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The Croft Nursing Home (Barrow) Good

Inspection Summary


Overall summary & rating

Good

Updated 28 July 2016

This inspection took place over two days 15 and 17 December 2015. The inspection was unannounced. The Croft Nursing Home (Barrow), (The Croft) provides personal and nursing care for up to 46 people with a physical or learning disability some of whom have complex  and challenging physical, medical and mental health needs.

The home is in its own grounds with easily accessible outdoor patio and garden areas. The front and rear gardens are well maintained and there are flowerbeds and patio areas for people to enjoy and use for recreation such as barbeques. All rooms are single occupancy and have ensuite facilities that are adapted to meet the individual needs of the people using them. The accommodation is on the ground and first floor of the main building and there is a passenger lift to assist people to access the first floor of the home. There are also four bungalows in the ‘village’ area of the home where people are able to live more independently. The home has a range of specialist equipment to promote mobility and independence for the people living there. At the time of our inspection the home was fully occupied.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that there was a relaxed and inclusive atmosphere in the home and people had a good quality of life with high levels of engagement and activity. We saw staff spending time with and interacting with people in a very calm, positive and respectful manner and displaying empathy and compassion in these interactions. People using the service told it was a “good place to live”. Surveys completed by people living in the home and relatives indicated people were very happy with the care, safety and support in the home. A relative told us, “We feel it’s a very safe place” and professionals coming into contact with the service and the people living there commented that it was a “caring” home.

People living in the home were at the centre of the service and were treated very much as individuals. People and their relatives told us that staff understood their specific needs. People told us that staff “Are all my friends”. We could see that staff had built up supportive relationships with people and were familiar with their life stories, goals and preferences.

We saw activities and leisure choices were personalised for each person and their plans were clear on how they wanted to live their lives and make their own choices. Staff were familiar with people’s life stories and people’s likes, dislikes, preferences and care needs and understood their different communication needs. We could see that staff knew how to respond and talk to each person to give them the support and care that they needed and wanted.

People’s care and health plans were detailed, person centred and clearly described the individual care, treatment and support people needed and preferred. Care plans had been written together with people to minimise risk but also to promote choice for the person and keep their independence. The care and health plans were regularly reviewed, the care evaluated and updated as required. The care plan format was pictorial to help people who used the service to understand them more easily. Individual plans of care included assessments and support for psychological, emotional and mental health needs and these were monitored closely so that appropriate support could be provided quickly if needed.

People were given time and the appropriate support they needed to take their medicines. People’s care plans detailed any assistance or support that people might need to take their medicines safely and to best effect. Medicines were stored, administered, recorded and disposed of safely and in line with current National Institute for Health and Care Excellence (NICE) guidelines. Staff were trained in the safe administration of medicines and kept records that were up to date and accurate.

Staff levels were organised to make sure there were enough staff on hand to support people to follow their interests and go out or take part in chosen activities as they wished. Some people who used the service required one to one support and we saw this was provided. All the staff we spoke with told us they enjoyed their work and felt valued by the organisation. The staff we spoke with demonstrated a good understanding of the values and the philosophy of the service.

Staff received appropriate training to carry out their roles and they also had specific training to support people’s different care and personal needs. This included training on diabetes, autism, epilepsy, swallowing difficulties, interactive communication and nutrition. Staff confirmed that their managers provided good support and supervision and encouraged their continual professional development. Some staff acted as ‘champions.’ They provided a resource to staff and people living there and gave additional support, advice and guidance. There were champions in privacy and dignity, health and safety, mental capacity and deprivation of liberty safeguards, medication and infection control.

A complaints procedure was displayed in standard and pictorial formats around the home. The registered provider had a pictorial complaints procedure which people told us they felt they were able to use. We looked at the procedures and records of complaints received and their investigation and resolution. All complaints received in the last 12 months had been resolved to the complainant’s satisfaction and within the timescales stated in the home’s procedures.

Staff had received training to recognise the signs of potential abuse and knew what action to take. They gave examples of what they needed to be aware of and what would give rise for concern. They said any concerns they raised were “always” listened to and looked into by the management team.

Staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they demonstrated a good understanding of these. Where people did not have the capacity to make decisions about their care, we saw that ‘best interests’ meetings were held. These included the people concerned, their relatives and health and social care professionals involved in their care. This helped to ensure that their individual rights were protected and that any decisions were made in their best interests.

The management team demonstrated strong values and a desire to learn about and implement best practice throughout the service. There was a strong organisational structure and all the people we spoke with were clear about their roles and responsibilities to the people living there. Surveys done showed that satisfaction with the care and support people received was high. One comment was "You offer an excellent service and [relative] always seems very happy in the Croft environment”. Another comment was “[Relative] could not be in a better place, this is an outstanding care home”.

Inspection areas

Safe

Good

Updated 28 July 2016

The service was safe.

People were safe and protected from harm. Staff knew what action to take if they suspected abuse was taking place.

Risks to people had been identified and risk assessments were centred on the needs of the individuals. People were supported to maintain their independence and lead full and meaningful lives.

There were always sufficient numbers of competent staff to ensure that people had their needs met promptly and safely. The service followed safe recruitment practices when employing new staff.

People’s medicines were managed safely and appropriate arrangements for the recording, safe administration, safe keeping, using and disposal of medicines were in place.

Effective

Good

Updated 28 July 2016

The service was effective.

There was a comprehensive training plan in place to provide continuous staff development and to update staff skills. Staff received all the training they needed to meet the needs of the people they cared for.

 All staff had regular supervision and appraisal to support their practice and they told us they felt supported and valued by the management team.

The staff and managers understood the requirements of the Mental Capacity Act 2005 (MCA) 2005 and the Deprivation of Liberty Safeguards (DOLs), their responsibilities under this legislation and acted confidently to put this into practice. People’s liberty was not being unnecessarily restricted and people living there were being fully supported to make choices in their lives.

Staff always had contacted healthcare professionals and specialist services when people had needed this to make sure that appropriate support, advice and treatment was accessed promptly. They had sought to provide high standards of care, treatment and support by identifying and implementing best practice.

People were involved in deciding on the menus in the home and were provided with range of homemade nutritious food and suited to their needs and preferences.

Caring

Good

Updated 28 July 2016

The service was caring.

People told us that they felt well looked after and we saw that the staff treated people in a supportive and respectful way and that their independence, privacy and dignity were promoted.

Staff knew the people they were caring for and supporting, including their personal preferences, interests and personal likes and dislikes.

People were supported to express their views. People had access to advocacy services. This helped make sure others who knew them well  were able to speak up on their behalf.

Responsive

Good

Updated 28 July 2016

The service was responsive.

On-going improvement and evaluation of care management was seen as essential. The service strived to achieve high standards in providing person centred care based on best practice.

The service was flexible and responsive to people’s individual needs and preferences, finding creative ways to enable people to participate in planning their care and to live as full a life as possible.

People were able to lead fulfilling lives because they were fully engaged in hobbies and activities that they enjoyed and were meaningful to them. The arrangements for social activities and work were tailored to people’s individual needs and preferences.

Concerns and complaints were always taken seriously, used to learn from and explored thoroughly and responded to in good time.

Well-led

Good

Updated 28 July 2016

The service was well led.

The philosophy of care and values of the service were person-centred and staff understood and practiced these values and made sure people were at the heart of the service.

People living in the home, their relatives and the staff were extremely positive about the way the home was managed and commented upon the open and inclusive management of the service.

Systems were in place to thoroughly monitor the quality of the service people received and to get people’s views on the way their home was run. There was a broad range of robust audit systems in place to measure the quality and effectiveness of the services and care provided.

The service worked in partnership with other organisations, local network meetings and online provider forums to make sure they were following current practice and providing a high quality service.

The service strived for the highest standards of individualised care through continuous consultation, research and reflective practice.