Archived: Little Croft Care Home

We found the following examples of good practice.

The home had designated entrance with posters displayed which explained the safety procedures in place. On arrival we were greeted by a staff member and had our temperature taken, we were asked to sanitise our hands and to wear a mask. We were shown to the registered managers office by the shortest and most direct route.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. When people were admitted to the home, risk assessments were completed, and people self-isolated for 14 days. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

Written thank you letters from relatives demonstrated how grateful they were for the care their loved ones received during the pandemic. Comments included, “It is difficult to find the words to express my thanks for the care during the pandemic. I know we are still at risk but you accepted risk and carried on”, “We can’t thank you enough especially during these difficult times” and “Thank you for keeping mum safe and well and helping her to reach a full recovery”.

Daily activities continued to take place which were organised by the activity coordinator. They told us they had increased one to one activity provision during the pandemic to support social distancing and people had enjoyed this individual interaction.

We saw that relatives received correspondence from the registered manager who provided them with updates on their loved ones, any changes in the home and informed them of positive news and events within the home for example how the residents would be celebrating Christmas. We saw one relative had recently written to the staff thanking them for keeping them up to date with their mothers’ illness.

Staff wellbeing was considered, and the registered manager had various support mechanisms in place. This included those who had previously tested positive to Covid or suffered with anxiety during the pandemic. Examples of support included weekly phone calls to make sure they were coping well; wellbeing forms were completed to see if additional support was required such as change of shift patterns for those with childcare duties and regular breaks were encouraged where needed.

Little Croft Care home is a care home that provides nursing and personal care for up to 41 people, some of whom are living with dementia. The home was an adapted detached building.

At the time of the inspection 35 people were living in the home.

People’s experience of using this service:

People were cared for safely. Any risks to their care were assessed and measures put in place to mitigate identified risks. The home was clean and tidy, and staff ensured people were protected from abuse or harm. Visitors were welcome at any time.

Staff were trained and were supported to fulfil their roles. People could be assured they were cared for by staff who had been recruited using safe recruitment procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were aware of the importance of gaining people's consent prior to carrying out care and support.

People received a varied menu of food each day and had additional choices according to their preferences. Staff knew the importance of maintaining people's hydration and encouraged plenty of additional fluids.

Staff were caring, kind and compassionate. People were complimentary about the staff and the care they received. Staff promoted and maintained people's independence by encouraging them to care for themselves, where possible. Advocacy services information was available and accessible to people.

People’s care plans were adequately detailed and contained detailed information. People's communication needs were included within care records and staff knew how to communicate with them effectively. People knew how to complain. Complaints received were fully investigated and subsequent action was taken.

Staff felt they were valued and respected by the registered manager and the management team. The registered sought their involvement to improve and develop the home.

Rating at last inspection:

The last rating for this home was requires improvement (report published September 2018). There were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the home until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

At the previous inspection carried out 29 June 2017 and 4 July 2017 we rated the service as Requires Improvement and identified concerns around medicines, compliance with the Mental Capacity Act 2005 (MCA), recording of information and ineffective quality monitoring audits. The registered manager had submitted an action plan to the Care Quality Commission so that we could monitor the improvements made.

At our inspection on 3 and 4 July 2018 we found that the provider had made some improvements. However further improvements were still needed.

During this inspection, we found that the registered provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. We rated the service overall Requires Improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Risks to people had not been assessed and the appropriate action had not been taken to reduce or eliminate risks to people.

People were at risk of harm as the appropriate checks of people’s wellbeing had not been undertaken by staff to ensure people were safe at the service.

People’s ability to consent to care and support had not been assessed in line with legislation and guidance.

We identified concerns where people lacked capacity. When applications had been submitted for assessment under the Deprivation of Liberty Safeguards the appropriate action had not been taken to ensure these people were safe.

People’s care records were not always up to date or a reflection of their needs. There was a risk that people were not receiving the care and support that they needed.

Quality monitoring systems were not in place to identify, monitor, manage and mitigate risks. Audits undertaken were not effective and had not identified the shortfalls which we found at the service.

People told us they felt safe living at the service. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse.

People were provided were cared for by adequate numbers of appropriately skilled. Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate people were employed to work at the service.

Medicines were handled appropriately and were now stored at the right temperature. Medicine Administration Records (MAR) were now appropriately signed to indicate people's prescribed medicine had been given. Clear protocols were in place for as required medicines.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively.

People were supported to meet their dietary needs and preferences. They also received the support they needed to stay healthy and to access healthcare services.

People said they were treated in a kind and caring manner. People's privacy and dignity was respected.

People's wellbeing was supported by the activities. The service had a range of activities for people to take part in.

The previous inspection was completed in June 2016. At that inspection we found a breach of regulation in relation to ensuring people’s mental capacity was assessed to ensure they were following the principles of the Mental Capacity Act. This is important where a person lacks the mental capacity, without this information there was a risk that people’s rights were not protected. At this inspection we found these mental capacity assessments had been completed for people.

There was 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.

People’s medicines were not always managed safety. Medicine audits had not identified these shortfalls. Care plans did not always include how to support people with their medical condition such as diabetes. We have asked the provider to make improvements to the audit systems to ensure these shortfalls were identified and addressed.

There were mixed messages from health and social care professionals in respect of the admission process. Assurances were given by the registered manager that they took into consideration the needs of the people already living in the home and the needs of the new person to ensure they could respond to their needs effectively and responsively. There was a staffing tool used to calculate the staffing based on people’s needs and this was kept under review. Feedback from people and staff said the home was very busy. They felt people were safe.

People’s nutritional needs were being met. Where there were risks to people there were clear plan of care in place. These plans identified the additional monitoring required and how good communication between the care and catering staff would be maintained. However, improvements were needed to ensure that fluid charts were clearer and that any concerns could be rectified where a person had not drunk sufficient fluids.

The home was clean and free from odour. There had been an occasion when a member of staff had not worn the appropriate protective clothing when supporting a person. This had been discussed through supervisions with staff and team meetings as a reminder of the importance of ensuring risks in relation to cross infection were minimised.

People were involved in structured activities in the home. These were organised taking into consideration the interests of the people and were organised in small groups or an individual basis. People were treated with dignity and respect and were involved in decisions about their care. Whilst improvements had been made in relation to best interest decision recording this was not consistent. Where sensor mats and door alarms were in place more information was needed on who was involved in the decision and why the decision was made. This should be kept under review to ensure they were the least restrictive options.

People were treated with kindness and compassion by staff. The atmosphere was relaxed and we saw that staff knew people well. People appeared relaxed around staff. People’s views were sought during care reviews, resident meetings and annual surveys. Complaints were responded to and, learnt from to improve the service provided.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management. Safe recruitment practices were in place to protect people.

Staff were caring and supportive. Staff received training and support that was relevant to their roles. On-going training was planned based on the needs of the people such as additional training in wound care management and end of life care. Systems were in place to ensure open communication including team meetings and daily handovers.

We found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full copy of this report.

The previous inspection was completed in May 2015 and there were two breaches in regulation. This was because there were concerns about the staffing levels at night and care plans did not fully capture the needs of people. The provider sent us an action plan telling us how they were going to ensure on-going compliance. We found at this inspection there was enough staff working in the home. Care plans had been reviewed and updated as people’s needs had changed and included information on specific health conditions. The provider had demonstrated compliance.

There was 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.

People’s consent was sought before any support was given. However, there was a lack of information about whether people had mental capacity to make decisions about their care and treatment. A new form was devised during the inspection. The registered manager told us they would be completing this with each person involving their family and the GP. However, without this information there was a risk that people’s rights were not protected especially where they lacked capacity.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed. Improvements were made during the inspection on the recording of controlled medicines.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management.

Staff were caring and supportive. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings, daily handovers. One to one meetings were not happening at the required intervals. The registered manager during the inspection devised a new audit tool to enable these to be monitored with assurances this would be addressed.

People’s views were sought through care reviews, meetings and acted upon. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

People were provided with a safe, caring and responsive service that was well led. The provider had systems to assess, monitor and improve the quality of care.

We found there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People had person centred care plans and assessment of individual risks had been carried out, however daily notes were not always person centred. People's care plans contained information about activities they liked and their interests but we did not see anybody engaged in an activity during the morning.

Medicines were managed safely and the premises were safe and in good condition. People had the equipment they needed to support them and this was serviced regularly.

The home undertook appropriate checks before employing new staff. We found that sometimes the home was short of staff and did not have robust arrangements in place to cover staff sickness or unexpected absence.

The provider had a system in place to monitor the quality of the service and planned to introduce systems to increase feedback from people living at the home.

People were supported at their own pace and their independence was promoted.

People's care and support needs were assessed and care plans were individualised. Where appropriate people's families were involved in the planning of care and important decisions.

Staff had received appropriate training and were knowledgeable about how to keep people safe. Staff told us that they enjoyed working at the home and felt supported in their role,

The home was clean and there was a relaxed atmosphere. We observed that staff spoke to people with respect and warmth. People made many positive comments to us about the staff team