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Inspection Summary


Overall summary & rating

Requires improvement

Updated 19 May 2018

This inspection took place on 25 and 27 September 2017. The first day of our inspection was unannounced. The Croft is registered to provide accommodation for up to 21 people who require nursing or personal care. At the time of our inspection there were twelve people using the service.

At the last inspection in March 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-

Regulation 9 Person-centred care

Regulation 11 Need for consent

Regulation 12 Safe care and treatment

Regulation 13 Safeguarding service users from abuse and improper treatment

Regulation 14 Meeting nutritional and hydration needs

Regulation 17 Good governance

Regulation 18 Staffing

Following our last inspection we asked the provider to take action to make improvements. During this inspection we found improvements had been made and there were no continued or new breaches of regulations.

There was not 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 provider had secured the services of a manager consultant with a background in mental health. Arrangements were in place to appoint a new manager and candidates were due to be interviewed on 28 September 2017.

People had care plan documents which were accurate, up to date and regularly reviewed. We found these described people’s individual needs and provided staff with a profile of people’s mental health needs. Where risks to individual people had been identified we found staff had been given guidance and advice on how to mitigate these risks.

Staff had been trained in safeguarding vulnerable adults. They told us they felt able to speak to the manager if they had any concerns

There were enough staff on duty. A new board on the wall told people who used the service who were their staff member for the day.

Staff provided appropriate support to people with dignity and respect. We found changes had been made in the service which promoted people’s independence.

Pre-employment checks were carried out on staff to ensure they were of suitable character and had the necessary skills to care for vulnerable people. Staff completed an induction when they first started work which supported them to get to know the home and people who used the service. Staff received regular supervision, appraisals and training. Staff had recently registered to undertake training in mental health.

The provider had used the knowledge and skills of a manager from another service to implement a programme of checks which ensured people were protected from living in an unsafe environment. These included, for example, fire safety and water temperature checks.

Accidents and incidents were recorded by staff. These were monitored by managers to ensure the right actions had been taken and prevent the same type of accident happening again.

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

Some people in the service were provided with additional staff hours to support them to carry out activities of their choice. Staff had begun to engage with people about the type of activities they would like to see provided.

Staff had completed food and fluid charts to monitor the food and fluid intake of people were at a nutritional risk. People made positive comments about the meals and we found people had a menu choice. Alternatives were available if people preferred other options.

We saw discussions had taken place with mental health professionals. The staff had made referrals to other health care profe

Inspection areas

Safe

Good

Updated 19 May 2018

The service was safe.

The service had reviewed people’s risk assessments and guidance was in place to ensure staff knew and understood how to mitigate identified risks.

Staff had been trained in how to safeguard vulnerable people.

Staff were trained and assessed as competent to give people their medicines in a safe manner.

Staff employed in the service had pre-employment checks carried out to see if they were suitable to work in the home.

Health and safety checks were carried out on the premises to ensure people lived in a safe environment.

Effective

Good

Updated 19 May 2018

The service was effective.

The service was compliant with the Mental Capacity Act 2005 and the Mental Capacity Act Code of Practice.

Staff had received support through training, supervision and appraisal.

Fresh food was prepared and people were offered meal choices. Snacks were available for people throughout the day.

Caring

Good

Updated 19 May 2018

The service was caring.

We observed staff working with confidence with people in ways which were caring and respectful.

During our inspection a local advocacy service had been invited to attend a meeting for people who used the service. This was intended to promote people’s use of advocacy.

People who used the service spoke to us in positive terms about the staff who worked in the home.

Responsive

Good

Updated 19 May 2018

The service was responsive.

We found people’s care plans were up to date and accurate. Clear guidance was given to staff about how to meet people’s needs and what actions were required to support people.

Staff had begun to address with people the kind of activities they would like to do in the home.

People who lived in the home felt confident in approaching staff to raise any concerns or make a complaint.

Well-led

Requires improvement

Updated 19 May 2018

The service was not always well led.

There was not a registered manager in post.

Documents held by the service were accurate and up to date.

Since the last inspection systems had been implemented in the service to monitor quality. Staff were now delegated tasks to carry out audits.

Staff and people who used the service spoke highly of the manager consultant who was in charge of the home at the time of our inspection.

The provider had not notified us of incidents in line with the requirements of regulations.