CQC report explained · a residential care home
What the CQC found at Cromwell House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some people missed medicines, medicines stock records did not always match, and prescribed creams were not always stored securely. Risks involving falls, pressure ulcers, stomas and catheters were not always fully assessed or managed.
- Effective?
- Requires improvement
- Care needs were not always fully assessed or recorded, and staff did not always follow best practice for catheters, stomas and pressure ulcers. Training, supervision, food and support with decisions were positive.
- Caring?
- Good
- People said they were treated with dignity and respect. Staff knew people's histories and supported choice, privacy and independence.
- Responsive?
- Requires improvement
- Care records were sometimes inaccurate or unavailable, and changes in people's needs were not always reflected in risk assessments. Activities, communication support, informal feedback and end-of-life planning were positive.
- Well-led?
- Requires improvement
- The home's checks did not reliably identify or fix problems with medicines, care records and recruitment checks. People found managers approachable, and the provider said extra quality assurance support had been arranged.
What inspectors found, January 2024
Rated Requires Improvement; inspectors found kind care and good activities, but serious medicines, risk assessment and record-keeping problems.
This was an unannounced comprehensive inspection on 7 November 2023. Inspectors spoke with 12 people, 6 relatives and 9 staff. They reviewed care, medicines, staff recruitment and management records.
The main concerns were medicines not always given as prescribed, incomplete risk assessments and care records, and weak checks by managers. Some staff recruitment records were also incomplete. These problems created a risk that people could be harmed.
People were treated with dignity and respect. They spoke positively about the atmosphere, food and activities. Staff knew people well and supported their independence. Caring was rated Good, but Safe, Effective, Responsive and Well-led were all rated Requires Improvement.
The previous overall rating was Good in 2018. The home was found to be in breach of Regulation 12 and Regulation 17. CQC issued warning notices and will monitor an action plan from the provider.
Kind and respectful care
People consistently said they were treated with dignity and respect. Staff understood people's life stories, preferences and interests.
“We observed the atmosphere within the home to be warm and caring, and people told us they felt the same way.” from the report
Choice and independence
People were involved in decisions about their care and encouraged to remain independent. Some people could leave the home independently.
“People told us they were given choices, and these were respected.” from the report
Activities and social life
People spoke highly of the activities, including groups, games, religious services and use of the garden. Activities were adapted to individual interests.
“We saw that people were encouraged to engage in ways which were meaningful to them as individuals.” from the report
Food and mealtimes
People were supported to eat and drink enough. Mealtimes were relaxed and social, and catering staff understood people's dietary needs.
“We observed mealtimes to be relaxed and sociable.” from the report
Medicines were not always safe
seriousSome people missed doses, including one person who missed medicines 47 times in 26 days. Stock discrepancies and a missing constipation medicine were not properly acted on.
“We were not assured that people received their medicines safely or as prescribed.” from the report
Risks were not fully assessed
seriousImportant risks were not always reflected in care plans. Examples included falls, pressure ulcers, stomas and catheters, with gaps in repositioning records.
“The provider had failed to ensure the risks in relation to people's health, safety and welfare had been fully identified, reviewed, and mitigated.” from the report
Care records were inaccurate
needs fixingRecords did not always describe the care people needed or show that care had been provided appropriately. Changes in needs were not always added to risk assessments.
“People's care records did not consistently evidence that people received care to best meet their needs.” from the report
Management checks missed problems
seriousAudits did not reliably find or correct the medicines, care record and recruitment problems. Some actions identified by the home were still outstanding weeks later.
“We found systems to assess, monitor and improve the service were not sufficiently robust.” from the report
Some staff records were incomplete
needs fixingThe home had enough staff, but employment records for three staff members had gaps. This meant the home could not be fully assured about their suitability to work with vulnerable adults.
“We found gaps in the employment records of 3 staff working at the service.” from the report
- 01What has been done to prevent missed medicines and to make sure stock discrepancies are investigated promptly?
- 02How are risks from falls, pressure ulcers, stomas and catheters now assessed and recorded?
- 03How will you make sure care records accurately reflect each person's current needs and the care they receive?
- 04What changes have been made to management audits since the warning notices, and how will you show that problems are being fixed?
- 05Have all staff recruitment files now been completed, including the checks needed to confirm staff suitability?
This was an unannounced comprehensive inspection covering all five key questions, including infection prevention and control, care and the premises. This explanation was written from the published report of 18 January 2024 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, July 2018
Rated Good; inspectors found safe, kind and responsive care, with some mental capacity records needing improvement.
This was an unannounced inspection on 11 June 2018. One inspector and an expert-by-experience spoke with people living in the home, visitors, staff and a healthcare professional. They also reviewed care plans, medicine records and records about safety and quality.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicine administration, suitable training, good support with food and healthcare, respectful care, varied activities and effective leadership.
The report says the overall Good rating continued from the 2015 inspection. Inspectors found no serious risks or concerns, but noted gaps in some mental capacity and best-interest records. They also identified some cleaning, staff knowledge and end-of-life training improvements.
People felt safe
People said they felt secure and trusted the staff. Inspectors found safeguarding knowledge, risk assessments, safe equipment and enough staff.
“Without exception, people told us they felt safe.” from the report
Kind and respectful care
Staff respected privacy and dignity, asked permission before care and encouraged people to remain as independent as possible.
“Staff offered people privacy as much as possible when delivering personal care, ensuring doors were closed and offering to leave the room when people preferred to be alone.” from the report
Activities and choice
People could choose from many activities and decide how to spend their time, including when to get up, go to bed or have a bath.
“There was an abundance of different activities every day to meet people's needs and provide opportunities for stimulation and social engagement.” from the report
Effective leadership
The home had an established manager, supportive leadership and systems to monitor care, medicines, the environment and feedback.
“There were effective systems in place to monitor and improve the service.” from the report
Mental capacity records
needs fixingSome records did not clearly show that people's capacity had been assessed for the specific decision, or fully record best-interest decisions.
“Their capacity had not always been formally assessed in line with the decision relating to the DoLS application, and where decisions had been made in people's best interests, this was not always fully documented.” from the report
Understanding individual conditions
needs fixingTwo people said some staff could improve their understanding of their conditions. The manager added more detail to care plans and arranged further training.
“However, two people told us that some of the staff could still improve in their understanding of their conditions.” from the report
Dining room cleaning
minorSome dining room chairs did not appear clean. The home had changed the night staff schedule and planned to check whether cleaning was happening regularly enough.
“We did feed back to the registered manager that some chairs in the dining room did not appear to be clean.” from the report
- 01How have you corrected the gaps in mental capacity assessments and best-interest records?
- 02How do you make sure staff understand each resident's health conditions and care needs?
- 03How often are dining room chairs and other communal areas checked and cleaned?
- 04What end-of-life care training has been provided since the planned end-of-life care champion was introduced?
- 05How do you use residents' and families' feedback to improve the service?
This was an unannounced inspection covering all five CQC questions, and the report says the Good ratings continued from the 2015 inspection. This explanation was written from the published report of 10 July 2018 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
3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- January 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 22 December 2010.
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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Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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