CQC report explained · a nursing home
What the CQC found at Cromwell House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- People told inspectors they felt safe. Risks had been assessed, call bells were available, staffing had improved, infection control was effective and medicines were managed safely.
- Effective?
- Good
- People received support with health care, eating and drinking, and communication. Staff had appropriate training, and the environment had been refurbished to meet people's needs.
- Caring?
- Good
- Staff were kind, respectful and supported people's dignity, choices and independence. However, some people were unclear about the key worker role and communication was not always easy for people whose first language was not English.
- Responsive?
- Requires improvement
- Care plans were detailed and personalised, but people and relatives were not always involved in reviewing them on an ongoing basis. Activities had improved but could not reach everyone because of vacancies in the activities team.
- Well-led?
- Requires improvement
- Leadership and governance had improved, but the systems needed more time to become fully established. Inspectors found that an unexplained bruise and skin injury had not initially been reported to the local authority safeguarding team while the registered manager was away.
What inspectors found, December 2023
Rated Requires Improvement; the home improved from Inadequate and left special measures, but care planning and leadership still need work.
Inspectors visited unannounced on 30 August, 26 September and 3 October 2023. They spoke with 13 people, 12 relatives and 16 staff. They reviewed care, medicines, staffing, training, complaints and management records.
The home had made extensive improvements since its last inspection, when it was rated Inadequate and placed in special measures. Inspectors found people were safe, received effective care and were treated kindly and with dignity. The home was clean, medicines were managed safely, staffing had improved and health professionals were involved when needed.
The overall rating is Requires Improvement because care planning did not always involve people and relatives on an ongoing basis. Activities could be better, and management systems needed more time to become fully established, especially when the registered manager was absent. The home was no longer in breach of regulations and was no longer in special measures.
Safer care
Risks were assessed for individual people and staff followed measures to reduce risks such as pressure sores and falls. People had access to call bells and said staff responded promptly.
“We found people were being supported in line with their individual assessed needs.” from the report
Staffing and training
The home recruited to vacant care and nursing posts. Inspectors found enough staff, suitable recruitment checks and training linked to people's needs.
“This meant people were supported by staff who knew them and their needs well.” from the report
Kind and dignified care
Staff treated people with kindness and respect. Inspectors saw staff protect privacy, promote independence and support people to make choices.
“At this inspection, people's dignity was promoted through staff practice.” from the report
Improved management culture
Inspectors found a more open and inclusive culture, with regular meetings and evidence that suggestions led to changes. Staff morale had improved.
“We found staff morale had increased, and staff worked together to provide an inclusive environment for people to experience good outcomes.” from the report
Ongoing care plan involvement
needs fixingCare plans were personalised, but people and relatives were not always routinely involved after the plans were put in place. Inspectors recommended regular, timed reviews involving them.
“Feedback from people and their relatives did not always evidence their awareness of regular ongoing involvement following their implementation.” from the report
Activities may not reach everyone
needs fixingActivities and social opportunities had improved, but vacancies meant the two activities staff could not provide opportunities and engagement for everyone.
“However, due to staff vacancies within the activities team, it was not possible for the 2 activities staff to provide social opportunities and engagement for all people within the care home.” from the report
Oversight when the manager is away
seriousManagement systems had improved but were not fully embedded. One unexplained bruise and skin injury was reported to the local authority safeguarding team only retrospectively while the registered manager was on leave.
“During our review of records, we identified 1 person had experienced unexplained bruising and skin injury, which had not been reported to the local authority safeguarding team.” from the report
- 01How often will my relative and our family be involved in reviewing and updating the care plan?
- 02Who is responsible for oversight and safeguarding reporting when the registered manager is absent?
- 03How will you make sure my relative can take part in activities if there are vacancies in the activities team?
- 04How will you support my relative's communication needs, especially if English is not their first language?
- 05What changes have been made since inspectors raised concerns about the key worker system?
This was an unannounced follow-up inspection after the previous Inadequate rating and special measures; inspectors considered all five key questions, with Safe, Effective and Caring rated Good and Responsive and Well-led rated Requires Improvement. This explanation was written from the published report of 2 December 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2023
Rated Inadequate and placed in special measures; inspectors found serious failures in safety, staffing, dignity, personalised care and leadership.
Inspectors visited the home without notice on 2, 8 and 12 August 2022. They spoke with people, relatives, staff and health professionals. They observed care and checked care records, medicines records, accidents and incidents.
They found widespread and serious problems. People were at risk from poor pressure care, low staffing levels, delayed help with food and drink, poor infection control and inaccurate care records. Some people were kept in bed for long periods and had few chances to socialise or go outside.
People and relatives gave mixed feedback. Some said staff were kind and helpful, but others said their needs were not met and relatives felt they had to visit frequently to make sure care was safe. Inspectors also found that staff were rushed and that people were not always treated with dignity or supported according to their wishes.
The overall rating and all five key question ratings were Inadequate. The home was placed in special measures. The provider took some immediate steps after the inspection, including increasing staffing, ordering equipment and arranging further professional assessments, but CQC required an action plan and continued monitoring.
Pre-entry assessments
People's needs were assessed before they moved into the home. This was a positive starting point, although inspectors found that care plans were later inaccurate or inconsistent.
“People's needs were assessed before they moved in the home.” from the report
Recruitment checks
The home had pre-employment checks and references before staff started work.
“There were pre-employment checks and references in place before staff started working in the home.” from the report
Immediate safety actions
After the inspection, the provider increased staffing, checked pressure mattresses and arranged additional equipment and professional assessments.
“The provider took some immediate actions to ensure people were safe and they received care and support effectively.” from the report
Safeguarding failures
seriousUnexplained wounds and other incidents were not always investigated or reported to safeguarding authorities. Staff also lacked confidence that concerns raised with management would lead to action.
“The provider and the registered manager failed to operate effective safeguarding processes and learn lessons when things went wrong.” from the report
Not enough staff
seriousStaffing levels and deployment did not meet people's needs safely or promptly. This contributed to delays, people remaining in bed and missed repositioning and drinking support.
“The lack of staff to meet people's needs was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Poor records and care planning
needs fixingSome care plans contained another person's name or conflicting instructions. This created a risk that people would receive incorrect care.
“Care plans developed were not always personalised, relevant or up to date.” from the report
Loss of dignity and choice
needs fixingSome people were washed and dressed during the night, then left in bed. Inspectors also found open bedroom doors, limited independence and care that did not follow people's preferences.
“This practise did not promote caring and personalised support for people.” from the report
Weak leadership and checks
seriousAudits failed to identify serious shortfalls or ensure that agreed improvements were completed. Staff and relatives described poor communication and a blame culture.
“The provider's quality assurance systems and processes were not effectively used to assess, monitor and improve the quality and safety of the service.” from the report
- 01How many staff are now working on each shift, and how do you check that staffing is enough for people's needs?
- 02How do you make sure pressure mattresses are set correctly and that people are repositioned at the intervals in their care plans?
- 03What equipment is now available for people who need hoists, slings or mobility support?
- 04How do you check that care plans contain the correct person's information and match their current needs?
- 05What evidence can you show of progress against the action plan and the special measures review?
This was an unannounced full inspection covering all five key questions, including infection prevention and control; it did not examine the circumstances of the serious injury that partly prompted the inspection. This explanation was written from the published report of 22 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cromwell House Care Home
5 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- December 2023Requires improvementcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2023InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- January 2021Inspected but not ratedSafe: Inspected but not rated
- November 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- December 2015Inspected but not ratedSafe: Requires improvementEffective: Requires improvement
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 7 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,200 a week. 14 can care for a couple. 12 years' experience on average.
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