The Croft

The Croft is a care home providing personal care to three people at the time of our inspection. The service can support up to six adults who may have a learning disability or autistic spectrum disorder or mental health condition. Bedrooms are of single occupancy with ensuite facilities, with various communal spaces for people’s comfort.

People’s experience of using this service and what we found

The provider did not always ensure people were adequately protected from unsafe recruitment of staff. They did not always reduce the potential risk of mistakes by ensuring staff were well-rested. Staff understood correct procedures to follow to safeguard people from harm or abuse. The registered manager mitigated the risks of an unsafe environment to maintain everyone’s welfare. Staff followed correct procedures in the safe management of people’s medication.

Although there were extensive policies and procedures to underpin safe care delivery, these were not always customised to the needs of the service.

We have made a recommendation about service policies and procedures.

The registered manager regularly checked each person’s experiences of living at the home. People’s survey responses were consistently positive. The provider developed The Croft as an inclusive service to help people and staff feel safe and comfortable.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture.

Staff supported people to make their own decisions and lead discussions on what they wanted to do. Staff were consistently kind and respectful, ensuring each person maintained their independence and privacy. People confirmed they were happy and settled at The Croft.

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

Rating at last inspection and update

The last rating for this service was good (published 09 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, medication, staffing and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections and what action we have asked the provider to take at the end of this full report.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Croft on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staff recruitment and the continuous deployment of sufficient staffing levels.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 26 January 2017 the service was rated Requires Improvement. During the inspection we found improvements had been made and all breaches had been met from our inspection on 19 April 2016. However further work was required to embed the changes made to the care records. We made recommendations about this.

At this inspection carried out on 13 February 2018 we have rated the service Good.

The Croft is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate six people in one adapted building. The home has six single bedrooms. Communal space comprised of a lounge and open plan dining room located on the ground floor.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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 spoke with the two people who lived at the home. They both said they were happy, felt safe in the care of staff and were treated with kindness. Comments received included, “I have lived here for 20 years and I am very happy and enjoy living here.” And, “I am happy and feel safe. I like the staff who are kind to me.”

The registered provider and staff worked between The Croft and its sister home, Malvern House. People told us they were happy with staffing levels and staff were available when they needed them. We saw the staff member on duty was attentive, showed concern for people’s wellbeing and was available to spend time socially with people in their care.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during their daily routines and delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs.

People told us they received their medicines as prescribed and when needed. We found appropriate arrangements were in place for the safe storage of medicines.

We saw there was an emphasis on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered person centred care. Care plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place and staff had received infection control training. People told us they were happy with the standard of hygiene at the home.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The staff member on duty knew people they supported and provided a personalised service in a caring and professional manner. Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We saw people who lived at the home had access to healthcare professionals and their healthcare needs had been met.

People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment. These included external activities in the local community including attending concerts, going for a meal and trips to Blackpool.

People told us staff were very caring towards them. The staff member on duty understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by them.

The service had a complaints procedure which was on display in the hallway for people’s attention. The people we spoke with told us they were happy with the service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and resident meetings to seek their views about the service provided.

At the last comprehensive inspection on 19 April 2016 the service was not meeting the requirements of regulation 12 – safe care and treatment and regulation17 - Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was rated overall as requires improvement with well led as inadequate, safe and caring as requires improvement and effective and responsive as good. On this inspection we found improvements had been made and all breaches were met. However further work was required to embed the changes made to the care records and we have made recommendations about this.

The Croft is a small home registered to provide personal care for up to six older people or people with learning disability. All bedroom accommodation is for single occupancy. Communal space consists of a lounge dining room. The home is in a residential area of Morecambe, close to shops and travel links.

At the time of the inspection visit two people lived at the home.

The registered provider was an individual who also managed the service on a day to day basis. Registered providers 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.

Care records had improved since the last inspection. Risk assessments were in place to reduce any potential risks of harm to people who lived at The Croft and their visitors and staff. They were informative in the main but information was not easy to find in each person’s file.

People told us they felt safe living at The Croft and liked living there. There were procedures to protect people from unsafe care or abuse. Staff were aware of these and had received training in safeguarding adults.

People said staff were caring and helpful. They said their health needs were met and staff responded to any requests for assistance promptly. Staff knew the care people needed, which showed us they were familiar with people’s care needs, and preferences.

People we spoke with said staff were caring and respectful, listened to them and assisted them promptly. They said staff supported them to remain as independent as they could be. People looked relaxed and comfortable with the staff who supported them.

Staff recognised the importance of social contact, companionship and activities. They supported people to engage in activities and interests in the home and local community.

The registered provider and staff worked between The Croft and its sister home, Malvern House. People said they were satisfied with staffing levels and staff were available when they needed them. They said staff supported them without rushing.

There had been no new staff appointed to work at the home since we last completed a comprehensive inspection of the service in April 2016. We did not identify any concerns about the services recruitment procedures during that inspection.

Staff had received the training, skills and knowledge to provide support to people.

Staff managed medicines competently. People told us they felt staff gave them their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

People told us they were offered a choice of meals which they enjoyed. Drinks were available throughout the day and people’s dietary and fluid intake was sufficient for good nutrition.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This enabled staff to work within the law to support people who may lack capacity to make their own decisions.

People told us they knew how to raise a concern or to make a complaint if they were unhappy with something. They said staff were easy to talk to and were willing to listen which encouraged them to express any ideas or concerns. However where relatives or others had expressed concerns about care or financial practices these were not recorded as complaints by the registered provider.

There were audits to monitor the quality of the service. The registered provider worked and lived in the home so spent a lot of time with people. The registered provider sought people’s views in a variety of ways, listened and took action where needed.

Although we found bedroom doors wedged open, these were immediately removed by the registered provider when informed. The building and equipment had been maintained and was clean, hygienic and otherwise safe.

Although the service had improved since the last inspection we need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

The inspection visit took place on 19 April 2016 and was unannounced.

The Croft is a small home registered for up to six people of either sex. The people currently accommodated have a diagnosis of mental illness/learning disability. Detailed information about the services provided by the home was contained within a Statement of Purpose and Service User Guide which is available from the home. The home is in a residential area of Morecambe, close to shops and travel links. At The time of the visit there were five people who lived at The Croft.

There was an individual registered provider in place. . The registered provider manages the day to day running of the home. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection carried out in April 2016 we found risk assessments were not always in place to ensure people received care and support which met their needs. In addition we found risks were not always assessed or in place. This was a breach of Regulation 12 (Safe Care and Treatment). We also identified a breach of Regulation 17 (Good Governance) as an accurate record in respect of the care and support for people who lived at the home was not always in place.

We found records of care for people who lived at the home did not contain all the information to ensure people received the right care and support. This meant staff would not have all the information available to ensure the right care was provided. We found there were no contracts in place for people who lived at the home. In addition there were no records kept that highlighted costs to the individual such as toiletries and cleaning products. This meant people were unaware of financial implications to the cost of living at The Croft.

This was a breach of Regulation 17 (Good Governance) as an accurate record in respect of the care and support provided was not in place. This placed people at risk of care and support that did not meet their needs.

We found recruitment checks were carried out to ensure suitable people were employed to work at the home. There was sufficient staff to meet people’s needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

Medicines were dispensed in a safe manner and people received their medicines on time. However we made a recommendation the registered provider seek advice and guidance to ensure staff received formal training to ensure medicines were administered correctly and safely.

The registered provider told us they understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). They had the knowledge of the procedure to follow if applications were required to be made.

People who lived at the home were happy with the variety and choice of meals available to them. Regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration. We asked people who lived at the home about the quality and quantity of meals at The Croft. One person said, “You saw the breakfast it was lovely.”

We observed staff treated people with respect, patience and dignity. People we spoke with told us staff were caring and respectful.

During the inspection we observed people had choices how they spent their time. Activities and social events in the community had been arranged and people were encouraged to be as independent as they were able to.

The Croft had a complaints procedure which was made available to people on their admission to the home. One person said, “Yes I would complain to [registered provider] if I needed to.”

People who lived at the home and relatives had opportunities to feed back to the registered provider about the quality of their care through surveys and meetings.

The registered provider used a variety of methods to assess and monitor the quality of the service. This was to ensure The Croft continued to improve through monitoring systems.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our inspection we looked at the way these four people were being cared for, the safe management medicines, the way staff were supported; the effectiveness of quality monitoring systems and the way complaints were managed. We spoke with the homeowner who was also the registered manager and individually with three of the four people living at the home. At the time of our visit no other staff were on duty.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We saw that people living at the home were treated with respect and dignity by the homeowner. When speaking with each person living there we were told that they felt safe and secure.

Policies and procedures were in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DOLS). This meant that the staff team had clear guidance should consideration need to be given in respect of a DOLS application.

Medication practices were robust. A regular, routine medication audit was in place. This helped to ensure that medication practices remained safe, by enabling any shortfall to be quickly identified and addressed.

Care plans had been developed based upon people`s individual needs. A range of risk assessments were in place and reviewed periodically. It was clear from talking with people that they had a good understanding of their care plan and were happy with the content. The home worked in partnership with the local health care team to support people with their health conditions. People we spoke with told us they were very happy living in the home. One person told us, “They look after us well, Flora (registered manager) is jolly.

It the service effective?

People living at the home told us that they were pleased with the level of care and support that was being delivered to them and that their needs were being well met. From our observations and through speaking with the registered manager it was clear that there was a good understanding of each person’s assessed needs and that accommodating personal preferences had been given high priority. We were told, “This is a happy home”. Another person said, “Things have changed for the better I have no complaints”.

At the time of our inspection there was only one other member of staff employed at the home. We saw from training records and training certificates that a wide range of training had been provided to meet the need of people living at the home.

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Is the service caring?

We saw that the registered manager was sensitive and caring toward the people being supported. Individual needs, preferences, wants and wishes had been given high priority and patience and encouragement was shown when supporting people. We observed that people were encouraged to do things at their own pace and at a time of their choice. It was clear that there was an inclusive and supportive culture that helped people to feel comfortable and valued.

Individual preferences, interests and needs had been recorded along with the actions required to ensure these were met. This helped to make sure that people were provided with an individualised service that met their specific requirements.

Is the service responsive?

People had opportunity to undertake a range of activities suited to individual needs and preferences. The home had its own transport that helped people to keep involved in their local community.

People knew how to make a complaint if they were unhappy about anything. However nobody expressed any complaints or concerns to us. People told us that they were happy living at the home and that they could say what they wanted at a time of their choice. One person said, “The complaint procedure is on the wall, I would say if things were not alright, I would tell Flora (Registered Manager)”. We looked at the only complaint that was addressed some time ago and found that the response had been open, thorough and timely. People could therefore be reassured that complaints were investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up way.

We saw from the meeting minutes that the registered manager held weekly and monthly house meetings so that people living at the home could have their say and influence change. This was also strengthened by an annual satisfaction survey that was comprehensive and through. The outcomes we saw were all positive.

The service had quality assurance systems in place. Records seen by us showed that any shortfalls were addressed promptly. As a result the quality of the service was continually improving.