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Croftland Care Home with Nursing Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 January 2019

This inspection took place on 29 October and 7 November 2018 and both days were unannounced. At our previous inspection in 2017 we found the service was not meeting the Regulations on safe care and treatment and good governance. Following the last inspection, the registered provider sent us an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we checked to see whether improvements had been made and found the registered provider had rectified the breaches we found at the last inspection. There were areas which required further improvements and they needed to demonstrate improvements had been sustained.

Croftland Care Home with Nursing is a 'care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The manager had been registered since 2015. 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.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

The registered provider had rectified their previous breach around the safe management of medicines. Systems were in place to ensure medicines were managed safely and staff had been trained to support people with their medicines. Staff had their competence to administer medicines checked.

Each person had a personal emergency evacuation plan (PEEP) which detailed how the person would need to be supported in the event of an emergency, the safety plan, route, equipment, staff support, for a named individual in the event the premises must be evacuated.

We found the environment to be maintained to a high standard and was extremely clean with good infection control practices in place. Staff were observed to follow good practice guidelines in the management and prevention of infections.

The service used standardised risk assessments and risk reduction measures to ensure people’s needs were met safely. We had concerns in relation to the lack of specialist seating for those people with postural instability, but the registered manager acted promptly to our concerns.

Staff received an induction and training to ensure they had the skills to meet the needs of most of the people who lived there. Specialist training on managing behaviours that challenged and around postural stability was required so staff could gain skills in these areas.

Staff supported people to eat their meals in an appropriate and sensitive manner and people told us how much they enjoyed their meals. People’s nutritional and hydration needs were met,

The home was compliant with the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations to the local authority and were awaiting the outcome for several requests. People were supported to have maximum choice and control of their lives although further work was required to ensure decision specific mental capacity assessments and best interest decisions were in place for all decisions.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well.

Care plans were personalised and reflected people's current needs and preferences. However, the service was in transition between paper to electronic records which meant the records were not always complete and both had to be used. Some of the

Inspection areas

Safe

Requires improvement

Updated 12 January 2019

The service was not always safe

Staff had not all had training in how to manage people with behaviours that challenged including acceptable restraining techniques.

There was a lack of specialist seating to ensure people’s seating requirements had been met.

Staff understood their responsibilities around protecting people from abuse and they knew how to report it if they suspected it was occurring.

People’s medicines were administered by staff who had been trained and had their competence checked once in line with best practice.

Effective

Requires improvement

Updated 12 January 2019

The service was not always effective.

The home was compliant with the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS). There were some decision specific capacity assessments in place, but for some people they were missing for some decisions.

Staff supported people to ensure their hydration and nutritional needs were met and prepared meals to their preference.

Staff received a review of their performance annually and were regularly supervised. Staff were provided with a range of training opportunities, although they had not been trained around restraining techniques.

Caring

Good

Updated 12 January 2019

The service was caring.

People were supported to be as independent as possible in their daily lives.

Staff interacted with people in a caring and respectful way.

People were usually supported in a way that protected their privacy and dignity.

Responsive

Requires improvement

Updated 12 January 2019

The service was not always responsive.

People’s care needs were assessed prior to the service being delivered. Care plans detailed the support people required although you had to search for this information between paper and electronic records.

There were some activities on offer and a dedicated activities coordinator. However, there were times when there was very little occupation for people to ensure their mental wellbeing.

People and their relatives know how to raise concerns and complaints.

Well-led

Requires improvement

Updated 12 January 2019

The service was well-led.

Staff told us the registered manager was extremely supportive and listened to the staff. The deputy manager was proactive in ensuring the service continued to improve.

The registered provider had employed a consultant who had undertaken a robust audit which had identified issues for improvement. The registered manager could demonstrate how they acted upon the recommendations.

The registered manager acted in partnership with key organisations to promote effective working relationships.