Archived: Croft Nursing Home

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation and condition of registration. The provider sent us an action plan setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This unannounced visit was carried out on 12 September 204 by an adult social care inspector and a pharmacy inspector. We considered all the evidence gathered under the outcomes inspected and used the information to answer the questions; Is the service safe? Is the service well-led?

During our visit we met all seven people who currently lived at the home, spoke with two of them as well as three of their visiting friends, the new acting manager, two qualified nurses and four care staff. We also spent time observing care and support being delivered in the main communal areas and looked at some records relating to the management of the home.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had taken appropriate action to ensure people were given their prescribed medicines at times they needed them, and in a safe way.

People told us they were happy living at the Croft. They also told us staff were kind and caring, and our observations and discussions with visiting friends supported this. We saw staff treated people with dignity and respect. We also saw staff had built up good working relationships with people who lived at the home and were familiar with their individual needs and preferences. One person using the service said, 'Staff are so polite and friendly. They are very respectful to us and everyone else they come into contact with.' Another person told us, 'I've always been impressed with the care given to my friend by staff here.'

We also found there were enough properly trained and well supported staff working at the home to meet people's needs.

Is the service well-led?

Although the service did not have a registered manager in post when we visited; we found the provider had recently appointed a suitably experienced and qualified nurse to be the Crofts acting manager.

Below is a summary of what we found. The summary is based on our observations during the inspection, examining records and speaking with 3 people who lived at the home. We also spoke with the nurse who was in temporary day-to-day charge of the home and 3 care workers. Before our inspection, we reviewed the information we held about the home and contacted the commissioners of the service to obtain their views.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection in May 2014, we found the provider did not ensure people were protected against the risks associated with the premises in that hot water discharged from hot water outlets to which people using the service had access to was above 44 degrees Celsius. There were no risk assessment in place and people were at risk of scalding. We asked the provider to tell us what they were going to do to meet the requirements of the law.

During this inspection we looked to see if improvements had been made and found the temperature of hot water discharged from all the water outlets we tested were within a safe range.

We saw staff were kind, attentive and patient when supporting people who lived at the home. Two people we spoke with told us they were happy living at the home and they felt staff who worked there were kind and caring. One person said 'I like living here' and another person told us 'The home's alright'. We also found there were enough qualified, skilled and experienced staff on duty to meet people's needs.

Although people told us they were happy and we saw that they were well supported by staff, we found that people may be at risk because the provider had failed to ensure appropriate arrangements were in place for the safe management of medicines. Improvements were needed in respect of how the provider stored, used, recorded and disposed of medicines handled on behalf of the people who used the service.

Is the service well-led?

At the time of our inspection the provider did not have a registered manager in post. We have written to the provider to remind them that the service still needs a suitably competent manager to be in day-to-day charge of the home who is registered with the Care Quality Commission. Although the home does not currently have a registered manager, the qualified nurse in temporary day-to-day charge of the home told us that as an interim measure both they and the provider's own quality assurance consultant would take it in turns to manage the home until a suitably fit permanent manager was appointed.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Although representatives of people using the service told us they felt The Croft was a safe and hygienically clean place for their relative or friend to live; we found the temperature of hot water being discharged from some water outlets people who used the service had access to was excessively hot. This failure to maintain a safe environment may put the people who use the service at risk of scalding. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring equipment used in the home to safely control water temperatures are suitable for their purpose and available in sufficient quantities.

The home had proper policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. The acting manager and relevant senior staff had been trained to understand when an application should be made, and how to submit one.

There were enough suitably competent staff on duty to meet the needs of the people who lived at The Croft. The acting manager and nurses set the staff rota and we found they take account of people's care needs when making decisions about the numbers, skills and experience of the staff required to cover each shift in the home. This ensured people's needs were always met.

The provider's staff recruitment and selection processes were effective, which meant people who used the service were protected from unsuitable staff.

Is the service caring?

The feedback we received from visiting relatives and friends was positive about the standards of care and support provided by the staff who worked at The Croft. Comments included, 'I can't speak highly enough about the place and the staff that work here', 'I think my friend is very happy living at The Croft' and 'The care is excellent. The staff are so patient'.

We saw people who used the service were supported by kind, attentive and compassionate staff. Staff treated the people who used the service with respect and dignity.

Peoples personal, health and nursing needs had been recorded in their person centred care plan and we saw support was provided in accordance people's needs and wishes.

Is the service responsive?

At our previous inspection of 13 February 2014 we found the provider did not have sufficiently robust systems in place to routinely obtain the views of the people who used the service and their representatives. During this inspection we saw the views of people who used the service and their relatives were now being ascertained on a more frequent basis, through regular face-to-face contact with the acting manager and the use of satisfaction surveys. One person said 'I really do think the manager here listens to us and takes on board what we have to say. He's a very approachable chap'.

We saw that people who had recently moved out of The Croft had been reasonably well supported by staff at the home throughout the discharge process and that the new service people had transferred too had been informed about the person's needs.

Is the service effective?

At our previous inspection of 13 February 2014 we found there was a lack of suitably adapted bathing/shower facilities for people in bedrooms located on the ground floor to easily access. During this inspection we saw the provider was in the process of converting the old Parker bathroom into a new wet room, which the acting manager was confident would soon be available for use.

People were cared for by staff who delivered care to an appropriate standard because they had been suitably trained to meet people's needs and were well supported by the homes managers and senior staff team. Staff we spoke with were clear about their support worker roles and responsibilities. It was also clear from speaking with staff that they understood people's diverse care and support needs, and were familiar with their individual likes and dislikes, such as their food and drink preferences.

People were supported to be able to eat and drink sufficient amounts to meet their needs. The feedback we received from people's relatives and friends was positive about the quality and choice of the meals offered at the home. One person told us 'The staff always make sure the cook prepares the food my friend likes', and another person said 'If my friend doesn't fancy what's on the menu the staff are pretty good at making them something else they might like'.

Is the service well-led

In this report the name of the registered manager appears who was no longer in post and therefore not managing the regulatory activities at The Croft at the time of our inspection. Their name appears because they were still the services registered manager on out register at the time. We have written to the provider to remind them that the service still needs a suitably competent manager to be in day-to-day charge of the home who is registered with the Care Quality Commission.

Although the home does not have a registered manager, The Croft has been managed by a suitably experienced and qualified person. People's relatives and friends we spoke with said they felt the service was well managed.

At our previous inspection of 13 February 2014 we found the provider did not have enough effective systems in place to monitor the quality of the service that people received. We found the provider had significantly improved their quality assessing and monitoring arrangements since our last inspection. For example, the acting manager is now responsible for undertaking regular audits of key aspects of the home's operation that includes their arrangements for infection control, cleaning, medication, maintenance, fire safety, legionella, hot water temperature checks, staff recruitment, training, and supervision.

However, although people receiving services in the home and their relatives told us they were happy with the care provided at The Croft; we found that failures to appropriately maintain essential equipment needed in the home, such as a bathing facilities and mechanism's for safely regulating hot water temperatures, may be putting the people who live there at risk of harm or discomfort. We also found people's needs may not always be fully met because the service had failed to establish sufficiently robust systems to continually monitor the quality of the care they provided.

In this report the name of the registered manager appears who was no longer in post and therefore not managing the regulatory activities at The Croft at the time of our inspection. Their name appears because they were still the services registered manager on our register at the time. The service needs a suitably competent manager to be in day-to-day charge of the home who is registered with the Care Quality Commission.

During this follow up visit we found that appropriate action had been taken by the provider to address all the concerns identified at the previous inspection. We spoke with the services new deputy manager who confirmed that they had been in day-to-day charge of the Croft since 8 July 2013. We spoke with a person who lived at the home and a visiting relative. They both told us they felt the new deputy manager had significantly improved the way the home was run in a relatively short period of time. One person said 'the place looks a lot better now it's been painted' and another individual told us 'the new deputy is great. He's done lots to make the place feel more homely'. We spoke with four members of staff who all told us they felt staff morale had significantly improved because of all the changes implemented by the new deputy manager in the past two months.

However, although most stakeholders were happy with the staff that worked at the Croft we received mainly negative comments about the way the service was managed and the environment maintained. Typical feedback, included; 'You rarely see the homes manager', 'in my opinion the home has definitely gone downhill recently because it's not being managed properly' and 'the lift has been broken for a month. It's a disgrace'.

We saw that failures by the provider to appropriately maintain essential equipment, such as the passenger lift and an adapted bath, had adversely affected the well-being of the people who used the service. We also found people's needs may not always be met because staff were not properly supervised or appraised. Several members of staff told us they felt the home was not properly managed which had adversely affected their morale. Finally, the provider had failed to ensure sufficiently robust systems were in place to routinely assess and monitor the quality of care and support that people received.