CQC report explained · a residential care home, run by Methodist Homes

Cromwell House

Cecil Road, Norwich, NR1 2QJ

Requires improvementpublished 18 January 2024, 2 years ago

Rated Requires improvement: inspectors found the service was not performing as well as it should and told it what to change.

The five questions inspectors ask

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.

The latest report, explained

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.

What inspectors praised

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

What inspectors were concerned about

Medicines were not always safe
serious
Some 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
serious
Important 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 fixing
Records 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
serious
Audits 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 fixing
The 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

Questions to ask them, based on this 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.

The story over the years

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 Good
Safe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Cromwell House →
July 2018Goodstayed Good
Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
We are reading this report · the original is on cqc.org.uk
November 2015Good
Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read this report on cqc.org.uk
May 2014
Report published without a new overall rating.
Read this report on cqc.org.uk
November 2013
Report published without a new overall rating.
Read this report on cqc.org.uk
June 2012
Report published without a new overall rating.
Read this report on cqc.org.uk
December 2010
Registered with the Care Quality Commission on 22 December 2010.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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