We were very dissapointed to be downgraded from 'Good' to 'Needs Improvement' in 2018. If you are considering using Crimson Manor and are concerned about this inspection report, please contact us to discuss this further. We are also happy to send you a copy of our response documents submitted to CQC.
We were rated 'Good' by the CQC in September 2016 (see 2016 report). During the inspection the inspector made recommendations of small ways we could improve things such as improvements to the signage and quality auditing. We put these into effect straight away. We also put systems into place to ensure staff properly adhered to the PRN medication protocol which had resulted in 'needs improvement' for safety.
Between the 2016 and 2018 inspections we also did the following:
We had the same management structure, the same quality mangement system, the same staff development & training programme and the same care planning system. We had continued to work hard to develop our service in a number of smaller ways and received regular positive feedback from residents and their families. We therefore consider it to be simply absurd to suggest that there had been a deterioration in our service provision by the time of the 2018 inspection.
The 2016 report remains a better reflection of the quality of service we provide than the more recent, and highly flawed 2018 report.
Whenever a care provider is said to be in breach of regulations, they must submit an action plan showing how the breaches are being rectified. We submited an action plan which set out that there was no breach of regulations. We received no follow up from the CQC. Please contact us if you wish to see a copy of this action plan.
Following CQC inspections, care providers are sent a draft report. Care providers have the opportunity to submit objections to the factual accuracy of the report and also submit any additional evidence that hasn't been considered, in the interests of completeness. We submitted 47 factual accuracy objections (see examples of misleading information in report) and 32 additional pieces of evidence (see examples of additional evidence) that hadn't been considered by the inspector.
Very few of our responses was accepted. Moreover, the CQC breached their own inspection procedures by refusing to even consider any of the 'additional evidence' not considered by the inspector . Because of these failures, the inspection report can be considered as nothing other than completely biased. We have never had this kind of experience at any previous CQC inspection.
Unfortunately there was very little improvement we could make in response to the findings of the report as it did not accurately reflect the level of service we were offering in reality:
Some actions taken were already underway and were not influenced by the inspection:
If our home was really 'needs improvement' across all 5 categories there would have been extensive work that needed to be carried out over several months in order to address all the issues found. This simply was not the case.
Irresepctive of the unfair inspection rating of 2018, we have maintained our commitment to continual improvement. Some of the larger changes made include:
There are many examples of misleading information in the 2018 report:
The inspector did not like how the recording protocol of our body maps even though this has been the same for many years and accepted by all other professionals. We amended our recording in line with her advice but were later told to change it back to our original protocol following independent advice from the Tissue Viability nurses.
We had a number of safety systems in place to eure our care was not compromised whilst a new nurse call system was installed. We had discussed all our measures and action taken with CQC manager Helyn Aris and were told she was satisfied we had done everything we could. We had a recording of this conversation.
There is no such department within the local authority that supports care homes with telecare equipment.
We were already familiar with such guidance and were following all aspects of this. The inspector was not able to specify what it was she felt we were failing to do.
The inspector took issue with the specific risk assessment tool that we used. This tool is listed as one of several alternate tools which can be used by the NICE guidance (National Institute of Clinical Excellence who review all evidence to make reccomendations for best practice). Crimson Manor follows all best practice guidance and Kirklee's recommendations for the safe mangement of people's skin health.
In the weeks prior to the inspection our full time Maintenance person had been taken ill with cancer. We had recruited a temporary cover who started the same week as the inspection. In the meantime we risk assessed all maintenance jobs. Any urgent jobs were completed by external repair workers. A small number of jobs remained that were completed within a few hours of our maintenance cover person starting.
At the time of the inspection we had 91% external audit score from Kirklees Infection Prevention and Control.
In line with the Mental Capacity Act Code of Practice, recorded capacity assessments are only required for some decisions.
We informed the inspector upfront that we carried out supervison every eight weeks but since the last inspection there had been a period where this was not done in line with schedule while we faciliated a change of care managers. The records supported exactly what we said.
This was done at the request of the inspector but it was made clear by us that they had not been made prior to the inspection because they were not actually necessary. One referral was rejected by the specailists as not required; the other referal was not made as it was not supported by the family or the care home. There was no evidence that the Home fails to make appropriate referals for specialist assessments where required.
The level of detail in care plans can vary depending on how long a resident has been at the home and how much information can be obtained from the resident, family members or other professionals. The Home has consistently recieved high praise for the quality of our care plans. Around the time of this inspection a social worker commented that they were some of the best and clearest he had seen.
The Home had submitted a total of 35 notifications in the 12 months prior to the inspection. The inspector alleged that we had missed 3 such notifications. In reality we had missed only 1. This was an unusual notification we had never come accross before and do not expect to again. The 'safeguarding' notification did not in fact meet the definition of a safeguarding incident warranting notification and the notification for change of service user bands was not required at all (the inspector had misinterpreted the notificaiton requirements).
Under normal circumstances, the Home would have been re-inspected in 2020. Due to Covid-19 resitrictions, this did not happen. Unfortunately, the Home therefore still has the 2019 'needs improvement' rating. We are hoping to acheive a fairer and more favourable rating at our next inspection.