deal with a number of health issues. Supervisions were undertaken regularly and considered important in offering an opportunity for discussion between staff and management. Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples.

Further information is in the detailed findings below.

The service provides accommodation and care for up to 20 people. At the time of our inspection there were 19 people living at the home.

The service had 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.

Medicines were not always managed safely and guidance to staff on the administration of ‘as required’ (PRN) medicine was not always in place.

There were not always enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded, although the causes of these had not been analysed to allow the provider to identify preventative actions which could be taken to reduce the number of occurrences.

Staff received training to ensure that they had the necessary skills to care for the people who lived at the home, and were supported by way of supervisions and appraisals.

People’s needs had been assessed when they moved into the home and they and their relatives had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were happy and felt safe living at the home but said that they did not always have enough support with activities to keep themselves occupied during the day. They had a choice of food and drink with snacks and fruit available throughout the day.

Staff were caring and friendly. They knew the people they cared for well. They protected people’s dignity, treated them with respect and encouraged them to maintain their independence. Staff understood the need for confidentiality.

Information was available to people about how they could make a complaint. People were assisted to access healthcare services to maintain their health and well-being. Staff worked with healthcare professionals and people’s relatives to ensure that the care provided to people best met their needs.

The provider had not submitted notifications to the Care Quality Commission (CQC) as required by law. Neither had they displayed the rating of ‘requires improvement’ given at the last inspection carried out by CQC. The manager completed regular audits of the service to check on quality but there was a lack of evidence of Provider oversight. People were asked for their views but the information provided was not consistently used to make improvements to the service.

We found that the provider was not meeting some legal regulations. You can see what action we told the provider to take at the back of the full version of the report.

Crowley Care Homes Ltd- St Annes Care Home is a residential service providing care and support to older people in central Luton. They provide long-term care and short-term respite care to up to 20 people. At the time of our inspection there were 18 people using the service.

The service had a manager who was not registered by the Care Quality Commission (CQC) yet, although our records confirmed that their application had been received. 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 & Social Care Act and associated regulations about how the service is run.

People were kept safe from risk of harm and supported by staff who understood their needs and maintained their health and well-being. They had enough to eat and drink and were provided with a varied and balanced diet which took into account their individual preferences and choices. The service worked closely with healthcare professionals to ensure that people’s healthcare needs were assessed and met. People were provided opportunities to provide feedback on their care and were supported to maintain relationships with friends and family. The service provided some activities to people, but there was no activity co-ordinator in post at the time of our inspection and people were not always stimulated with a full programme of activities throughout the day.

Staff received training which was relevant to their role and enabled them to provide person-centred and effective care. People were cared for by staff who were knowledgeable, caring and compassionate. There were enough staff on duty to keep people safe and people were positive about the consistency of support they received and the attitude of those who supported them. Staff were provided with supervisions and performance reviews, and attended regular team meetings to enable them to contribute to the planning and development of the service. Staff understood the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs) and how they applied to the people using the service.

People, their relatives and staff were complimentary about the management of the service. There was a robust quality assurance system in place which identified any improvements needed in the service and took action to resolve them. Medicines were administered safely, and risk assessments were detailed and supported staff to keep people safe from any risk of harm.

Details of people’s support needs, likes and dislikes and social histories were included in their care plans, and daily notes showed that people’s daily routines and tasks were carried out efficiently. However, care plans did not always contain consistent and relevant information, and the review process did not always lead to appropriate changes being made. The provider had not submitted notifications when there had been a death in the service.

During our inspection we found that the provider was in breach of two regulations of the Health and Social Act (2008). You can see what action we’ve asked the provider to take at the end of the report.

We saw that each person received an assessment of their care needs, including any risks associated with their care provision. Records showed that people and their families had been involved in the development of their care plans.

People's nutritional requirements were assessed and managed in line with their needs, and these were reviewed on a regular basis. We found that people living in the home received their prescribed medication when they needed it and in a way that suited them.

We found the premises to be maintained to ensure the home remained safe for people using the service, staff and visitors. However some areas of the home required redecoration. We were told and we saw that this had already commenced.

There was an effective complaints system in place and comments and complaints people made were responded to appropriately.