CQC report explained · a nursing home
What the CQC found at Cromwell House (West Bromwich)
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- There were enough staff, safe recruitment, safeguarding procedures and good COVID-19 infection control. However, medicines records and some risk and care plan information were not always accurate or complete.
- Effective?
- Good
- People received support from health professionals and were involved in decisions about their care. Staff understood people's needs and supported choice, consent and least restrictive care.
- Caring?
- Good
- This question was not inspected during this focused visit. The previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. The previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- People and staff had confidence in the manager and described an open culture. However, audits had failed to identify problems with records, medicines, staffing information and a missed notification to CQC.
What inspectors found, February 2021
Cromwell House (West Bromwich) was rated Requires Improvement; inspectors found kind and effective care, but weaknesses in medicines records and quality checks.
This was an unannounced focused inspection over four days in January 2021. Inspectors spoke with people, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and management documents.
The home had enough staff, safe recruitment and safeguarding procedures. Inspectors were assured about infection control during COVID-19. People were supported with their choices, healthcare, food and daily care.
Some medicines records were inaccurate or incomplete. Care plans and risk assessments had also not always been kept consistent. The new audit system was still being introduced and had not yet identified these problems.
The overall rating was Requires Improvement. Safe and Well-led were Requires Improvement, while Effective was Good. The home had improved since the previous inspection, but it remained in breach of Regulation 17 on good governance.
Enough staff
People and staff said there were enough staff on shift. Inspectors found staff had been recruited safely.
“People and staff told us there were enough staff on shift.” from the report
Infection control
Inspectors were assured that the home had suitable measures to prevent and manage COVID-19 infection.
“We were assured that the provider was using PPE effectively and safely.” from the report
Choice and consent
People were involved in decisions and staff supported them in line with mental capacity law and least restrictive practice.
“People were supported to have maximum choice and control of their lives” from the report
Health support
People had access to a range of health professionals and were included in reviews about their care.
“People had multidisciplinary teams [MDT] involved in their care.” from the report
Medicines records
seriousSome medicine instructions and records were conflicting, missing or incomplete. The manager corrected several issues during or shortly after the inspection.
“Medicine management required improvement. For example, one person's medicine records had conflicting times in regard to when a medicine needed to be administered.” from the report
Care plan inconsistencies
needs fixingSome information was not recorded consistently across care plans. One care plan had not been updated after a low-level restraint, including risks linked to the person's health.
“The audits of the care plans had not identified where some information was not consistently recorded or was missing.” from the report
Weak quality checks
seriousThe home's checks did not identify several problems, including medicines issues, inconsistent records and an incident that had not been reported to CQC on time.
“We found no evidence that people had been harmed however, systems and processes were not robust enough to demonstrate good governance.” from the report
- 01What changes have been made to check that medicine instructions, PRN protocols and cream body maps are complete and up to date?
- 02How do you now make sure care plans and risk assessments contain the same current information in every relevant section?
- 03What results have your new audits found since the inspection, and how are you checking that they identify problems promptly?
- 04How do you make sure staff receive the same information when a person's support needs or staffing levels change?
- 05What action has been taken in response to the Regulation 17 breach and the required action plan?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 26 February 2021 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, November 2019
Rated Requires Improvement; inspectors found safe, kind and responsive care, but weaknesses in consent records and management checks.
The unannounced inspection took place on 13 June 2019. Inspectors spoke with six people living at the home, staff, managers and health professionals. They reviewed seven care records and records about how the home was run.
People said they felt safe and were happy with the care. Staff knew people well, treated them kindly and supported their independence. Medicines were given safely, the home was clean, and people had suitable food, activities and access to healthcare.
There were important gaps in records and oversight. Mental capacity assessments were not always decision-specific, support plans were not always reviewed monthly, and audits did not always identify or record actions needed. Two incidents involving the police had also not been reported to CQC when required.
The overall rating fell from Good to Requires Improvement. Safe, Caring and Responsive were rated Good. Effective and Well-led were rated Requires Improvement.
People felt safe
People told inspectors they felt safe, and staff understood how to recognise and report abuse.
“People told us they were safe at Cromwell House.” from the report
Safe medicines
Medicines were stored and given safely. Records showed people received their medicines as prescribed.
“Medicine administration records (MARs) had been completed correctly and assured us people received their medicines as prescribed.” from the report
Kind and respectful staff
Staff supported people with empathy, reassurance and respect. People were encouraged to make choices and remain independent.
“There were caring interactions between staff and people who used the service.” from the report
Personalised support and activities
Care plans reflected people's preferences, and staff supported people to take part in activities and develop interests.
“Care plans contained personalised information that was specific to each individual and people told us they have been involved in creating and reviewing them” from the report
Mental capacity records
needs fixingSome people who lacked capacity did not have clear, decision-specific assessments. This created a risk that staff might not know which decisions people could make themselves.
“people who lacked capacity to make certain decisions did not always have clear assessments in place that were decision specific to demonstrate compliance with the Mental Capacity Act 2005.” from the report
Care plans were not always reviewed
needs fixingThe home's own guidance said support plans should be reviewed monthly, but this did not happen consistently. Staff might therefore have had inaccurate information about people's needs.
“However, support plans were not always reviewed regularly.” from the report
Weak management checks
seriousAudits did not always identify missing information or show what action had been taken. This was a breach of the good governance regulation.
“The provider's audits did not record if any actions had been taken to address any points identified in audits or what the outcome was.” from the report
Incidents not reported to CQC
seriousTwo incidents involving the police in November and December 2018 were not notified to CQC without delay. The manager submitted the notifications after the inspection.
“In November and December 2018 there had been two incidents when police were contacted due to the behaviour of a person.” from the report
- 01How are you now making sure mental capacity assessments are specific to each decision?
- 02How often are care and support plans reviewed, and how do you check that reviews happen on time?
- 03What changes have you made to your audit system, and how do you record actions and their outcomes?
- 04How do you make sure all incidents that must be reported to CQC are notified without delay?
- 05What progress has been made with the new risk assessment system mentioned in the report?
This was an unannounced inspection that looked at all five CQC questions, the overall quality of the home and its legal requirements. This explanation was written from the published report of 1 November 2019 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 (West Bromwich)
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- February 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Cromwell House (West Bromwich) →
- November 2019Requires improvementdown from GoodSafe: GoodEffective: Requires improvementWell-led: Requires improvement
Read what inspectors found at Cromwell House (West Bromwich) →
- March 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- June 2011
Registered with the Care Quality Commission on 28 June 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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