CQC report explained · a residential care home
What the CQC found at East Croft Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected by safeguarding systems, risk assessments and safe recruitment. Inspectors noted a period when people with dementia were unsupervised in a communal area, and said guidance for some medicines needed improvement.
- Effective?
- Good
- People received support suited to their health, nutrition, hydration and personal choices. Some behaviour plans lacked detail, power of attorney information was not always recorded, and one weight-loss referral had not been followed up.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People were involved in decisions about their care and the running of the home, and staff understood their communication needs.
- Responsive?
- Outstanding
- Care was highly personalised and flexible. Inspectors found exceptionally strong end of life care, a wide range of activities, good community links and quick responses to changing needs and concerns.
- Well-led?
- Good
- The home had positive and open leadership, good staff morale and effective partnerships with health professionals. However, quality monitoring had not always identified missed follow-up or gaps in staff guidance.
What inspectors found, December 2019
Rated Good overall; inspectors found kind, highly responsive care, with some gaps in supervision, guidance and follow-up.
This was an unannounced planned inspection on 21 and 31 October 2019. Inspectors observed care, spoke with people, relatives, staff and health professionals, and checked care, medicines, staffing, training, recruitment, complaints and quality records.
The home was rated Good for Safe, Effective, Caring and Well-led. It was rated Outstanding for Responsive. Inspectors found enough trained staff overall, safe medicines management, good support with food and health needs, kind care, and strong links with other professionals.
The inspectors also found some areas that needed tightening. People with dementia were briefly left unsupervised in a communal area, some guidance for medicines and behaviour support was not detailed enough, and a weight-loss referral had not been followed up. The manager began addressing these issues during the inspection.
Kind and respectful care
Staff showed kindness, empathy and respect. They knew people well, supported their independence and protected their dignity.
“The service was consistently focused on providing person-centred care and support and staff displayed kindness, caring and great empathy towards people” from the report
Outstanding end of life support
People and families were supported to discuss their wishes and receive care from familiar staff. Health professionals said staff managed symptoms well and helped people stay in the home.
“People received responsive, compassionate and holistic end of life care at East Croft Grange from highly motivated and skilled staff.” from the report
Meaningful activities
People could choose from activities, trips and community events. The home adapted activities to people's energy levels and used creative approaches to include people who were physically frail.
“People chose from a range of social activities to help them live as full a life as they wanted.” from the report
Good communication and partnerships
Staff worked well with health and social care professionals. Inspectors were told communication was excellent and that the home accessed the right treatment and support.
“Professionals we spoke with confirmed the registered manager and staff contacted them appropriately so people could access the healthcare and treatment they needed.” from the report
Open culture
People, relatives and staff felt able to raise ideas or concerns. The home acted on feedback and kept people informed about changes.
“There was an open culture and clear learning from people's comments.” from the report
Supervision in the dementia unit
seriousInspectors saw people living with dementia unsupervised while two staff attended to someone in a bedroom. They discussed staff deployment with the manager.
“We observed an occasion when people living with dementia on the Garden Unit were unsupervised whilst two staff on duty attended to a person in their room.” from the report
Guidance for some medicines
needs fixingInstructions for some 'as required' medicines used for agitation did not give staff enough detail. The manager began addressing this during the inspection.
“Medicines prescribed for use 'as required' for agitation did not always have clear guidance and enough detail for staff on their use.” from the report
Missed health follow-up
needs fixingA referral linked to weight loss had not been followed up. Inspectors discussed formalising the system so this would not happen again.
“We noted a referral for weight loss that had not been followed up for action” from the report
Care plan detail
needs fixingSome behaviour management plans did not contain enough detail for staff to support and divert people effectively. The manager started reviewing these plans during the inspection.
“some behaviour management plans did not have sufficient detail for staff to follow to support and divert people.” from the report
Quality checks
needs fixingThe home's monitoring systems did not always identify missed referrals or missing guidance. The manager said the trend analysis and audit programme would be reviewed.
“the monitoring systems had not always highlighted oversights such as when a referral was not followed up or there had been a lack of guidance for staff.” from the report
- 01What changes have been made to ensure people in the Garden Unit are always supervised when staff are supporting someone in a bedroom?
- 02How do you now make sure 'as required' medicines for agitation have clear instructions and their use is monitored?
- 03How are weight loss and other health referrals recorded, checked and followed up?
- 04How often are behaviour support plans reviewed, and how do staff use them in practice?
- 05What improvements have been made to audits so that missed follow-up and gaps in staff guidance are identified?
This was an unannounced planned inspection covering all five CQC questions, including the care, premises and records of the home. This explanation was written from the published report of 10 December 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.
What inspectors found, April 2017
Rated Good; inspectors found safe, kind and person-centred care, with clear improvements since the previous inspection.
This was an unannounced inspection on 21 March 2017. Inspectors spoke with people living in the home, relatives, staff and visiting health professionals. They observed care, looked at medicines and records, and checked staffing, recruitment, training, premises and quality monitoring.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines systems, suitable care plans, kind interactions and a wide choice of activities. People and relatives gave very positive feedback.
The previous comprehensive inspection in March 2015 rated the home Requires Improvement and found three breaches. A focused inspection in November 2016 found better staff training and supervision. By this inspection, inspectors found significant improvements in care planning, dementia care, record keeping and quality checks.
Improved care planning
Inspectors found substantial work had been done to make assessments and care plans more detailed and useful for staff.
“significant work had taken place to improve and evaluate the assessment and care planning systems in the home” from the report
Kind and respectful care
Staff were seen speaking positively with people, responding promptly and protecting privacy and dignity.
“We saw that the staff treated people in a kind and respectful way and engaged positively with people.” from the report
Activities and choice
There was a broad activities programme, including outings and community events. People were asked what they wanted to do and could choose not to join in.
“There was a broad programme of organised activities for people to take part in if they wanted to and this promoted good community access.” from the report
Safe medicines management
Inspectors found medicines were administered, stored and recorded safely. A sample count matched the records, including controlled drugs.
“We found that medicines were being safely administered and records were kept of the quantity of medicines kept in the home.” from the report
Positive leadership
People, relatives, staff and visiting professionals spoke positively about the management. Quality checks and feedback systems were in use.
“Quality assurance and audit systems were being used to monitor and critically assess the service's performance and to help drive a culture of improvement.” from the report
No formal dependency tool
minorThe home did not use a formal tool to calculate staffing dependency. Inspectors still found staffing was sufficient and kept under review, but families may want to understand how staffing needs are assessed.
“Although we did not see a formal dependency tool in use we saw in care plans that people's levels of need and risk were kept under constant review” from the report
- 01How do you now assess staffing levels when people's needs or risks change, given that inspectors did not see a formal dependency tool?
- 02What dementia care strategy is currently in place, and how do you check that it is being followed?
- 03How are care plans reviewed when a person's health, weight or support needs change?
- 04What activities and community access are available now, and how are residents' choices used to plan them?
- 05How are residents' end-of-life wishes recorded and shared with staff and health professionals?
This was an unannounced inspection covering all five rated areas and checking improvements after breaches found at the March 2015 comprehensive inspection. This explanation was written from the published report of 21 April 2017 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 East Croft Grange
4 rated inspections over 5 years: the service has improved, from Requires improvement to Good.
- December 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2016Requires improvementstayed Requires improvementEffective: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 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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