Archived: Croft Manor Residential Home

This inspection took place on 21 and 22 August 2017 and was not announced.

There was a registered manager in place. 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.

At our last inspection, in July 2016, we identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The care and treatment of people was not always person-centred; people’s capacity to make decisions was not assessed; not all risks to people’s safety had been identified; and quality assurance systems were not effective.

At this inspection, we found some action had been taken, but continuing breaches of regulations were identified.

A quality assurance system was in place, but his had not been effective in identifying and bringing about required improvements. Concerns identified at the last inspection had not been fully addressed, which resulted in continuing breaches of three regulations.

Staff were aware of risks to people’s safety and knew what action to take to keep them safe; however, risk assessments had not always been completed to help ensure the risks were mitigated consistently.

Medicines were administered by trained staff and records showed that most people had received all their medicines as prescribed. However, one medicine was not being given at the correct time and no action was taken when the temperature of the medicines fridge exceeded the recommended level.

Staff sought consent from people before providing care or support. However, people’s capacity to make specific decisions was not always recorded and decisions that staff had taken on behalf of people were not always documented.

While some people told us their needs were fully met, others said this was not always the case. For example, not everyone was supported to have a bath as often as they wished. Following the inspection, the registered manager told us they had introduced new procedures to improve this.

A range of activities was available to people, but no provision had been made for people who did not want to engage in group activities.

People told us they felt safe and staff knew how to identify, prevent and report incidents of abuse. There were enough staff deployed and recruitment procedures helped ensure only suitable staff were employed. Staff received appropriate training and support to enable them to support people effectively.

People praised the quality of the meals and told us there was always a choice. Staff provided appropriate support for people to eat and took action when people lost weight. People were supported to access healthcare services when needed.

People were cared for with kindness and compassion. We observed positive interactions between people and staff. Staff created a calm atmosphere and supported people in a patient and unhurried way.

People’s privacy was protected and their dignity respected. They were encouraged to remain as independent as possible and were involved in planning the care and support they received. They were also encouraged to make choices and decisions about how and where they spent their day.

Staff sought and acted on feedback from people and people knew how to complain about the service. People described an open culture where visitors were always made welcome.

There was a clear management structure in place. Staff were organised, enjoyed working at the home and worked well as a team. They expressed a strong desire to provide high quality care to people.

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

The service had a registered manager. 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.

Staff understood the principle of keeping people safe and were aware of the associated policies and procedures regarding safeguarding. People’s risk assessments were not competed or detailed to ensure staff were aware of all the risks associated with people’s care. Staffing levels met the needs of people, with the home having a long standing static staff group. Staff received supervision and there was a training programme in place to ensure staff were supported in their roles. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely.

There was a lack of understanding regarding the Mental Capacity Act and people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without their agreement and may not have been in their best interests. People enjoyed their meals and were offered a choice of refreshments around the clock. People were supported to access a range of health professionals.

People did not always have their needs planned in a personalised way, which reflected their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations of these concerns, however the outcome of complaints had not been recorded.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and providers and were clear about their roles and the values of the home. Records were not always accurately maintained and this was not an effective part of the quality audit process. Notifications were being submitted as required.

We found breaches in four 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.

During our visit we spoke with five people who lived at the home. We also spoke with the providers, a relative of one person, the registered manager and six members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

None of the people we spoke with had any concerns about the support they received. People were treated kindly and with dignity and respect by staff. People and their relatives told us about their satisfaction with the home and told us they felt safe.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had assessment tools in place to assist staff in establishing the level of risk for people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that staff had received training with regard to DoLS and the home was contacting the local DoLS team for advice on this subject.

Records showed regular checks of the fire alarm and emergency lighting systems were recorded. We also saw that regular fire exercises were conducted. Safety certificates were in date for gas safety, electrical wiring and for portable appliances.

There were arrangements in place to deal with foreseeable emergencies. The service had a business contingency plan to deal with any short or long term emergencies such as loss of electrical power or loss of gas supply. There was also a contingency plan should the home become uninhabitable and people could not return to the home after an evacuation

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff we spoke with were aware of people's needs and the preferences of people they cared for in how people wanted care to be delivered. We saw staff offered advice and support and enabled people to make their own choices and decisions.

A relative told us 'I am very happy with the care provided for my relative, I can't believe how easy it's been for my relative to settle in, everyone is so good'.

Is the service caring?

We observed staff speaking to people appropriately and they used people's preferred form of address; People we spoke with told us staff were kind and patient in their approach.

We saw care workers taking time to chat with people. They responded promptly to people's requests for assistance and had a good understanding of people's needs. People described their satisfaction with the home. One person told us, "I am very happy here'. Another person told us 'They (the staff) are very good, they always have time for you'.

Is the service responsive?

We saw people had reviews of the care and support they received. We saw that care plans showed alterations had been made to people's plans of care as people's needs changed.

We saw people were able to participate in a range of activities. Staff told us that they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home was meeting people's needs. Any concerns or ways to improve the service were considered by the management team and if appropriate were acted upon..

Is the service well led?

A relative we spoke with told us that they had regular contact with the home and said that they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relative. They told us the home's staff were "easy to approach".

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These including a number of audits including health and safety, medicines, cleaning and infection control.

Staff meetings took place every three months and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had positive experiences. The mealtime was well organised. Meals were brought promptly and staff helped people if they needed it.

We saw that people were clean and well cared for. People and their relatives said the home provided a good standard of care. One relative told us, 'The home is wonderful and has always looked after our relative well.' We found people were able to take part in activities for stimulation.

We found each person had a folder with assessments and care plans. We noted some specific needs were not fully assessed nor care plans devised for these needs. We noted that accidents to individuals were monitored.

The home's environment was clean and well maintained. There was a lack of assessments regarding identified risks to people such as from a first floor window openings and regarding the use of bed rails.

We saw the home's medication procedures ensured people received prescribed medication although we noted for one person, who had medication 'as required,' there were no recorded guidelines for staff to follow of when this was needed.

We saw that newly appointed staff were subject to checks on their suitability to work with vulnerable people.

The home had sufficient numbers of staff to meet people's needs.

We saw the home had a number of ways of checking the environment and of incidents in the home. The views of people, their relatives and staff were sought by the use of survey questionnaires.

They told us if they had any concerns or wished to raise a complaint they would tell the manager. One person said that that the staff were wonderful and worked very hard but always found the time to talk and ask how they were.

Visitors we spoke with told us they were happy with the care their relatives received. One visitor told us: 'My mother is very safe here, the staff treat her well, if I had concerns I would speak to the manager, but I have no concerns'

We saw that people's privacy and independence were respected. People experienced care based on detailed care plans and risk assessments that documented people's preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

The provider employed the correct number of staff that received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.