The Croft

We found the following examples of good practice:

• Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and the provision of new personal protective equipment (PPE) such as a face mask.

• Policies, procedures and risk assessments related to COVID-19 were up to date which enabled staff to keep people safe.

• All staff had received training and followed correct infection control and using PPE processes. The provider ensured a sufficient stock of appropriate PPE and there were designated notice boards available to remind staff about correct guidelines and handwashing techniques. There was a programme of training refreshers to ensure staff knowledge was kept up to date. Spot checks took place to ensure staff adhered to the training provided.

• The service was clean and fresh, staff carried out daily and hourly additional tasks, such as cleaning of any regular touchpoint surfaces. Regular infection control audits took place and actions had been followed up when required.

• The provider offered support to aid the wellbeing of the team, individual assessments had been carried out with staff members to ensure any individual circumstances or health conditions were known and the support could be offered as needed.

• The registered manager reported good support from the local health professionals including the local GP practice and the team at the provider's head office throughout the pandemic.

About the service:

The Croft is a residential service that provides care for up to 60 people. At the time of our inspection there were 43 people using the service. The service provided accommodation and personal or nursing care to older adults, in particular those with dementia. People lived in their own bedrooms. Rooms had ensuite bathroom facilities. There were also communal bathroom facilities, lounges and dining rooms.

People’s experience of using this service:

People’s experience of using the service was positive. People told us, “Yes I am being looked after here and yes of course I am safe”, “All the staff are very nice to me” and “Everyone should live here.” People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe. People’s risks were assessed and measures put in place to reduce the risks. Staff received supervision and training, which provided them with the knowledge and skills to perform the roles they were employed to do.

Care was person-centred and focused on people living with dementia to ensure they lived rewarding lives. The care was designed to ensure people’s independence was encouraged and maintained. The management team had embraced continuous learning, and new ways of working. There was workplace culture that was open and honest, staff we spoke with provided positive feedback about the management team. The staff were committed to ensuring improvements continued to ensure the best care for people who lived at The Croft.

Rating at last inspection:

At our last inspection the service was rated Requires improvement and the report was published on (27 January 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. We inspect services rated ‘requires improvement’ within one year of our previously published inspection report. We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The inspection took place on 23 and 27 November 2017 and was unannounced. Our previous inspection carried out in October 2016 found a breach of the Health and Social Care Act 2008.The provider was now compliant with the regulation.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The service accommodates people across four separate units, each of which have separate adapted facilities. Two of the units specialises in providing care to people living with dementia.

We could see improvements had been made since our last inspection in relation to the atmosphere, culture and staff support. Staff told us they felt supported by senior staff. Comments we received included, “Managers are amazing, and support is phenomenal.” “Very supported.” “Happy and supported.” “I love it here, it’s so much better now.” They went on to say how much the service had improved since the new registered manager took over. Another member of staff said, “The management are good, [registered manager] is the best I’ve seen.”

The atmosphere was calm and pleasant we observed good interaction between staff and people living at The Croft. People were treated with dignity and respect. Staff knocked on doors before entering. One person told us how friendly and polite the staff were and that they always knocked on the door before entering. They went on to say they would recommend the service to a friend.

At this inspection we found staff received training in safeguarding people from abuse and neglect and demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider had reported instances where this had occurred to the Local Safeguarding Authority.

Personal Emergency Evacuation Plans (PEEPs) were in place in the event of a fire.

Where people were required to have their fluids monitored this was not always recorded. We saw poor recording of people’s fluid intake. The registered manager acknowledged this was an area for improvement and we were aware they were looking at implementing a more robust way of recording people’s fluid intake.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA). People had their capacity assessed when required and consent was obtained in line with legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems were in place to support this.

Where reviews of care were carried out, there were no records to show involvement with people or their families. However, we were told this was being implemented at the service and at the time of our inspection a review meeting with a person and their family was taking place.

Staff people and their relatives told us the service was well managed. Quality assurance systems were in place to monitor the quality of the service.

We have made a recommendation in relation to the management of medicines.

At the time of our inspection there was no 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.

The home was overseen by the service’s regional manager, who visited the service four days every week. There were also two deputy managers who supported the regional manager. The provider was actively recruiting for a registered manager to run the home.

Our previous inspection carried out in December 2015 found several breaches of the Health and Social Care Act 2008 and associated regulations. We asked the provider to take action to make improvements to the management of medicines, meeting people’s social needs, investigating when people were found to have unexplained bruising and ensuring systems were in place to control and prevent infection. We carried out this inspection to see if the provider had made improvements and was meeting the current Regulations. We consider the provider had made significant improvements in previously breached Regulations. However, there were continued ineffective systems for the management of medicines. We have made a recommendation of the implementation of robust auditing to identify shortfalls.

People’s feedback about the home was mainly positive. One person told us, “Staff are kind especially [staff name]. The food’s not bad. We have exercises and all sorts of things.” A visiting professional told us, “The staff here are kind and considerate”.

People were safeguarded from abuse and neglect as staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider reported instances where this had occurred to the local authority.

Staff had received training in safe handling of medicines and were competency-assessed to support them in the role. However, medicines were not always managed effectively. Staff had received training in areas such as mental capacity, infection control, moving and handling and safeguarding.

Regular supervisions did not always take place. However the regional manager was in the process of putting in place more robust procedures to ensure staff had supervisions on a regular basis.

People’s privacy was maintained and they were treated with respect by staff who knew the people they supported well. Staff appeared kind and considerate with people they supported. We saw several acts of kindness during our visit. For example, one person decided they did not want to sit in the dining room eating their lunch. Staff ensured the person was safely escorted back to their room at their own pace. The home had several agency staff at the time of our inspection. However, the agency staff had worked at the home for a continuous period of time and demonstrated they knew people well. One relative told us, “I don’t know the difference between agency staff and permanent staff; they are all good”.

Care plans and risk assessments did not always reflect current needs and in some cases instructions had not always been followed. For example, instructions from the district nurse were not always followed. We found one person did not have a risk assessment for self-administration of their medication. Involvement with people in terms of care plan reviews could not be identified. One person told us they had never seen their care plan.

Activities were planned and people were encouraged to participate. However, some people told us the activities were not to their liking, and at times boring. However, we were aware the home was encouraging members of staff to take part in conducting activities for people. One member of staff we spoke with had recently been appointed to do this. They were enthusiastic and motivated to carry out this role.

The atmosphere in all the units we visited was warm and welcoming and people were happy and content. Staff did not rush people, people were able to sit chatting with each other following lunch or sit quietly in the lounge reading or watching the television.

There were systems in place for monitoring and auditing to enable improvements in the quality of care. However medicines audits had not identified stock control. We noted several items of medicines were out of stock.

We set a compliance action for the provider to improve practice. The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 10 March 2014 to check if improvements had been made. We looked at supervision records and spoke with three members of staff. We found the provider had put in place measures to ensure staff supervision and appraisals were undertaken in line with the providers policy.

The provider and staff had a working knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how this impacted upon people using the service. Where people were deprived of their liberty, the correct processes were followed to ensure peoples dignity and human rights were upheld.

The provider had adequate numbers of skilled and experienced staff to ensure people's needs were met. Where there were vacancies, the provider ensured that there were sufficient staff in place to ensure that staffing levels did not impact on people using the service.

We saw staff received training to assist them in their roles, however staff were not always receiving supervision in line with the providers policy. This meant staff were not always supported to deliver care, treatment and support safely and to appropriate standards

Information was displayed in the main reception and dining rooms in each unit, to advise people of their rights and choices. This meant that people using the service were given choice and was informed of the support on offer.

We observed staff engaged with people and offered them more food and drink throughout the lunch period. This showed there were choices of suitable food and drink to meet people's nutritional needs.

One person told us, 'The home gave me information to tell me what abuse is. I know what to do if abuses occur.' This showed people who used the service are aware of how to raise concerns of abuse

People we spoke with talked about whether staff could meet their needs. One person told us, 'They are able to meet some of my needs but need training in others.' The service had arrangements in place to ensure staff received the necessary training. However, we found staff were not always supported to deliver care and treatment and support safely and to appropriate standards. Supervisions were not consistently held and there were no evidence to show appraisals had been undertaken.