We carried out an unannounced inspection of Cravenside Home for Older People on 4 and 5 April 2018.

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.

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We carried out an inspection of Cravenside Home for Older People on 13 and 14 April 2016. The first day was unannounced.

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 spoken with were satisfied with the service provided, one person told us, “Everything is top notch, nothing is too much trouble for the staff” and another person commented, “They do their best and they really look after you”. People told us their rights to privacy, dignity and independence were upheld and respected. Relatives spoken with were also complimentary about 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.

During our inspection we spoke with ten people living in the home on three different units. All people expressed satisfaction with the service, one person said, “I’m perfectly happy, I think it is a very good home” and another person commented, “Everyone is so nice, they do everything they can to help you”.

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.

People told us they were happy living in the home and they were consulted about the way they wished their care to be delivered. They said they were able to express their views and their opinions were taken seriously and acted upon. One person said, “I am cared for in every respect, all the staff are lovely, you couldn’t wish for better”. People spoken with felt they were well cared for and the staff respected their rights to privacy, dignity and independence. People were supported to participate in a variety of activities both inside and outside the home. People told us they particularly enjoyed going into the local town.

Staff were well supported in their role and were given the opportunity to regularly update their knowledge and skills. Staff also had access to up to date policies and procedures. However, staff spoken with raised concerns about the number of staff on duty, especially in the afternoon.

People and their relatives made positive comments about the staff team and felt they could talk to any of the staff or the manager if they had a problem or query. People were asked if they were satisfied with the quality of the service provided and were given the opportunity to participate in consultation exercises and attend residents’ meetings.

We carried out an inspection of Cravenside Home for Older People on 15 and 16 October 2014. The first day was unannounced. We last inspected Cravenside on 30 December 2013 and found the service was meeting the current regulations.

Cravenside is a 44 bedded care home providing care to older people with a range of needs. Accommodation is divided into six units, two of which provide care for people living with a dementia. At time of the inspection there were 44 people accommodated in the home.

The service had a registered manager in post. 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.

People told us they felt safe and were well cared for in the home. All staff spoken with were aware of the procedures in place to safeguard people from harm.

As Cravenside is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. At time of the inspection one application had been submitted to the local authority for authorisation. However, we found the use of coded keypad locks had not been considered as potential deprivations of liberty.

We found that medicines were not always managed safely and some risk assessments had not been carried out in line with changing needs. This is important to protect the health and well-being of people living in home. 

We found staff recruitment to be thorough and all relevant checks had been completed before a member of staff started to work in the home. Staff had completed relevant training for their role and they were well supported by the management team.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink.

People had individual personal plans that were centred on their needs and preferences. However, we noted one person’s care plan required significant updating following a change in needs. Whilst, the plan was updated by the registered manager during the inspection, we also noted other gaps in record keeping in respect of positional change charts and the application of creams.

People had opportunities to participate in a variety of activities and we observed staff actively interacting with people throughout our visit. All people spoken with told us the staff were caring, compassionate and kind. We saw that staff were respectful and made sure people’s privacy and dignity were maintained.

All people, their relatives and staff spoken with had confidence in the registered manager and felt the home had clear leadership. However, we found there were lack of effective systems to assess and monitor the quality of the service. 

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.