Archived: Croft Dene Care Home

This unannounced comprehensive inspection took place on 22 and 27 March 2018. This meant that the staff did not know we would be visiting the home. At the last inspection in November 2017, we identified breaches of regulations which related to safety, person-centred care, staffing and governance of the service. After the last inspection we told the provider that we were considering serious enforcement action and gave them a period of time to fully address all of the issues. The provider voluntarily suspended admissions to the home until they had taken action to alleviate the concerns raised.

Prior to our inspection, we reviewed the provider’s action plan which had been shared with us, the local authority and the Clinical Commissioning Group (CCG). We saw all of the actions had been completed or there was satisfactory on-going progress being made.

This service has been in ‘Special Measures’. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had taken immediate action to rectify the shortfalls with the leadership of the service. Two new temporary care managers were in post who managed the service on a daily basis and reported to the registered manager. The established registered manager of the service told us they had been able to spend more of their time at this service. 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 been strongly supported by the provider during the past four months to ensure that compliance with the regulations was achieved. They had both concentrated on the safety, governance and leadership of the service and implemented the improvements and changes required.

The two new care managers had ensured that checks on the service were in operation and recent robust audits showed that the service was being monitored to ensure its safety and quality. However, this needed to be evidenced over a longer period of time to ensure sustainability.

All of the environmental safety risks which we highlighted at the last inspection had been removed or reduced and were now closely monitored by the new care management team.

Medicine audits had recommenced and we saw that any issues identified were addressed by the care management team. Medicines were managed well. People received their medicines safely and at the right time. The records kept to monitor medicine administration were completed to a satisfactory standard. We noted some minor issues related to ‘as required’ medicines which the registered manager told us would be addressed immediately.

There was an outbreak of Norovirus at the service, which limited the areas we could observe on the second day of the inspection; however, we liaised with a local infection prevention and control nurse who told us they had concerns about the cleanliness of the service. The registered manager took immediate action to address these and we were satisfied the actions taken were sufficient.

The activities coordinator post had been filled since the last inspection but had recently become vacant again. The care management team had taken proactive steps to manage this whilst recruitment started over. We saw there was information on display about planned meaningful activities. People told us they enjoyed the activities on offer but still felt there was room for improvement. An activities coordinator from one of the provider’s other care homes was spending two days per week at Croft Dene to assist the care staff. Designated care staff were arranging stimulating activities on the days we visited and they told us they had been allocated time to socialise with people. Records to show that people had participated in activities had improved.

Since our last inspection, staff had completed their mandatory training. A training plan was now in place to develop staff skills with awareness courses being organised in topics which would be beneficial to the staff.

Staff recruitment continued to be safe and pre-employment checks were in place to ensure staff were suitable to work with vulnerable people. All staff had taken part in a formal supervision meeting with the care management team and a plan was in place to complete annual appraisals over the forthcoming year, which the registered manager had started to conduct. Competency checks had been carried out with care and nursing staff to ensure they were supported in their role and were competent to carry out the tasks they were responsible for.

We observed people enjoying a pleasant mealtime experience. We saw staff were more organised and relaxed throughout mealtimes and they were deployed correctly to ensure people who required one to one assistance were supported in a timely manner. We found that staff made an effort to create a homely environment for people to enjoy their meals in.

The cook was aware of people’s dietary requirements and their nutritional and hydration needs. We saw the cook came out of the kitchen at mealtimes and engaged with people and staff. Special diets were catered for and all meals were well presented, including food which had been pureed. People had a choice of meals and alternatives were made available.

People told us they felt safe living at Croft Dene. The relative and visitor we spoke with confirmed this. Staff were able to demonstrate their responsibilities with regards to protecting people from harm and they had received the appropriate training. The provider had up to date policies and procedures in place to support staff to deliver the service.

Accidents and incidents continued to be recorded, investigated and monitored by the care management team. The action taken to minimise the likelihood of a repeat incident were recorded. All incidents had been reported to the appropriate external agencies as necessary.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of most people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.

Staff displayed approachable and caring attitudes and people told us staff were kind to them. We saw people enjoyed a positive relationship with staff and it was apparent they knew each other well. We saw all staff treated people with dignity and respect.

Individual care needs were assessed and regularly reviewed. Support plans were person-centred, informative and reviewed as necessary. Risks which people faced in their daily lives had been evaluated and measures were in place to reduce these.

An established system for monitoring complaints was in place. This had continued from our last inspection. This meant the provider was now able to look for trends and identify areas of the service which may need further improvement and development.

This unannounced comprehensive inspection took place on 1 and 2 November 2017. At the last inspection on 31 May 2017, we identified breaches of regulations which related to safety, person-centred care, complaints and governance of the service. We asked the provider to take action to make improvements. We found some improvements had been made but not enough to ensure compliance with all of the statutory requirements.

This is the third consecutive time the service has required improvement. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A new on-site care manager was in post who managed the service on a daily basis. The registered manager of the service attended part of the inspection. 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 and relatives told us they were unsure of who was in charge at the home and were confused about the ownership of the home. They also told us further improvements were required.

We undertook an initial observation around the home to look at the safety issues which had been highlighted to the provider and registered manager at our previous two inspections. We found some action had been taken; however we found audits and checks on the service were still not robust enough to ensure compliance with all of the regulations. Several serious safety concerns remained at the home which had either not been wholly addressed or had not been properly monitored to ensure that staff complied with the directions given to them.

The provider had told us in an action plan that the on-site care manager carried out daily and monthly checks on the quality and safety of the service and together with the registered manager were confident that issues had been addressed. We did not find sufficient evidence to corroborate these checks had taken place. Although two ad-hoc checks had taken place, they had not been consistently carried out and were not robust enough to identify the continued issues we highlighted during our visit.

Routine audits that had previously been carried out in relation to medicines, infection control and health and safety had ceased. The registered manager took some immediate action to rectify issues which we drew their attention to. After our inspection the provider told us that the leadership and governance shortfalls at the service would be swiftly and thoroughly addressed this time.

Medicine audits had not been completed since May 2017. This meant the issues that we highlighted during the inspection has not been identified or addressed by the management team. In particular, the application of topical medicines and the completion of medicine administration records were not safely monitored.

The activities coordinator post was now vacant. We saw there was no information on display about constructive activities. People told us they were bored and relatives and staff added that structured activities had not taken place for some time and there was much room for improvement. We found there were no meaningful and stimulating activities taking place on the days we visited and care staff had minimal spare time to socialise with people. Records related to people’s participation in activities had not been completed for two months and previous records were unacceptable.

The upper floor of the home was designated for people living with dementia or similar health conditions. A care team leader was responsible for ensuring the environment was suitable for people’s needs. We saw a lot of progress had been made towards improving the design and décor of the environment and they had coordinated some communal activities with people such as films or sing-a-longs.

Staff training had not been monitored and as a consequence of this, some staff were overdue key training such as moving and handling training. Formal routine supervision and appraisals had also fallen behind which meant the registered manager was not assured of ongoing staff capabilities or competence. Although staff told us they felt supported by the on-site care manager.

Staff continued to be safely recruited and we considered that there were enough care staff employed at the service, however they were sometimes not deployed appropriately throughout the service, particularly at mealtimes.

The mealtimes we observed were not well organised and they continued to lack an opportunity for socialisation in most of the communal dining areas. A hot meal was prepared at lunchtime; we saw some people had asked for alternatives which they had been given. The food looked attractive, healthy and well balanced. Some people told us they enjoyed their meals whilst others waited so long for assistance that they meals went cold. Special diets were catered for and the kitchen staff were familiar with people’s dietary requirements.

People told us they felt safe living at Croft Dene. Relatives confirmed this. Staff were trained in the safeguarding of vulnerable adults and they were able to demonstrate their responsibilities with regards to protecting people from harm. Policies and procedures were in place to support staff with the delivery of the service.

Accidents and incidents continued to be recorded, investigated and monitored by the on-site care manager. Actions taken to reduce the likelihood of a repeat occurrence were recorded. All incidents had been reported to external agencies as necessary.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of most people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.

We saw care workers treated people with dignity and respect. Staff displayed friendly, kind and caring attitudes and people told us staff were nice to them. We observed people enjoying a pleasant relationship with staff and it was evident they knew each other well.

Support plans were person-centred, descriptive and regularly reviewed. We examined five people’s care records in detail and reviewed three others. Individual care needs were assessed and reviewed as necessary. Risks which people faced in their daily lives had been assessed and preventative measures were in place to minimise the possibility of an incident occurring. We found some discrepancies which we followed up in relation to the safe use of equipment.

The management of complaints had been improved since our last inspection. We reviewed complaints and saw there had been an acknowledgement or outcome letter sent to complainants. Investigation notes had been made in response to complaints and there was written evidence to suggest the procedures were now properly followed.

We have identified three on-going breaches and one further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Croft Dene is a residential care home situated in Wallsend. It provides accommodation, personal and nursing care for up to 42 people with physical and mental health related conditions. At the time of our inspection 28 people lived at the service and five people were staying on a short-term basis.

A care manager was in post who managed the service on a daily basis but they were unavailable when we visited. The registered manager of the service was present. 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.

We undertook an observation around the home to look at the safety issues which had been highlighted to the management team at our last inspection. We found that some action had been taken and checks were carried out around the premises; however we found these were still not robust enough to ensure compliance with the regulations. Several serious safety issues remained at the home which had either not been entirely addressed or not been monitored to ensure the staff complied with the instructions given to them by the management team.

The issues we previously found which related to the management of medicines had been addressed. We saw that the nursing staff and senior care workers took a consistent approach to managing medicines throughout the home. There was an updated medicines policy and procedure in place. We found no issues with the storage, receipt, administration, disposal and recording of medicines.

The provider had told us in an action plan that the care manager carried out daily, weekly and monthly checks on the quality and safety of the service and reported her findings onto the registered manager. We were only given evidence of monthly manager’s reports. Although these checks had taken place they had not been robust enough to identify the on-going concerns we highlighted during our visit. The registered manager took immediate action to rectify the safety issues we highlighted. After our inspection the registered manager and provider gave us their assurance that the leadership and governance shortfalls within the service would be promptly addressed.

We received mixed feedback from staff, people and relatives about the leadership of the service. Some staff felt supported by the management team but equally there were staff who did not feel supported or valued by the management. People and relatives told us further improvements were still required.

The management of complaints had not been sustained since our last inspection. We reviewed the last 10 recorded complaints and saw there was no acknowledgement or outcome letter sent to the complainants. Some investigation notes had been made in response to complaints but there was a lack of written evidence to suggest the procedure had been properly followed. A suggestion box was in place in the foyer to acquire feedback from people, relatives and staff, but their overall opinion was that they were not generally listened to.

There was an activities coordinator employed at the service. We saw information on display about planned activities but we noted this didn’t reflect what had been arranged the week we visited. People, relatives and staff told us that activities still needed much improvement. We found there was a lack of meaningful and stimulating activities taking place on the day we visited and the planned activities had not always gone ahead. Records related to people’s participation in activities were brief, unorganised, not up to date and had been unsuitably stored.

The upper floor of the home was designated for people living with dementia or related health conditions. The provider has recently employed a clinical lead nurse to oversee dementia care. They were not available on the day of inspection but we saw progress had been made towards improving the design and décor of the environment and the registered manager told us that the clinical lead nurse led most of the activities on the upper floor.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of most people to restrict their freedom in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.

A roast dinner was prepared at lunchtime; we saw some people had asked for a lighter alternative which they were given. The food appeared appetising and well balanced. Special diets were catered for and the cook was familiar with people’s dietary needs. People appeared to enjoy their food but spoke of previous dissatisfaction. The mealtimes we observed still lacked an opportunity for stimulation and socialisation and the dining rooms were not dressed consistently with a homely appearance. We have made a recommendation about this.

We saw care workers treated people with dignity and respect whilst assisting with personal care and at mealtimes. All staff had received formal supervision since our last inspection and had been made aware of our findings and the importance of ensuring people’s dignity was always protected and promoted. Staff displayed kind and caring attitudes and people told us the staff were nice to them. People enjoyed a good relationship with the staff and it was apparent they all knew each other well.

Support plans had been improved and they were person-centred, thorough and up to date. We examined three individual care records in detail and reviewed four others. We did not find any issues with the care records. Care needs were assessed and reviewed as necessary. Individual risks which people faced in their daily lives had been assessed and preventative measures were in place to minimise the possibility of an incident occurring.

People told us they felt safe living at Croft Dene. Most relatives confirmed this. One relative raised concerns about the safety of the premises and of the care their relation sometimes experienced. The provider and registered manager were aware of this and a satisfactory resolution was on-going. Staff were trained in the safeguarding of vulnerable adults and they were able to demonstrate their awareness with regards to protecting people from harm and abuse. Updated policies and procedures were in place to support staff with the delivery of the service.

Accidents and incidents continued to be recorded, investigated and monitored. Actions taken to reduce the likelihood of a repeat event were recorded. All incidents had been reported to external agencies as necessary. The information was analysed to track trends throughout the provider’s organisation.

Most people and relatives told us that the staff responded quickly to them when called upon but felt there was not enough staff employed at the service. We heard a lot of comments about sporadic staff shortages. Care staff told us that in general they did not feel hurried in their duties and were able to meet people’s needs in a timely manner. Staff continued to be safely recruited, trained in topics relevant to their job and had their competence regularly checked. Formal supervision and appraisals were carried out with staff to support them in their roles.

We have identified two on-going breaches and two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Croft Dene is a residential care home situated in the Howdon area of Wallsend. It provides accommodation, personal and nursing care for up to 42 people with physical and mental health related conditions. At the time of our inspection 35 people used at the service and three people were in hospital.

Croft Dene has a care manager in post who manages the service on a daily basis. There was also a registered manager in post who manages another of the provider’s registered locations however, she was not present during this inspection. 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.

Routine safety checks were carried out around the premises; however we found these were not robust enough to ensure compliance with statutory requirements. We highlighted several safety issues in the home which had not been addressed.

There was a medicines policy and procedure in place, however medicines were managed inconsistently throughout the home. We found issues with the storage, administration and recording of medicines on the upper floor although these tasks were well managed downstairs.

We observed all staff interacting with people throughout the inspection. Communication with people was not always respectful and in particular we witnessed two undignified interactions between non-care related staff and people who were diagnosed with dementia. We reported our observations to the care manager and later to the registered manager. They told us they would take immediate action to address this issue.

All other staff displayed kind, caring and compassionate attitudes and people told us everyone was nice to them. We saw care workers treated people with dignity and respect whilst assisting with personal care and we saw discreet interactions with people who required support to eat their meal. People enjoyed a friendly relationship with the staff and it was apparent they knew each other well.

The upper floor of the home was designated for people living with dementia or similar health conditions. We found the design of the upper floor was not dementia friendly. Walls and floors were bland and handrails and other adaptations did not stand out. There was a lack of décor and memorabilia to stimulate memories and conversation. We have made a recommendation about this.

There was an activities coordinator employed at the service. We saw information on display about forthcoming activities and we observed people engaging in a craft activity during the inspection. However, people, relatives and staff all told us that activities in the home needed much improvement. We were told the activities on display didn’t always happen and the activities coordinator did not spend time with people on a one to one basis. We have made a recommendation about activity provision.

The service offered people a choice of meals. The food looked appetising and was well balanced. Special diets were catered for the cook was familiar with people’s dietary needs. Following a recent choking incident, all risk assessments had been reviewed and all staff had been refreshed regarding people’s individual needs around soft and pureed diets. People appeared to enjoy their meals, however some relatives told us their relations preferences were not always responded to. We observed mealtimes to be functional but they lacked an opportunity for stimulation and socialisation.

Improvements had been made with updating support plans and making them person-centred following concerns raised by the local authority and the clinical commissioning group at one of their previous visits. We saw one page profiles were being completed with personalised information about life history, interests and preferences. We examined three individual care records thoroughly and found that all of them were incomplete, contained inaccuracies and documents held within the records were not always signed and dated.

People we spoke with told us they felt safe living at Croft Dene. Relatives confirmed this. Staff were trained in the safeguarding of vulnerable adults and they demonstrated their awareness and responsibilities with regards to protecting people from harm and abuse. Policies, procedures and systems were in place to support staff with the operation of the service. Care needs were assessed and reviewed as necessary. Individual risks which people faced in their daily lives had been assessed and control measures were in place to reduce the possibility of an accident occurring.

Accidents and incidents were recorded, investigated and monitored. Action plans were in place to reduce the likelihood of a repeat event. The care manager reported all incidents to external bodies as necessary. The registered manager analysed this information to track trends throughout the provider’s organisation.

People and relatives told us they felt there was enough staff employed at the service and staff responded quickly to them when called upon. We heard some comments about staff shortages at weekends. There were mixed opinions amongst the staff team about staffing levels although most care workers told us they did not feel hurried in their duties and felt they were able to meet people’s needs. Staff had been safely recruited. Staff completed training in topics relevant to their role and competencies were checked.

The care manager and care workers demonstrated an understanding of the Mental Capacity Act (MCA) and their responsibilities. Records showed they had assessed people’s mental capacity and reviewed it as necessary. 13 people had their freedom restricted through an approved Deprivation of Liberty Safeguard (DoLS). This had been appropriately assessed and applied for in line with the MCA and deemed necessary for people’s own safety. Complex decisions that were made in people's best interests’ had been appropriately taken with other professionals and a relative involved. Other decisions about aspects of daily life were not always recorded in line with MCA principles. We have made a recommendation about this.

There was a complaints procedure in place. Seven complaints had been received by the service in 2016. We reviewed response letters and saw evidence of internal investigations into the issues raised had taken place and complainants had received a timely response in line with the policy. A suggestion box was in place to acquire feedback from people, relatives and staff.

There were differing opinions from the staff about the leadership of the service. Some staff told us they felt supported by the management team and had received regular supervision and appraisal. Staff meetings had not been held as often as planned however some staff told us they felt able to approach the care manager and the registered manager whenever necessary. Equally there were staff who did not feel supported or valued by the management.

The provider had recently visited the home and carried out a quality assurance audit on 20 October 2016. The care manager carried out daily, weekly and monthly checks on the quality and safety of the service and reported her findings onto the registered manager. Although these processes were in place, they had not been completed effectively in order to identify all of the issues we raised during the inspection regarding compliance with statutory regulations. After the inspection, we discussed this with the registered manager who told us immediate action had been taken to address the safety issues and herself, the care manager and the provider had an action plan to attend to the shortfalls.

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.