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Inspection carried out on 10 November 2020

During an inspection looking at part of the service

Carr Croft Care Home is a residential care home in Leeds. The home provides accommodation and personal care for people living with learning disabilities. At the time of our inspection there were 30 people using the service.

We found the following examples of good practice.

• The home completed PPE competency checks on all staff to ensure they were competent in PPE and handwashing procedures.

• People and staff had access to regular COVID-19 testing.

• The registered manager had used technology and letter writing to maintain established links with local community groups and religious organisations to enhance people's wellbeing.

Inspection carried out on 2 November 2018

During a routine inspection

This comprehensive inspection took place on the 2 and 14 November 2018 and was unannounced.

Carr Croft Care Home 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.

Carr Croft Care Home is registered with the Care Quality Commission to provide accommodation and personal care for up to 35 older people some of whom may be living with dementia. There were 30 people using the service at the time of this inspection.

At our last inspection in February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no 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.

There was no registered manager at the 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. A new manager, who had been the previous registered manager of the service, had been appointed and was due to re-commence shortly after our inspection. An acting manager and the provider had managed the service in the interim period.

People continued to feel safe using the service and staffing levels were sufficient to provide safe care. We found some improvements were needed to fully ensure the safe management of medicines. The acting manager took prompt action to ensure the issues with the management of medicines were addressed by the end of the inspection. People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to. Safe recruitment practices were followed to make sure staff were suitable to work with vulnerable adults. Staff were trained in good hygiene practice and were supplied with personal protective equipment such as gloves and aprons.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and procedures in the service supported this practice. Staff asked for people's consent before providing any care and understood the principles of the Mental Capacity Act 2005 (MCA). People and their relatives had been involved in assessments of care needs and had their choices and wishes respected.

The provider had a plan in place to ensure staff attended required training. We received positive feedback about the effective care and support provided. People told us staff were well trained. Staff were supported in their on-going development through supervision and appraisals. Staff said they received good support from the provider.

People received appropriate support to meet their nutritional needs. People’s nutritional needs were assessed and monitored and they enjoyed the food and variety of choice available to them. The service worked well with health professionals such as nurses, doctors and occupational therapists to promote people's health needs.

There was a positive and inclusive culture at the service. The provider promoted a culture of dignified and respectful care. People told us they were supported by staff who were kind, caring and compassionate. Staff knew people well and made sure people received care and support that was personal to their needs and was responsive to any changing needs. Care plans were person-centred and gave good detailed guidance for staff to follow.

People and their relatives had regular contact with the acting manager or provider and re

Inspection carried out on 9 February 2016

During a routine inspection

This inspection took place on 9 and 11 February 2016. The first day was unannounced and the second day was announced because we wanted to make sure the registered manager was available. At the last inspection in December 2014 we rated the service as requires improvement. We found the provider was breaching two regulations. People were not always protected against the risks associated with medicines and robust recruitment checks were not always carried out before staff started working at the service. At this inspection we found the provider had taken appropriate action and improved how they managed medicines and recruited new members of staff.

Carr Croft Care Home provides care and support for up to 35 older people. 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.

During the inspection there was a happy and friendly atmosphere. Staff were kind, cheerful, considerate and helpful; they maintained a professional and caring approach even when they were very busy. People enjoyed the company of staff and management who often sat and chatted to them. People told us the service was caring and they received person centred care.

Staff knew people well and responded to people’s individual needs. Care plans were person centred and covered key areas of care and support. People were involved in making decisions about their care. People engaged in social activities in the home and the local community.

People felt safe. Systems were in place to keep people safe, which included protecting them from abuse. Checks were carried out to make sure the environment was safe. We found a small number of areas when we looked around the home that needed addressing to mitigate risk. For example, bath and shower hot water outlets were not regularly tested. The provider took prompt action to make sure these areas of risk were managed.

People lived in a comfortable and clean environment. The provider had improved some of the premises and had a formal plan to improve other areas; this included creating a safer and more supportive environment for people living with dementia to make sure they can live comfortably and maintain their independence.

People received a varied and nutritious diet and enjoyed the meals. They received good support that ensured their health care needs were met.

There were enough staff who were skilled and experienced to meet people’s needs. Staff were trained and supported to do their job well.

The service had good management and leadership. People were complimentary about the registered manager and provider; they told us the service was well led. The home’s management team promoted quality and safety and had good systems in place to help ensure this was achieved. They worked alongside everyone so understood what happened in the service. People were encouraged to share their views and contributed to the running of the home.

People had no concerns about their care but were informed how to make a complaint if they were unhappy with the service they received.

Inspection carried out on 16 December 2014

During a routine inspection

This was an unannounced inspection carried out on the 16 December 2014.

At the last inspection in June 2014 we found the provider had breached three regulations associated with the Health and Social Care Act 2008. We found people did not experience care, treatment and support that met their needs, appropriate steps had not been taken to ensure that, at all times, there were sufficient numbers of staff and the assessing and monitoring the quality of service provision did not ensure people’s safety and welfare. We told the provider they needed to take action and we received a report on 9 August 2014 setting out the action they would take to meet the regulations. The provider told us they would have met the regulations by the 31 October 2014. At this inspection, we found some improvements had been made with regard to these breaches. However, we also found other areas of concern.

Carr Croft Care Home is situated near Chapel Allerton on the outskirts of Leeds. It is a care home without nursing. They are registered to provide accommodation for up to 35 persons who require personal care. Accommodation is situated over two floors with lift access. There is good parking facilities and a ramp to the front door providing level access.

At the time of this inspection the home 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.

At this inspection we found people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were not protected from staff unsuitable to work with vulnerable people because checks were not robustly carried out prior to staff starting work at the home.

People were supported by sufficient numbers of staff to keep them safe. The provider had a programme of training and supervision, however, we were concerned that the training provided may not equip staff with the knowledge and skills because staff sometimes completed multiple training sessions in one day.

People were happy with the care they received and felt they were competent and caring. They were involved in activities within the home and the local community. People received good support to make sure their health needs were met. Care plans gave staff information about the best way to support people and assessments had been completed where areas of risk were identified in the care plans. However, staff did not always know and understand people’s history or their cultural and religious needs.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of audits produced by the registered manager. Staff were complimentary about the registered manager and said the home was well managed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 19, 23 June 2014

During a routine inspection

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on observing care, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People did not experience care and support that met their needs and protected their rights. People�s needs were not assessed and care and support was not delivered in line with their care plan. Care and support was not planned and delivered in a way that ensured people�s safety and welfare.

People who used the service were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were not enough qualified, skilled and experienced staff to meet people�s needs. We looked at the staffing rotas for the five weeks prior to the inspection and these showed that there had not always been the full complement of staff on duty. People told us they sometimes had to wait a long time before staff could support them. One person said, �There is a lack of staff. You have to wait. Going to the toilet is one of them and you have to hang on.� Another person said, �When you are calling for the toilet sometimes you have to wait a long time and then you worry about what you might be doing in the meantime. I get very tired but have to wait for them before I can go in the chair lift and to bed. At my age I�d like to be able to go to bed when I�m ready.�

Relevant staff had not been adequately trained to understand the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. The provider said they had identified they needed to develop their knowledge and skills in this area.

Is the service effective?

People who used the service told us they could choose where to spend their time. During the day some people were in their room and others spent time in communal areas. A number of people also spent time sat outside in the sunshine. One person said, �This is my home. I choose when to stay in my room and when to spend time with others. I�ve got the best of both worlds. I have time on my own but don�t get lonely.� Another person said, �I like to sit here then I can see what�s going on.�

People�s diversity, values and individual needs and wishes were not taken into account. One person was very upset and said they did not want to stay at the home. Staff confirmed the person had shared this view on a number of occasions. We asked what the home had done about this and were informed no action had been taken.

Staff had not considered the spiritual or religious aspects of care. There was no evidence to show how the home had supported people to fulfil their religious faiths. The menu did not include appropriate meal options to meet people�s cultural needs.

Is the service caring?

People were happy with the care staff that supported them. We spoke with nine people who used the service. They told us staff were respectful and described staff as �caring�, �kind� and �friendly�. One person said, �Carers are very kind. They put themselves out and get you what you want. I have no fault with the carers what so ever.� Another person said, �They are a lovely bunch and very helpful.�

We spoke with four visiting relatives. They were complimentary about the staff that provided care and support. One relative said, �They are really nice staff and do their best.� Another relative said, �The staff here are lovely.�

Is the service responsive?

People told us contradictory things about the support they received with personal care. One person told us they enjoyed having their weekly bath and didn�t want to have one more frequently. Another person said they were unhappy because they had not been appropriately supported to have a shave.

When we arrived at the home staff were very busy and could not spend time with people. There should have been four staff on duty but one member of staff had not turned up for their day shift so there were only three. Staff told us this often happened because some staff were not reliable.

We were at the home in the early evening and observed staff were very busy. One person who used the service was walking around the home and entered other people�s rooms. They sat in one person�s room when they were in bed and were asked to leave but remained in the room. Staff were unaware of this incident because they were not in the vicinity. Another person was in their bedroom with the door open but had a commode chair placed in the doorway. They confirmed this was to prevent others from coming into their room.

Is the service well led?

The service was not appropriately managed. The registered manager was no longer in post. The deputy manager was covering on a temporary basis but had not been allocated any additional time to carry out management responsibilities. The provider had visited the home on a frequent basis but this was often for short periods.

The office was locked when the provider was not present in the home so others did not have access to important information such as policies and procedures and accident records.

The provider must notify the Care Quality Commission (the Commission) when certain significant events occur but had failed to report all events. For example, an incident occurred which involved the Police and the Commission were not notified.

Staff training and supervision was not being monitored to make sure staff received appropriate support. The provider showed us a training matrix and a supervision matrix but said these were not up to date. The provider said staff had completed on-line training but when we asked to see evidence of this the provider found that most staff had not completed the training.

Inspection carried out on 24 September 2013

During an inspection looking at part of the service

There were effective recruitment and selection processes in place. The provider had reviewed and updated their recruitment policy and procedures for employing new members of staff. People who used the service said they were well cared for and the staff knew how to look after them safely. Staff told us people who used the service were supported by suitably skilled and experienced staff.

Inspection carried out on 18 April 2013

During a routine inspection

We spoke with six people who used the service. They said they were happy with the care and support they received. People were complimentary about the staff who assisted them. One person said, �I�ve no grumbles. Staff are very nice, very pleasant.� Another person said, �I�m quite happy here, the staff are very good.� One person told us their care plan was discussed with them and that they had signed it to say they agreed to how their care should be delivered.

Staff understood how to respect people�s cultural, social values and beliefs and how decisions should be made for people who were unable to give consent.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that there were not always effective recruitment and selection processes in place which could result in people being cared for, or supported by unsuitable staff.

People who used the service, their representatives and staff were asked for their views about their care and support and they were acted upon. Staff we spoke with said people received safe quality care. One member of staff said, �It runs smoothly. We�ve got things in place so we know what we�re doing.� Another member of staff said, �The provider visits everyday and checks everything out.�

Inspection carried out on 17 July 2012

During an inspection looking at part of the service

We spoke with seven people who used the service and they told us they received good care and were well looked after. One person said, �I can�t grumble. I have everything I need. I don�t need much help but I get it when I need it.� Another person said, �I�ve had a few ailments but they�ve helped me sort them out. They help me get ready for bed when I�m ready to go.� Another person said, �Everything is fine, I�m quite satisfied.�

We spoke with three visitors who were relatives of people who used the service and had visited the home on a frequent basis. They all told us they were happy with the care their relative received. One visitor said, �People are well looked after. I�ve got experience of visiting different homes and this is very good.� Another visitor said, �I�m very happy with the care. Mum has really come on since she moved in here.�

We spoke with three members of staff who told us that better systems had been introduced to check that people�s needs were being properly assessed and met. All three staff said people received good care. One member of staff said, �People are being cared for properly and I have no concerns.� Another member of staff said, �People are receiving good care.�

Staff said they had received a range of training sessions since the last inspection, which helped them understand how to meet people�s needs properly, which included, moving and handling, dementia, healthy eating and safeguarding. One member of staff said, �Receiving this training has helped make things better.�

When we carried out our inspection the manager had only been in post for four weeks. People were very positive about the work the manager had done so far. One person who used the service said, �Last week I had a problem with my ear and she got me sorted out straight away; she was very efficient.� Another person who used the service said, �She�s lovely and always comes and talks to me.�

Inspection carried out on 2 April 2012

During a routine inspection

People who use the service told us they were able to make decisions. One person said, �I have my own routine and let staff know when I want support. I decide when to go to my room and when I spend time with others.� Another person said, �The staff are very nice. They always ask what I want and make sure I�m ok.�

The service cares for and supports people with a wide range of needs. Some people have capacity to make decisions whilst others are confused and need more support. We were unable to communicate verbally with some people who use the service to find out their views and experiences. Three of the six people we spoke with mentioned the behaviours of others and said it affected their care. One person told us there was arguing and shouting everyday and they couldn�t cope. Another person said, �Things soon flare up, it happens very quickly and often. I sit away from them.� Another person said, �There is a lot of arguing.�

Five of the six people we spoke with told us they were satisfied with the care. One person said, �Everything is ok, I�m fairly satisfied.� Another person said, �Everything is fine, I enjoy walking and helping out when I can.� Another person said, �Things are alright, as good as can be expected.� One person told us they were not satisfied with the care.

A visitor we spoke with said, �The care�s alright. There was an issue, we told them about it and they sorted it. Otherwise everything is ok.�

Four people who use the service said they were satisfied with the food and had enough to eat. One person said, �The food is fine, I always clean my plate.� Another person said, �I�ve no complaints, we get plenty.� One person who uses the service told us they were not happy with the food and said, �It�s not to my liking.�

People said they were comfortable in their environment and could choose to spend time in communal areas or time in their room. One person said, �I have a lovely room and enjoy watching my television and having my own space.�

Two of the six people we spoke with said staff were very busy. One person said, �They are too busy.� Another person said, �They don�t have enough time but I don�t need much help so it doesn�t really affect me.� The three staff we spoke with told us they had enough time to meet people�s needs and carry out their duties; they did not raise any concerns about staffing levels.

Inspection carried out on 23 September 2011

During an inspection looking at part of the service

People who use the service told us they were happy with the care they received. Generally people said they were getting the right care. One person said, �I�m well looked after. Staff help me with what I need and I can ask for anything.� Another person said some health checks had not been carried out recently.

People who use the service said staff asked them what help they wanted but generally they did not know they had a care plan. One person said, �I�ve not seen a care plan but they do ask what I want.� Staff said the care is more person centred and the care planning and risk assessment process was working much better. One staff said, �We check out what people want. The care plans have been updated and these are much better.� The manager and provider said they were continuing to develop the plans and risk assessments, and would be looking at involving people more in the care planning process.

A visitor said people received a good service and the staff were �pleasant and friendly�.

People who use the service told us they felt safe and would talk to a relative, staff or the manager if they had any concerns. One person who uses the service said, �The staff are very nice and always ask if I�m alright.�

People said staff give them appropriate support with their medication and always give them sufficient time to take their medicines.

People who use the service told us they were comfortable in their surroundings and could choose to spend time in their room or in communal areas.

People who use the service were complimentary about staff. One person summed up the views of people by saying, �They are nice staff and like to help.�

Inspection carried out on 8 July 2011

During an inspection looking at part of the service

People who use the service said they receive a good service. One person summed up the views of people by saying, �We�re well looked after.�

Some people who use the service were unable to tell us if they get the right care to meet their needs. People who can express their views said they were satisfied with the service and did not raise concerns about their care.

People who use the service were complimentary about the staff. One person summed the views of people by saying, �Staff are very good to me.�

Staff told us the routines of the home had improved and people were being given more choice in the times they were getting up and going to bed. One care worker summed up the views of the staff and said. �We�re doing it differently and it�s working better because people are getting up when they want.�

One person said there was �not much to do� and they �get a bit bored�. The provider told us they do regular activities at the home and have an external organisation that visit the service and do a �motivation session�. They said activity was an area that needs to develop.

Inspection carried out on 18 May 2011

During a routine inspection

People who use the service said they receive good care. One person summed the views of people by saying, �We get the help we need. Staff are very good.�

People who use the service also said staff respond promptly when they want support. One person said, �I buzz for help if I need it and you don�t wait long.� People also said they receive good support if they have any health problems.

People said they can make decisions and choices about their care. One person said, �You can do what you want to do and I get the help that I need. They let me make my bed and do bits for myself.�

Some people who use the service were unable to tell us if they get the right care to meet their needs. The waking and breakfasting routine in the home appears regimented and not focused on the needs or wishes of the people cared for at Carr Croft Care Home. People are woken early and not everyone has a choice about this. As a result many people are tired and asleep again relatively early in the morning.

People who use the service told us that they were comfortable living at Carr Croft Care Home and did not raise any concerns about the premises.

People who use the service were complimentary about the staff and several described them as �good�. One person summed the views of people by saying, �Staff are lovely. Very polite and friendly.�

Inspection carried out on 24 February and 1 March 2011

During an inspection in response to concerns

People who use the service said they can generally make decisions and choices about their care. One person said, �I have always been an early riser and choose to get up at 6.00am.� Some people who use the service were unable to tell us if they can make decisions about their care and we didn�t feel that everyone who uses the service was always given choice.

One person talked about moving into the home and told us they were involved in making the decision to move into the home. They said, �I was given information, then came with my family and looked around, then came back and spent an afternoon here and had some food.�

One person said they would like to go out for a walk but they could not leave the building and didn�t not know why. We received mixed information about why the person could not go out alone.

Generally people didn't think there was much to do during the day. One person said, "We need more entertainment, we're lucky if we get a game of bingo.� Another person said, �Some of the people are not with it so they don�t get about as much as me.�

Staff said people get good care and they did not have any concerns about the home.

The manager said people are happy with the care they receive.

The manager and staff said people are involved in making decisions about their care and they influence how the service is run. The manager said they have regular residents� meetings.

Staff said they have received training to help them understand how to provide care and the management team spend time at staff meetings and talking to staff on a one to one basis about good care practices.

People who use the service told us that they had enough information about their medicines and that medicines were given at the same times every day. One person who managed some of their own medication confirmed �staff help if I need it�.

The manager confirmed that all care workers handling medicines had completed medicines training. But, whilst some care workers had received external training from a healthcare professional, some received only �in house� training.

People who use the service said they would have no hesitation in talking to the manager or staff if they wanted to talk about their care. They did not raise any concerns about staffing. One person said, �Staff are good.� Another person said, �Yes I�m very happy they look after me well.�

Staff we spoke to said there are enough staff working at the home although they said it is difficult to organise one to one support for people if they want to go out into the community.

Staff said they are well supported by the manager and the team work well together. One staff said, �It�s a good staff team, we get on well, there�s good management, they will be fair and do what they can, they are really good.�

The registered manager explained that they have recently had some problems with tensions within the staff team and this has affected the running of the home. The registered manager said the difficulties are being addressed and she believes the home will �soon be back on track�.

Staff and the manager confirmed that there are systems in place to support staff which includes regular staff meetings, supervision and management working closely with the staff team.

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