The Croft

Updated 16 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, one was a medicines inspector.

Service and service type

The Croft is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Croft is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

The manager for this location, has been in post since May 2022, and had been registered since September 2022, but this registration was cancelled in error in December 2022 whilst cancelling a registration for a separate location. The manager of the service is currently in the process of resubmitting their application to the CQC for registration.

Notice of inspection

This inspection was unannounced on the first day and announced to the manager for day 2. Inspection activity started on 08 December 2022 and ended on 16 December 2022.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed all the information received about the service including notifications and feedback from the local authority and safeguarding team. We used all this information to plan our inspection.

During the inspection

On the first day of our inspection we carried out observations of care as most people could not tell us about their lived experiences. We did however speak to people over lunch. We reviewed the environment and reviewed 2 care records. We reviewed medicine administration and associated records for 7 people and spoke with 3 members of staff about medicines and the quality assurance officer who was present on the first day. On the second day of our inspection we carried out further observations, spoke to 3 care staff, an activities staff member, and a relative. On both days of inspection, we spoke with the manager, operational manager and. Following the inspection, we spoke with a further relative by telephone.

Updated 16 February 2023

About the service

The Croft is a residential care home providing personal care and support and is registered to support up to 8 people. The service provides support to people with a learning disability, autistic people, as well as support for people's mental and, or physical healthcare needs. At the time of our inspection there were 7 people living at the service.

People's experience of using this service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. We were not confident people had received a well-planned, safe service over the last twelve months.

Right support: Incidents had occurred over a period of time which had not upheld people’s rights, safety and dignity. Safeguarding procedures had not been stringently followed in a timely way to ensure people were properly protected. The governance systems in place were ineffective in identifying and improving the service in a timely way to ensure people always received good outcomes of care.

Systems were now in place to ensure any allegation was effectively dealt with and staff responsible held to account. A newly created management team was now in place and care outcomes for people were improving with a greater accountability and improvements in people’s care.

Improvements in staff recruitment meant the reliance on agency staff was reducing and shortfalls in training were being addressed. We found however recent concerns had highlighted staff working in an unsupported way without the necessary skills and training to meet people’s needs safely.

Staff recruitment was ongoing and staff induction and training was being revisited to ensure all staff had the necessary competencies and attributes to meet people’s needs.

Recent care reviews had helped to identify gaps in service provision. Additional hours had been agreed for one person and were being sought for another to enhance their experiences, safety and opportunity.

Right care: Improvements were still necessary to enhance the quality of people’s lives and ensure that progress towards goals and outcomes were effectively measured to show how people’s wider social, cultural and physical needs were being met.

People have lived together for a long time and as their needs had changed reviews have been held to consider the continued suitability of the service. We discussed this with the manager in relation to the environment and the need for people to have sufficient space and a low sensory environment which was not always achieved.

A recent reduction of incidents between people could be attributed to more regular staffing and staff having a better understanding of people’s needs and creating a more predicable environment for people. However further thought should be given to people’s sensory and communication needs and how staff could offer meaningful choices and reduce people’s anxiety through greater continuity of care.

Right culture: People were not fully supported to have maximum choice and control of their lives. Staffing levels were in line with people’s needs and there was a staff member employed specifically to coordinate and plan activities. People’s records inspected showed some activities taking place and the scope of activities was improving since the lifting of COVID 19 restrictions and an improving staffing situation.

The overall governance and oversight of this service had been weak and a number of recent changes in management had affected the growth and stability of the service and resulted in poor outcomes for people living here. An experienced manager had come into post since May 2022 and was making significant improvement.

The current management team were helping to shape a more positive culture. Some of the changes were still being embedded. Better communication, support, training and organisation of shift patterns had given staff more coping strategies and reduction of their stress levels. This was resulting in improved care outcomes for people using the service.

The manager had built confidence within their teams and were open and visible. This helped ensure that past poor practice could be quickly identified and stamped out.

Audits helped to determine shortfalls within the service and the provider was listening and seeking formal feedback from relatives and staff. A visiting professional form had been developed but was not being effectively utilised to source feedback. The provider told us they encouraged and sought feedback from professionals.

Experiences of people needed to be captured in more detail and records needed to show how people were being supported in line with their assessed needs.

Overall improvements were still necessary, and we identified a breach of regulation 12 Safe care and treatment and regulation 17 Good governance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good and the report published (21 August 2018.)

Why we inspected

This inspection was carried out to follow up on concerns raised by the local authority as part of their ongoing monitoring of the service. Action plans had been received from the provider and CQC had sought assurances from the local authority and provider prior to inspecting.

This was a focused inspection that considered safe and well led, we found both key questions required improvement. The overall rating for the service has changed from good to requires improvement with breaches of the regulations, based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our The Croft website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.