6 April 2016
During a routine inspection
The Croft Residential Home is a care home with accommodation for upto 22 people. People living at the home are older people some of whom may be living with dementia. At the time of our inspection there were 21 people living at The Croft.
At the time of our inspection the provider was also the registered manager, and is referred to as the registered manager throughout the report. This was because they were in day to day charge at the home. 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 and associated Regulations about how the service is run.
Systems and processes were in place to protect people from the risk of harm. People were supported by care staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe. People we spoke with said they felt safe and spoke positively about the care and support they received.
People were protected by staff who had received training about safeguarding and could identify the different types of abuse. Staff knew how to respond appropriately to allegations of abuse and understood the procedure for reporting concerns.
Staff were knowledgeable about people and understood how to meet their diverse needs. We observed warmth and affection between staff and people who used the service and staff approached people in a caring manner. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.
People were treated with dignity and respect. Staff described how they protected people's dignity by closing curtains and doors and covering people with towels when they were washing them.
Staff understood about people's capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice.
People had individual care plans which gave guidance to staff on what support people needed. Care plans were written with people as much as possible and included an assessment of people’s needs and were written to reflect people’s individual preferences and wishes. Staff were knowledgeable about people’s needs and preferences. They told us they had read and understood the care plans and ensured they followed them. People’s end of life needs were planned with them were ever possible. People were supported to end their life with dignity and free of pain. People and staff were supported at the end of their life by the local hospice service, Rowcroft at home, Marie Curie nurses and the district nurse team.
People were involved in activities they liked and were linked to previous life experience, interests and hobbies. For example staff encouraged one person, who enjoyed knitting, by bringing in balls of wool so that they could continue with their hobby whilst living at the home. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives.
Mealtimes were a social occasion. People told us they enjoyed the food that was provided. We saw a choice of menu was available and the food looked appetising and nutritious. Risks associated with poor nutrition and the needs of people living with dementia were understood and menus adjusted and food and fluids provided throughout the day.
We looked at the way in which the home managed people’s medicines Medicines were secured safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the on going safe management of medicines. Safe systems were in place to manage medicines so people received their medicines at the right times.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to ensure staff were suitable to work in the care sector before they started work at the home. Staff received a range of training which supported them to understand and meet people's needs. Staff received regular supervision and appraisal of their work and felt well supported by the deputy manager and registered manager. There were sufficient staff on duty to meet people’s care needs.
We found that the building was clean, odour free and well-maintained. There were 3 lounges, one with access to a sunny balcony, all comfortably decorated to meet the varying preferences of the people. People were encouraged to personalise their rooms. Corridors had clear picture signage and peoples rooms had their photographs and names displayed. We saw that some photographs were of the person when they were younger to help them recognise themselves and their rooms better.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and saw that audits of infection control practices were completed.
The registered manager and deputy manager promoted a positive culture where person centred practice was promoted. They ensured people, staff and relatives were valued. The registered manager assured the quality of the service by completing a range of monthly audits. From these audits the management team were able to identify areas for improvement and formulate action plans to address these. This ensured the management team were assuring the quality of the care and support provided. Health and safety audits were carried out every 3 months and requirements acted on by the management team. The registered manager sampled and reviewed care plans and risk assessments monthly to ensure that systems and processes are robust. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously.