This inspection took place between 27 September and 2 October 2018. It was unannounced. Cromwell House Care Home is a care home for up to 66 older people, some of whom may be living with dementia. It is a three storey adapted building. There were 60 people living at the home at the time of this visit.

Cromwell House Care Home 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.

There was a registered manager at the home, although they were no longer in the position and a new manager was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to keep people safe, how to respond to possible harm and how to reduce risks to people. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely. Regular cleaning made sure that infection control was maintained. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practise or the environment, to reduce further occurrences.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. They were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around their home as independently as possible. Staff understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records provided staff with clear, detailed guidance in how to do this. People were able to take part in social events and spend time with their peers. A complaints system was in place and there was information in alternative formats so people knew who to speak with if they had concerns. Staff had guidance about caring for people at the end of their lives and information was available to show how each person wanted this.

Staff were supported by the new manager, who had identified areas of concern and developed a plan to address these. The provider’s monitoring process looked at systems throughout the service, identified issues and staff took the appropriate action to resolve these. People’s views were sought, although further systems were being developed to ensure everyone was able to give these.

Further information is in the detailed findings below.

Cromwell House Care Home is registered to provide accommodation and nursing care for up to 66 people. At the time of our inspection there were 48 people living at the home. The home is located in the town of Huntingdon close to local shops, amenities and facilities. The home is a three storey premises. These are accessible by stairs or a passenger lift for people or visitors whose mobility requires this. En suite as well as bathing and shower facilities are available.

We carried out a focused unannounced comprehensive inspection of this service on 5 November 2015. A breach of two legal requirements was found. These were in relation to the management of medicines.

After the focused inspection on 5 November 2015, the provider wrote to us to say what they would do to meet the legal requirements in relation to the safe management of medicines.

We undertook this unannounced comprehensive inspection on 30 March 2016 to check that the provider had followed their plan and also to confirm that they met legal requirements. We found that the provider had followed their plan which they had told us would be completed by the 15 January 2016 and legal requirements had been met.

The service did not have a registered manager. The previous registered manager left in August 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had a good understanding of the identification, prevention and reporting of any incident of harm. People’s assessed needs were not always met by a sufficient number of staff who were qualified and competent in their role. Satisfactory pre-employment checks were completed on staff before they were offered employment.

Action had been taken, and sustained, in the administration and management of people’s medicines. Staff had been regularly trained and assessed as being competent to safely administer people’s prescribed medicines. An effective staff training and induction process was in place to support staff in their role.

Risk assessments to help safely support people with risks to their health were in place and these were kept under review according to each person’s needs. This included risk assessments to support people in an emergency such as a fire should this ever occur.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The regional manager, home manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications had been made by the provider to lawfully deprive people of their liberty as well as people being cared for in the least restrictive manner. This meant that, where appropriate, people were being lawfully deprived of their liberty.

People were supported to eat and have sufficient quantities of their preferred food and drink choices. This included the provision and choice of appropriate diets for those people at an increased risk of malnutrition, dehydration or weight loss.

People were supported to access a range of health care services and their individual health needs were met.

People were cared for with dignity in a compassionate way. People were given the opportunity to be as independent as possible. People were involved in the planning and provision of their care

Information was made available for people or their relatives who may need access to independent advocacy services. People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. Some opportunities were missed to support people with their care needs in an individualised manner.

A range of effective audit

We carried out an unannounced comprehensive inspection of this service on 19 May 2015. We found breaches of three legal requirements. These were in relation to the administration of medicines, staffing levels at night and the management of people’s health conditions.

After our comprehensive inspection on 19 May 2015, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches that were made.

We undertook this unannounced focused inspection on 5 November 2015. This was to check that the provider had followed their plan and to confirm that they now met legal requirements. We found that the provider had followed their plan which they had told us would be completed by the 1 October 2015 and that legal requirements identified during our inspection on 19 May 2015 had been met.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cromwell House Care Home on our website at www.cqc.org.uk.

Cromwell House Care Home is a three storey building located in the town of Huntingdon. The home provides accommodation for up to 66 people who require nursing and personal care. At the time of our inspection there were 51 people living at the home accommodated in single occupancy en suite rooms. The home is made up of three main units where people are cared for according to their assessed care or nursing needs.

The home did not have a registered manager in post. The current manager who had worked at the home since August 2015 was in the process of applying to become 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.

Whilst action had been taken regarding the safe administration and recording of people’s medicines since our last inspection we found further improvements were required with regard to the management and control of some people’s medications.

Action had also been taken regarding the number of staff on duty during the night as well as new staff appointments in the posts of clinical lead and senior care staff.

Actions had been taken to identify, manage and improve the management of people’s health conditions.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Cromwell House Care Home is a three storey building located in the town of Huntingdon. The home provides accommodation for up to 66 people who require nursing and personal care. At the time of our inspection there were 52 people living at the home. Accommodation is provided over three floors and all bedrooms are single rooms with en suite facilities.

This unannounced inspection took place on 19 May 2015.

At our previous inspection on 02 June 2014 the provider was meeting all of the regulations that we assessed.

The home had a registered manager in post. They had been registered since February 2015 but had been managing the home since October 2014. 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.

Staff were trained in medicines administration. However, medicines were not always recorded or administered in a safe way. There were not always enough staff to meet the needs of people who used the service to ensure they received care and support when they needed it. The provider had a robust recruitment process in place. This ensured that only the right staff were recruited and offered employment.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager was knowledgeable about when a request for a DoLS would be required. We found no one living at the home was being deprived of their liberty. Staff had limited knowledge and understanding of the MCA and DoLS. People’s ability to make decisions based on their best interests were supported by records to demonstrate where this had been assessed as being lawful.

Staff consistently respected people’s dignity and provided care in a compassionate way. People’s requests for assistance were responded to but this was not always in a timely way.

Reviews of people’s care records were completed regularly and more urgently when required. This was to help ensure that the information about people’s care needs to inform and guide staff was relevant and up-to-date. People were supported to undertake their hobbies and interests.

People were supported to access a range of health care professionals. This included GP and community nursing services. Risks to people’s health were assessed but were not always acted upon.

People were provided with a choice of home-made meals and supplements when required. People’s independence with their eating and drinking was respected. There were sufficient quantities of food and drinks available and people were supported to access these.

People and their relatives were provided with information on how to make a complaint or compliment. Staff knew how to respond to any reported concerns or suggestions. Action was taken in response to compliments or concerns to drive improvement in the home. Access to advocacy services were offered in the home and people or their relatives were able to use these if required.

The provider had checks and audits in place to support their quality assurance of the care provided to people. This was to improve, if needed, the quality and safety of people’s support and care. Plans were in place to implement changes as a result of identified concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

An adult social care inspector carried out this this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with eight people who used the service, six family members of people who use the service, the registered manager, an operational manager, eight members of care staff and a visiting healthcare specialist. We also spoke with a member of staff from the Continuing Health Care team in Huntingdon, and a representative from the Local Authority Contracts team both of whom had regular contact with the home. We reviewed records relating to the management of the service which included five care plans, daily records, infection control procedures, staff rotas, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Risk assessments regarding people’s individual care and support needs had been improved to ensure there were measures in place to minimise any potential harm to people who used the service. Carers understood their roles and responsibilities in making sure people were protected from harm. The provider had taken appropriate action to ensure that there were appropriate levels of staff to meet people’s needs .There were safe infection control procedures in place. Staff we met confirmed that they had received training regarding Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Is the service effective?

We found that nurses and care staff were knowledgeable about people’s individual care and support needs. People that we spoke with confirmed that staff provided consistent and kind support. Care planning documentation was well recorded and reviewed to ensure that individual care and support needs were being met. The manager confirmed that support documentation was regularly audited to ensure it met people’s assessed needs.

Is the service caring?

People told us that they received consistent and respectful support from care and nursing staff and felt able to make choices and changes when required. One person we met told us that “The care staff are very kind and always help me with what I need”. Staff told us that they felt supported so that they could provide safe care and support to people.

Is the service responsive?

We saw that people’s personal care and social support needs were assessed and met. This also included people’s individual choices and preferences as to how they liked to be supported. People we spoke with told us that they felt well cared for and this was confirmed when we observed care delivery during our inspection.

Is the service well led?

The home has a registered manager in place. Staff we spoke with told us that they felt supported by the manager and were regularly trained to provide safe care and support to people who lived at the home. People we spoke with told us that they felt they were listened to and support was consistent and provided in a safe way. Quality assurance systems were in place to regular audit the care and services provided. Surveys were carried out to gather opinions from people who lived at the home, their relatives and care staff.

During our inspection on 9 May 2013 we spoke with several people about their care. We received very positive comments from every person about how they had bee treated by staff and how they had been given care and attention. One person said, "It's perfect living here; absolutely brilliant!” Another person said, I have everything I need and more". Six visiting relatives told us that they were regularly involved in making decisions about their family members care and that the home had kept them informed about their relative's wellbeing and care needs.

Care records gave staff clear guidance on meeting each person’s individual needs. Potential risks to people had been assessed and plans put in place to minimise the risks.

The home was very clean and there were systems in place to ensure that people were protected from the risks of infection.

People were adequately safeguarded from harm although not all staff were familiar with the Local Authority reporting procedures.

Medication was managed safely and the associated records had been accurately recorded.

The premises were well maintained and there was a large well kept garden that people and relatives told us they enjoyed.

The provider had suitable supervision arrangements in place to ensure staff were well trained and received regular management support.

Relatives told us they knew how to complain, but had never had to.

We spoke with several people living at Cromwell House who told us that they were satisfied with the way care staff treated them and that their care and support was good. They confirmed that they were treated with respect. One person said, "I would let them know about it if they were not polite". Another person said, "They (staff) have always treated me respectfully'. People told us how they could make decisions about their food and their daily routine and how they were enabled to enjoy excursions out to the wider community.

We spoke with relatives who told us that they considered the staff behaved appropriately and showed respect to them and to people living at the home. One relative told us how they had been involved in writing and preparing their relative's care plan and told us how they had advised the home about the care that should be provided for their relative. They told us "I gave them a lot of information and helped to write the care plan and I have seen the completed plan which is fine and I agree with it."

People told us they were never placed in a position that did not respect their privacy or dignity. People said that staff members were nice, usually polite and people were all happy living at the home. However, one person said not all staff knocked before going in to the person’s room and they did not always act as if they were entering the person's own home.

We spoke with people about their care and were told that staff members help them if they need this and they don't usually have to wait too long.

People told us they felt safe living at the home and that they would be able to talk to staff members if they were not happy with something.