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Inspection carried out on 23 July 2018

During a routine inspection

The Croft 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 Croft accommodates up to eight people. At the time of our inspection there were eight people living at the service. The Croft is a detached two storey house in the town of Diss in Norfolk. This unannounced comprehensive inspection took place on 23 July 2018.

The service had been developed and designed in line with the values that underpin the CQC guidance, Registering the Right Support, and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism who lived in the home could live as ordinary a life as any citizen.

At our last inspection we rated the service Good overall, however we rated the key question of effective ‘Requires Improvement’ because there had been a lack of consideration to the restrictions on people’s freedom because of locked doors within the service. We found that improvements had been made at this inspection and people had increased freedom to move around their home.

At this inspection we found the evidence continued to support the overall rating of Good. There was no other evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were supported by sufficient numbers of staff that had been recruited safely and had checks undertaken to ensure they were suitable for their role.

People were provided with a choice of meals which considered their likes and dislikes and were encouraged to eat a varied diet that took into account their nutritional needs. People were supported to access healthcare professionals when needed to maintain their health and wellbeing.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a service that was caring. Staff knew people's needs well and were responsive and supportive. Staff treated people with dignity and respect. Staff sought to gain people's views.

Good leadership continued to be in place that provided staff with the necessary support and training to make sure people received good quality care.

Further information is in the detailed findings below.

Inspection carried out on 16 May 2016

During a routine inspection

We inspected this service on 16 May 2016. The inspection was unannounced.

The Croft is a care home which provides accommodation, care and support for up to eight adults with a learning disability. Eight people were living at the service on the day of our inspection.

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

The registered manager had made applications to the local authority to ensure restrictions on people’s ability to leave the service were lawful in accordance with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. However, the same approach had not been extended to the locked doors within the service which, restricted people’s freedom of movement around their home.

Procedures were in place for responding to emergencies and managing risks in the service. This included safeguarding matters, managing people’s finances and medicines. Environmental risks were being assessed and measures had been put into place to minimise risks to people’s safety.

People using the service at times behaved in ways that were challenging to others. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Behavioural support plans were detailed and gave staff clear direction as to what action to take to minimise risk. This was done in a consistent and positive way.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.

People experienced a good quality of life because staff received training that gave them the skills and knowledge to meet each person’s assessed needs.

Staff talked passionately about the people they supported and knew their care needs well. People were involved in determining the kind of support they needed. Different communication methods had been used to support people to understand information about their care. Staff offered and respected people’s choices on how they spent their day. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.

People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.

There was a strong emphasis on promoting good practice in the service. A number of schemes were in place to motivate staff and drive improvement, such as staff excellence awards. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect.

The provider had a range of systems in place to assess, monitor and further develop the quality of the service. This included quality monitoring visits of the service and monitoring of incidents, accidents, safeguarding concerns and complaints.

There was an emphasis on fairness, transparency and an open culture within the service and throughout the organisation. Senior managers and the chief executive were contactable for staff to talk to openly whether they wanted to complain, raise concerns, or compliments or to share ideas to improve the service. Staff were encouraged to take part in the organisations’ ‘working groups’ to understand and have a say on changes to working conditions.

Inspection carried out on 23 October 2013

During a routine inspection

We were unable to speak directly with anyone who used the service as they each had some difficulties with communication but we observed staff interactions with them and were shown round the service with some assistance from one of the people who used the service. It was not possible to gain any verbal feedback from them.

We discussed with the registered manager how they ensured that people consented to their care and treatment and they explained the procedures followed which were in accordance with legal guidelines.

We examined a range of records which were all readily available, accurate and fit for purpose. These included care records, staff recruitment records, medication records and maintenance records.

We were therefore satisfied that the service offered safe and effective care, was well managed and responded quickly to situations that arose.

Inspection carried out on 28 November 2012

During a routine inspection

We spoke briefly with two of the seven people who used the service but their feedback did not relate to the standards we looked at.

We found that care plans were comprehensive, containing details of the needs of people who used the service and how those needs were met. The care plans all contained detailed risk assessments to minimise the risks around daily living and events and activities.

The staff team had received a range of training to equip them to carry out their role and were well supported by the service.

Inspection carried out on 27 March 2012

During a routine inspection

Although the majority of people living at The Croft could not communicate verbally, they showed many signs of well being. They interacted confidently with staff and were able to make their needs known by using simple sign language.

One person told us that they "Liked the staff and that they are taken on holidays and out for lunch."

One person was also happy to show the inspector around some of their home and appeared both relaxed and content.

Although people were unable to communicate their views verbally with regard to safety and safeguarding. One person spoken to said that they "Liked the staff and that they were kind."

Reports under our old system of regulation (including those from before CQC was created)