Archived: The Croft

Updated 2 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was brought forward because of concerns shared with us by the local authority quality improvement team for North and Mid Essex following their visit to The Croft on 20 June 2017.

This inspection took place on 04 and 05 July 2017 and was unannounced. The inspection was carried out by two inspectors.

We reviewed previous inspection reports and notifications received by the Care Quality Commission (CQC). A notification is information about important events which the service is required to send us by law. We also looked at information we held about the service.

Before the inspection the registered provider should have been asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems a PIR was not available and we took this into account when we inspected the service and the judgements in this report.

We spoke with two people who were able to express their views, but not everyone chose to or was able to communicate effectively and articulately with us. Therefore we spent time observing the care provided by staff to help us understand the experiences of people unable to tell us their views directly.

We looked at records in relation to three people's care. We spoke with the registered provider, registered manager, one senior carer and one of the care staff. We looked at records relating to staff recruitment and training and how the registered provider monitored the quality of the service.

Updated 2 September 2017

We inspected this service on 04 and 05 July 2017. The inspection was unannounced.

The Croft provides accommodation and personal care for up to six people who have a learning disability. The service does not provide nursing care. Five people were living in the service when we carried out our inspection.

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.

Neither the registered provider or registered manager had a good understanding of current guidance and legislation in managing health and social care services. The registered provider did not have systems in place to monitor the quality of the service and identify where improvements were needed. This lack of oversight had led to significant shortfalls in the way the service was being managed and failed to identify potential risks to people living there. For example, we found windows without restrictors which put people at risk of falling through windows on the first floor or being able to leave the premises unnoticed on the ground floor. Radiators were uncovered next to people’s beds which exposed them to the risk of burns.

The environment needed updating to create a more homely environment. Areas of the service were dirty and poorly maintained which placed people at risk of acquiring infections. There were insufficient hand washing facilities in the staff toilet and hygiene products, such as soap and toilet paper were not readily accessible to people using the service. People who used a hoist and sling to transfer from their bed to wheelchair were sharing slings. This placed them both at risk of acquiring infection where the same sling was being used following personal care and exposure to bodily fluids.

Peoples care plans and risk assessments need to be reviewed to ensure these reflect their current needs to protect them from harm, or the risk of harm occurring. For example, where a person had been diagnosed at risk of choking requiring their food to be pureed and thickening agent added to their drinks, this information had not been updated. Their risk assessment and care plans still referred to cutting their food up into small pieces. This placed the person at risk of choking if agency or new staff unfamiliar with the person read their care records. However, because existing staff knew the people really well they knew how to provide their care and responded well and quickly to their needs.

People were receiving their medicines as prescribed by their GP. The registered manager had revised the medicines policy and procedures, including reporting drug errors. They had implemented personal profiles files for each person containing important information about how they took their medicines and developed guidance for staff on the use of homely remedies and ‘as required’ medicines. However, further improvements were needed to ensure systems for obtaining; storing, administering and disposing of medicines were safe.

Staffing numbers had not been assessed to ensure there were sufficient staff available to meet people’s needs and to keep the premises clean. The recruitment of staff had not been carried out robustly to ensure staff were suitable and of good character to work with vulnerable adults.

Staff had access to training across a wide range of subjects. This was accessed via eLearning; however there was no process in place to test staff understanding of the training. For example, although staff had completed eLearning for the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), staff did not have a good understanding about this legislation and when it should be applied.

Moving and handling training had been provided through eLearning. This did not include practical guidance on how to safely move people using equipment. A senior member of staff and the registered manager were cascading this to other staff. Neither had completed the train the trainer for moving and handling or attended a recent refresher course, to ensure they were working in accordance with best practice and the most up to date safe moving and handling legislation.

The registered manager had understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who used the service by ensuring that if there are restrictions on their freedom and liberty these were assessed by professionals who considered whether the restriction is appropriate and needed. They had made appropriate DoLS applications to the local authority to ensure that restrictions on people's ability to leave the service were lawful.

People were provided with sufficient to eat and drink to stay healthy. People had access to health care professionals, when they needed them.

Staff were kind, caring and knew the care needs of the people they supported well. They offered people choices, for example, how they spent their day and what they wanted to eat. These choices were respected. People were supported to carry on with their usual routines and were able to choose what they wanted to do when they were at home. However, resources to run the service were held by the registered provider and were not always available. This resulted in people not having access to their own personal allowances, petty cash or transport to enable them to access the community.

People’s privacy and dignity was in the main respected by staff, however two people were sharing a bedroom. This was a large room, with no dividing curtain for privacy. The registered provider confirmed the option of these people having a room of their own had not been explored. They agreed they would arrange a best interest meeting with both people, their families, including advocacy involvement to discuss if either person would like a bedroom of their own. An advocate is a person who represents and works with a person or group of people who may need support to make decisions about their lives, and defend and promote their rights.

We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.

“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”