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Croftland Care Home with Nursing Requires improvement

Reports


Inspection carried out on 29 October 2018

During a routine inspection

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 carried out on 23 May 2017

During a routine inspection

The inspection of Croftland Care Home took place on 23 and 30 May 2017. We previously inspected the service in July 2015; we rated the service Requires Improvement. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

Croftland Care Home is a nursing home currently providing care for up to a maximum of 55 older people. The home has four distinct units providing care and support for people with nursing and residential needs including people who are living with dementia. On the days of our inspection 42 people were being supported in three of the four units within the home.

The service had a registered manager. 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 felt safe but we found some aspects of the service were not always safe. We observed some staff using unsafe moving and handling practices to transfer people and we also saw staff use wheelchairs which did not have footplates attached. We were not able to evidence that all the slings in use at the home were compliant with the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER).

There were systems in place to ensure staff were recruited safely and people did not raise any concerns there were not enough staff to meet their needs. People and relatives felt staff had the skills needed to meet their needs. New staff were provided with an induction and there was a programme in place to ensure staff received regular training and management supervision.

Medicines were not always stored safely to prevent unauthorised access. We observed safe storage and administration of medicines on two of the units but we raised concerns about some of our observations on the third unit. We checked the stocks of people’s medicines and found they tallied with the written records of administration. Staff completed training in medicines administration and had an assessment of their competency to administer medicines.

Peoples care plans contained an assessment of their mental capacity but the assessment was not always decision specific and there was a lack of evidence to support the best interest’s decision making process. We have made a recommendation about meeting the requirements of the Mental Capacity Act 2005.

People received support to access external healthcare professionals appropriately.

People spoke positively about the food. Meals looked well-presented and people were offered a verbal choice. On Redwood unit, not everyone was offered a drink at lunchtime and some people had their meal served to them prior to staff being available to support them to eat.

People were supported by staff who were caring and knew them well. Staff mainly worked on the same unit which enabled them to get to know people’s likes and preferences. Staffs’ interactions with people were appropriate and staff acknowledged people as they entered communal areas. People told us they were able to choose when they got up and went to bed. People’s privacy and dignity was generally respected although we observed two incidents on the first day of our inspection where people’s dignity was not maintained.

People told us there was a range of activities provided for them including trips out within the local area.

Peoples care plans were person centred and recorded details about their likes, dislikes and preferences. Care plans were reviewed and updated at regular intervals. Staff recorded the daily care and support people received including safety checks and personal care.

The registered manager recorded information regarding any concerns or complaints, including the action taken to address issues raised.

People spoke positively about the management of the h

Inspection carried out on 27 and 31 July, 3 August 2015

During a routine inspection

The inspection of Croftland Care Home with Nursing took place on 27 July 2015 and was unannounced. We also visited a second time on 31 July and 3 August 2015, both of these visits were announced. We previously inspected the service on 14 and 20 October 2014 and, at that time; we found the registered provider was not meeting the regulations relating to staffing, requirements relating to workers, supporting staff, consent to care and treatment, management of medicines and assessing and monitoring the quality of service provided. We asked the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Croftland Care Home is a nursing home currently providing care for up to a maximum of 55 older people. The home has four distinct units providing care and support for people with nursing and residential needs including people who are living with dementia. On the days of our inspection 37 people were being supported in three of the four units within the home.

The service had a registered manager in place. 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 we spoke with were aware of the signs of harm or abuse and their responsibility in reporting their concerns. Risk assessments were in place for people, these included skin integrity, nutrition, bed safety rails and falls.

We saw evidence that regular checks were made on the fire detection system and staff had received fire training. Although there was no record to evidence that all staff employed at the home had attended a fire drill. The home was clean, tidy and maintained.

Recruitment procedures were thorough and duty rotas took account of people’s dependency needs and staff skill mix.

People were protected against the risks associated with the use and management of medicines . People received their medicines at the times they needed them and in a safe way.

New staff were supported and there was a programme in place to provide training and support for existing staff.

Staff had received training in the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act (MCA) 2005 and understood how this impacted upon their role. The registered manager had begun to take action to ensure the home was compliant with this legislation. H however, further work was still required.

People told us the food was good and we saw people were offered choice. People had access to, and were offered regular drinks throughout the day, although recording of people’s dietary intake was not always clear.

People had access to other healthcare professionals and feedback from a visiting healthcare professional was positive.

The home was difficult to navigate due to a lack of directional signage and the layout of the lounges was not conducive to social interaction.

Staff were kind and caring. We observed staff supporting people appropriately and we saw examples of staff respecting people’s right to privacy. Staff encouraged people to make lifestyle choices, for example, which clothes to wear or what to eat.

The registered manager had taken steps to encourage families to be involved in their relatives care and support plan.

People’s care and support records were stored securely.

On the day of our inspection the only activity we saw people involved in was attending the hairdresser and having their nails painted. Peoples care and support records were person centred but there was limited information about people life history and past hobbies. We have made a recommendation about implementing and developing life history work and a person centred activity programme at the home.

Complaints were recorded, including a record of the action taken to resolve the issues raised.

Feedback from relatives and staff was positive about how the home was managed. The registered manager was organised in her approach to her duties and was knowledgeable about the needs of the people who lived at the home.

We saw evidence that a system was in place to monitor and review the safety and quality of the service provided to people. Regular meetings were held where the views and comments of staff and relatives were recorded. Formal feedback from relatives was gained on an annual basis.

Inspection carried out on 14 and 20 October 2014

During a routine inspection

The inspection of Croftland Care Home with Nursing took place on 14 October 2014 and was unannounced. We also visited a second time on 20 October 2014, this visit was announced. We previously inspected the service on 23 April and 1 May 2014 and, at that time; we found the provider was not meeting the regulations relating to consent to care and treatment, care and welfare of people who use services, meeting nutritional needs, staffing and records. We asked the provider to make improvements. The provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Croftland Care Home is a nursing home currently providing care for up to a maximum of 55 older people. The home has four distinct units providing care and support for people with nursing and residential needs including people who are living with dementia.

The service has a manager in place however; they are not yet registered with the Care Quality Commission. The manager had applied to the Care Quality Commission for registration and was awaiting the outcome of their application. 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 deployment of nursing staff within the service was inconsistent. We had concerns that people who were assessed as having nursing needs were not receiving adequate supervision or where appropriate, the intervention of a registered nurse. This demonstrated a continual breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found the provider’s recruitment processes were not thorough. There was no evidence that gaps in peoples’ previous employment history had been fully explored. This was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. This demonstrated a continual breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff understood their responsibilities for safeguarding people.

Training was not up to date and staff had not received regular management supervision. This was a breach of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Not all the care plans we looked at were compliant with the requirements of the Mental capacity Act 2005. This demonstrated a continual breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We saw improvements had been made in meeting people’s nutritional needs. People were offered choices and support was appropriate to their needs. We found the home had been inspected by the Food Standards Agency in September 2014 and had scored a five star rating.

People looked well cared for. We heard staff interacting with people in a caring, discreet manner.

We saw improvements had been made to people’s care plans. The files were organised and there was evidence they were being reviewed on a regular basis.

The manager had taken action to gain the views of people’s relatives. They had held relatives meetings and sent out surveys for them to complete. The manager had at time of inspection not yet received the completed surveys.

We observed that the manager had just begun to implement systems to monitor the quality of the service provided to people. The system however was not yet robust enough to ensure people’s safety and welfare was maintained.

This demonstrated a continual breach of Regulation 10 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 the report.

Inspection carried out on 23 April and 1 May 2014

During an inspection to make sure that the improvements required had been made

This was a scheduled inspection, which also followed up on our last visit in which two areas were non-compliant.

• Consent to care and treatment.

• Management of Medicines

Our inspection team was made up of three inspectors, a pharmacy inspector and a specialist advisor in relation to dementia care. We spoke with the director of care, the manager, the clinical lead, two nurses, a senior care assistant, nine care assistants, two cooks and the activity organiser. We looked around the building, including some bedrooms. We also spoke with four people who lived at the home and five people visiting their relatives.

If you want to see the evidence supporting our summary please read the full report. The inspectors also through observation and looking at records used the information they were given to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

People were not cared for in a pleasant and hygienic environment.

We saw that people who used the service did not look well cared for. This indicated staff had not taken the time to support people with their personal care in a way which would promote their dignity.

Staff told us they did not get time to look at the care plans.

Lack of staff knowledge about the specific dietary needs of people, combined with the fact that some people at the home had dementia and may not have been able to fully communicate their needs, put people at risk of inappropriate and unsafe care.

Is the service responsive?

We reviewed the complaints system for the home which was robust. Complaints were acknowledged within five days and resolved within 28 days. There were no outstanding complaints for the service.

On the second day of our inspection two staff meetings were being held. We were told this was in response to a previous visit by the Care Quality Commission and the findings of that visit.

Is the service safe?

We asked three members of staff if they could share their learning from training they had received in behaviours that challenge. None of them were able to share any knowledge about how to care for this specialist client group.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Records could not be located promptly when needed.

Is the service effective?

We looked at two people’s care records and saw they contained a generic mental capacity assessment ‘consent to care, treatment and photograph'. We did not see any other evidence of a person centred, decision specific mental capacity assessment.

During our observation of one lounge we saw staff did not interact with people, other than when a care task was being completed.

As part of our inspection we observed staff supporting people with their breakfast. We saw staff offered people a choice of what they would like to eat and drink

Is the service well led?

There was no evidence that the manager held regular reviews with each person using the service and their families.

When information was gathered by the service it was not analysed effectively and there was no evidence that action plans were created to rectify any complaints or pass on any compliments to staff.

Audits including health and safety, finance, fire safety, infection control, fire safety and medication were not always complete or available.

The manager told us a walk around of the home was completed weekly but that no formal audit was completed.

Quality assurance visits did not contain a detailed audit of health and safety or infection control at the service. Policies and procedures were in place for these areas of risk but there was no evidence staff understood the risk associated with health and safety or infection control.

Inspection carried out on 3, 6 December 2013

During an inspection to make sure that the improvements required had been made

During our visit, we spoke with three people who used the service, the manager, the provider, three nurses, a senior carer and five care workers.

We spoke with three people using the service. One person told us they were “Very comfortable living at the home.” They also told us they were, “Looked after well and felt safe.” We also spoke with two people and they both told us, “The quality of the food was variable, sometimes good and other times not so good.”

We spent time observing care being provided to people. This included the use of a formal process called a ‘Short Observational Framework for Inspection (SOFI 2). We observed people in the lounge on one of the units for part of the morning. During the session people mostly showed ‘neutral’ or ‘negative’ mood states, which were evidenced by signs of boredom, moaning and sadness. Throughout the session there was minimal staff presence and people were left for long periods without any interaction.

People responded positively when they received assistance or interaction from staff. For example, one person looked withdrawn for most of the session but as staff walked by they reached out to touch them and smiled when one member of staff stroked their forearm. When staff did interact they were polite, patient and explained what was happening.

Where people did not have the capacity to consent, the provider had made some improvement to act in accordance with legal requirements. However, a number of people who used the service did not have a relevant mental capacity assessment completed. There was a variation of consents in people’s care records that were either blank or partially completed and a number remained unsigned by people who use the service and/or their representative.

During the course of the inspection we found that appropriate arrangements were not in place in relation to the recording of medicines. We also saw a number of discrepancies in the accuracy and checking of people’s medicine records.

People who use the service and /or their representatives were involved and consulted in monitoring the quality of service provision. The majority of people’s care records were up to date and contained the appropriate records.

Inspection carried out on 29 May 2013

During a routine inspection

We spoke with six people who used the service. Three of them told us that they were comfortable living at the home and they felt the staff were very good and helpful when asked for support. Two people told us that they would rather be at home but accepted this was not possible. Another person told us “the care is quite good and staff are very nice but it doesn’t feel like home. I don’t expect it ever will”.

We asked one person about the activities on offer to them and they told us “there’s not a lot to do here, there’s not any activities on offer that I’ve seen”. Another person we spoke with told us “I feel like I’ve been put with people with very different needs to mine. I’m not happy here”.

We also spoke with seven members of staff. Three staff members told us they had recently completed their induction training to undertake their role. One member of staff told us they had just signed up to start further vocational training and a second member staff told us they were being considered for further vocational training.

Two members of staff we spoke with told us they felt there were issues with communication in the home. One staff member told us they felt that they were not made fully aware of what care needs people had. This was because they were not always told what was in the person’s care plan. They also told us they felt some of the directions in care plans were not clear.

Inspection carried out on 11 February 2013

During an inspection in response to concerns

We visited the home because we had received concerning information in relation to the care of people with specific health needs and on the cleanliness of the home. At the time of our visit, 45 people were using the service.

We spoke with a number of people who used the service, two people told us they were comfortable living at the home. Others were unable to express their views clearly about living at the home. However, we saw staff involving and encouraging people to make choices about their care and treatment. For example, how they wished staff to assist them in their daily hygiene routines and each person was allowed time to express their views and make decisions about their care.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time”.

Inspection carried out on 13 July 2012

During an inspection to make sure that the improvements required had been made

People who use the service told us that the staff were very good, friendly and courteous when carrying out their care and support. People said they were comfortable living at the home and that staff cared for them well. The majority of people provided us with positive responses when we asked them their experiences of the care provided. Five people told us that the staff were very good. One person said,” At times they appear to be short of staff, but compared to my last home this one is better”.

Inspection carried out on 18 April 2012

During an inspection in response to concerns

The people we spoke with told us there was enough staff to meet their needs. One visitor we spoke with said there was always enough staff. Other people who use the service spoke highly of the care staff. One person described them as ‘smashing’, other people spoke about them attending to their needs and making sure, they were all right. Two people said, “They were comfortable at the home and staff looked after them well”.