16 December 2014
During a routine inspection
This was an unannounced inspection carried out on 16 December 2014. The previous inspection was carried out in June 2014, when breaches had been found with six regulations. This inspection included following up the action taken by the service in response to the breaches.
The Croft provides accommodation and personal care for up to four people with a learning disability. It specifically provides a service for older people who have a learning disability and some who are living with dementia. At the time of the inspection there were four people living at The Croft.
The service does not have a registered manager; the manager had submitted an application to the Care Quality Commission to register. 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 told us they received their medicines when they should. However we found shortfalls in some areas of medicine management. Where people were prescribed medicine “as required”, there was a lack of proper guidance to enable staff to administer these medicines safely and consistently. Where people were prescribed “one or two” sachets, we were unable to ascertain what had been administered as staff had not recorded this detail.
People were not always protected by robust recruitment procedures. Records required by the law to be held on staff files that would reflect that a robust recruitment process had been followed were not always present. For example, a full employment history with written explanations regarding any gaps. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own. Although they had not undertaken training specific to people’s needs, such as dementia training.
The service was well maintained. There were systems and checks in place to help ensure that the equipment and premises remained in good condition and working order.
People felt safe living at The Croft. The service had safeguarding procedures in place, which staff had received training in. Staff demonstrated a good understanding of what constituted abuse and knew how to report any concerns.
People were supported by sufficient numbers of staff on duty, in order to meet their needs and facilitate their chosen activities. Staffing numbers had been reassessed and increased since the last inspection, in order to fully meet people’s needs. Staff received effective supervision as well as having staff meetings, although supervision was not in line with timescales within the provider’s supervision policy. Staff received training relevant to their role, which was periodically updated. There were some gaps in staffs training, although the manager was aware of this, further courses had been booked and there was a plan to address the shortfall.
Risks associated with people’s health and welfare had been assessed and guidance was in place about how these risks could be minimised. There were systems in place to review any accidents and incidents and make relevant improvements, to reduce the risk of further occurrence.
People had opportunities for a range leisure activities that they liked. Staff were familiar with people’s likes and dislikes and used different communication methods with people, to enable people to make their own choices.
People said the food was “nice”. They had a variety of meals and adequate food and drink. Where people were at risk of poor nutrition or hydration, professionals had been involved in assessments of their needs and advice and guidance had been implemented. Some people were involved in the planning and preparation of meals.
People were supported to make their own decisions. The manager and staff had received or were booked to attend training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), the manager was aware of the process, where people lacked the capacity to make their own decisions, to ensure these decisions would be taken in their best interests. The manager had contacted the local authorities DoLS office for further advice and guidance.
People and/or their relatives were involved in planning people’s care and support. Care plans were being further developed to include a step by step guide to people’s preferred routines, their wishes and preferences and skills and abilities. People had regular review meetings to discuss their support and aspirations. People’s health care needs were closely monitored; they had access to a variety of healthcare professionals and were supported to attend healthcare appointments to maintain good health.
People were relaxed in staffs company and staff listened and acted on what they said. People’s privacy was respected. People said they “like” all of the staff” or “love them”. Staff were kind and caring in their approach and knew people and their support needs well.
The service had systems in place to obtain people’s views, which included questionnaires and informal discussions. There were also systems in place to monitor and audit the quality of service provided. Senior managers carried out visits to the service and staff undertook various regular checks. People felt comfortable in complaining, but did not have any concerns.
Staff were aware of the ‘concept’ (vision and values) of the service. They worked as a team to support people with their independence and ensure they had equal opportunities as members of society.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.