Archived: Croftacres Residential Home

Croft Acres is a home offering accommodation over two floors for up to 25 older people and people living with dementia who require personal care and support. At the time of the inspection there were 19 people living at the home.

There was no registered manager in post at the time of the inspection. There was a manager who was absent from the service, and an interim manager who was responsible for the day to day running of the home in the manager’s absence.

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 was not meeting the requirements of ten regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one requirement of the Care Quality Commission (Registration) Regulations 2009. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

The service was not recognising incidents which put people at risk of harm and was not taking all reasonable measures to keep people safe.

Risk assessments where they were in place were not correctly filled out and did not identify specific risks or demonstrate the measures needed to mitigate those risks.

Medicines were not managed safely. People were not all receiving their medicines as prescribed.

There were not always sufficient staff on duty to meet people’s needs safely. Staff were not well-trained or supported.

Recruitment processes were not adhered to and the required pre-employment checks were not always carried out prior to people commencing work.

The service was not protecting people’s rights and working within the Mental Capacity Act 2005.

Food was not always of good quality and people did not all receive the required support to help them eat and drink adequately.

Staff were kind and caring, however did not always recognise when people were not being treated with dignity and respect.

People were not encouraged to be independent. Care was task orientated and had some institutionalised elements.

Care plans were not person centred. There was very little evidence of personal information being gathered and available for staff. Care plans were not reviewed to ensure they were up to date and included all current information.

There were activities in the home, however these did not meet the needs of some of the people in the home and were not helpful to people living with dementia. There were no opportunities offered for people to leave the home on outings.

The management of the home had been unstable and people and their relatives had lost confidence. People were not sure who the current manager was.

There were no processes in place to monitor the quality and safety of the service. The registered providers did not have any oversight of the performance of the home or the staff who worked there.

Records were of very poor quality and did not fulfil their purpose.

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.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

People spoken with told us that staff treated them with dignity and respect. All the people told us they felt 'safe' and did not have any concerns. People told us that they had choice which included choosing what to eat, when to go bed and where to have their meals. People's comments included: 'I like having my breakfast in the quiet lounge' and 'when they [the staff] ask us if we want to go to bed, we can say it is too early and go to bed later'.

Relatives spoken with told us their family members were treated with dignity and respect. One relative commented: 'the staff are lovely; people are definitely treated with respect'.

People were not fully protected against the risks associated with medicines because the provider did not always have appropriate arrangements in place to administer and record medicines and creams safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to the safe management of medicines.

The manager operated an effective recruitment procedure and carried out the relevant checks when they employed staff. When the manager started managing the home at the beginning of 2014 they identified that a Disclosure and Barring Check had not been undertaken for a few members of staff. The manager had taken action and arranged for a check to be completed for all staff working at the service.

The home had policies and procedures in relation the Mental Capacity Act and Deprivation of Liberty Safeguards DoLS.

Is the service effective?

We reviewed three people's care records. We saw people's care plans contained a range of information including the following: personal hygiene, nutrition, medication, moving and handling, people's personal preferences and details of people's life history. However, we found some people's care plans needed to be updated and/or were incomplete. Whilst there was no evidence to suggest that these concerns had negatively impacted upon people, there was a risk that the lack of updated and incomplete care plans could result in people not receiving appropriate care and treatment. The manager told us they had identified that people's care plans needed to be reviewed when they had started managing the home. They informed us that just over fifty percent of people's care plans had been reviewed. It is important that all the people being supported by a service have up to date records about care and they are clear and accurate.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to the management of records.

Although staff were able to support people appropriately, staff did not always have the capacity to engage in activities with people at the home. This meant there was a risk that people did not get sufficient opportunity for social and mental stimulation.

Is the service caring?

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Staff were respectful and treated people in a caring and supportive way. Staff also explained their actions to people and gained consent.

People spoken with told us they were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: 'the new manager is a great lass, she is right on the ball and a bit more organised', 'the food is very nice, sometimes we don't get enough but you can always ask for more', '[staff member] is very good to have little chats with' and 'nothing seems too much trouble for the staff '.

Relatives told us that the quality of care people received had improved since the new manager started working at the home. They also made positive comments about the staff. Their comments included: 'the staff are brilliant'; 'the staff are very welcoming when we come and visit' and 'we have seen a positive change since the new manager started working at the home'.

Is the service responsive?

A copy of the home's complaints procedure was displayed in the reception area of the home. People and/or their representatives told us if they had any concerns they would raise these with the manager.

People and relatives were concerned about the staffing levels at night and staff's ability to respond to an emergency or incident. One person commented: "when I ring the buzzer at night I just hope for the best".

Is the service well led?

We saw there was a range of quality monitoring checks in place to make sure the manager and staff learned from audit checks. The manager completed a daily visual check when they were working. We saw there was a range of monthly audits completed by the manager which included the following: health and safety check, lounge check, bedroom check, bathroom check and toilet check. The manager had completed an infection control audit and a medication audit. The manager had accessed support from the NHS to provide guidance and support for different areas in home. This included infection control, care planning and the management of medicines.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People living at Croftacres told us that they were offered choices and that staff respected their dignity and privacy. For example, one person stated that staff, 'always,' respected their dignity and privacy and said, 'the carers know me and what I like inside out.'

People were positive about the care and support they received at Croftacres. One person told us, 'I can't fault a thing about living here.' The relative spoken with as part of our inspection stated, 'they care for my Mum like I would.'

Our observation of the administration of medication and our check of medication records identified a number of issues. We found that people living at Croftacres were not protected against the risks associated with the unsafe management of medication.

Our conversations with staff and our check of records identified that staff received: supervision, an annual appraisal and a range of training courses. We found that there were some processes in place to record and evaluate information about the quality and safety of the care provided at Croftacreas.

We spoke with two relatives who told us that they had been fully involved in their relative's care planning and included in reviews but they had never been asked to sign anything. We saw that people were able to give verbal consent but we found that the new care plan documentation introduced by the home did not include a consent form for people or their representative to sign.

We observed staff providing reassurance, care and concern to people. We spoke to five people who told us that they were satisfied with the quality of care provided. Their comments included: "We can have a laugh and a joke with staff.' 'The staff don't rush you they tell you to take it steady.'

We saw that people in the home benefited from equipment that was comfortable and met their needs.

We found that the home had appropriate staffing levels and could respond to unexpected absences.

We found that staff had received training and were supervised but that some staff supervisions were overdue. We saw evidence that staff had the opportunity to develop and improve their skills.

We saw that the home had a system in place to deal with complaints but that it required updating. We also saw that the home had provided people with information about how to complain. All the people we spoke with told us that if they had a concern they would speak to staff or their relative.