Archived: The Croft (RCH) Limited

The Croft provides single bedrooms most with ensuite facilities, suitable communal areas and access to an enclosed courtyard garden.

We found the following examples of good practice.

The provider was aware of the correct procedures for professional visitors and the home’s policy reflected this. However, the person who answered the door on our arrival and allowed us to enter the home did not follow these procedures. People are supported to have family or friends to visit, access the local community and follow safe procedures.

Although not following the correct guidance for COVID – 19 testing as PCR tests were not being completed the provider and people living in the home were doing daily Lateral Flow Tests which would mean any infection would be identified early.

The home had ample space for people to socially distance. All bedrooms in use were for single occupancy with ensuite facilities. The provider understood how they would isolate people and the home if any positive Covid – 19 results were received. The provider was the only staff employed at the time of the inspection. Contingency staffing arrangements were in place should the provider need to isolate.

The home was not admitting any new people at this time. The provider was aware of actions they should take should a person require hospital admission and how to manage their safe return.

There were appropriate supplies of Personal Protective Equipment (PPE) available which we saw was being used appropriately during the inspection.

At our last inspection in March 2021 the provider had failed to ensure all infection prevention and control measures were fully implemented. This was a breach of Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve infection prevention and control procedures. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The Croft (RCH) Limited is a residential care home that provides accommodation and care for older people and younger adults living with a mental health condition. The service is registered to accommodate up to 21 people. At the time of our inspection, there were 16 people living at the service.

People’s experience of using this service and what we found

Although the service had a good supply of PPE to meet current and future demand, not all staff were wearing the correct type of face masks. Some staff were noted to be wearing fabric face coverings, not fluid resistant masks as required by best practice guidance. Immediate action was taken when we identified this to the management team.

Following the inspection, the provider updated their COVID – 19 policy. We received a copy of this which now reflected current best practice guidance. An infection control audit had not been completed since the previous inspection in November 2020. This meant the provider could not be assured that infection prevention and control measures were being followed by staff and procedures would protect people and others.

Staff had received training in the correct use and disposal of PPE. Staff had also received training in infection control practices.

There were procedures in place to support safe visiting by family members or professionals. Staff undertook temperature checks and asked questions to determine risks posed by visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.

New admissions or people returning from hospital were supported in line with best practice guidance. They were expected to provide recent COVID-19 test results, were further tested by the service following admission and isolated upon arrival for 14 days to minimise the risk of potential infection to existing people. These procedures were also followed if the service became aware that people had not followed safe practices when out of the home in the local community.

People and staff were regularly tested for COVID-19. Staff had LFT testing twice a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The manager understood the actions they needed to take should any tests return a positive result.

The home was kept clean. A program of frequent cleaning of high touch surfaces, such as light switches, handrails and door handles was in place.

The provider and manager understood good recruitment procedures and the requirement for pre-employment checks to be undertaken.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The previous comprehensive inspection resulting in a rating for this service, was Requires Improvement (published 24 August 2019). There were two breaches of regulation.

In November 2020 we undertook a targeted inspection of this service. We looked at the parts of the key question ‘Is the service safe’ we had specific concerns about. This identified areas for improvement. We issued the provider with a warning notice and told them they must make improvements.

At this targeted inspection we followed up the warning notice and looked at recruitment and infection prevention and control procedures. Some improvements had been made however, the service remains rated requires improvement and we did not assess all areas necessary to change the ratings for this service.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (infection prevention and control) and 19 (recruitment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Croft (RCH) Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to Infection prevention and control at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure people and others are safe. standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Croft (RCH) Limited is a residential care home that provides accommodation and care for older people and younger adults living with a mental health condition. The service is registered to accommodate up to 21 people. At the time of our inspection, there were 17 people living at the service.

People’s experience of using this service and what we found

Department of health best practice guidance on the prevention and control of infections, specifically Covid 19, were not always followed. This included the correct use of personal protective equipment and safe visiting arrangements.

Recruitment practices were not safe as some pre-employment checks for new staff had not been completed. Therefore, the service could not be assured that staff recruited were of good character or suitable to work at the service. There were sufficient numbers of staff available to people. Staff had the time they required to provide people with responsive and effective care in a relaxed and unhurried way.

Some aspects of medicines were not always managed safely. Medicines stock levels were checked and did not always correspond to records held. Therefore, we could not be assured that medicines administration records (MAR) were completed correctly or that people received their medicines as prescribed. There was a lack of specific individual detail as to when ‘as required’ (PRN) medications should be given meaning people may not receive these consistently as prescribed.

People told us they were happy living at The Croft and that they felt safe. They said staff treated them well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires Improvement (published 24 August 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected

We received concerns in relation to staff use of personal protective equipment (PPE) and safeguarding. As a result, we undertook a focused inspection to review these and the previous breaches of regulation relating to staffing and medicines.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to safe recruitment and infection prevention and control at this inspection. We issued warning notices telling the provider they must make improvements. The provider has told us they have taken the necessary action to keep people safe.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Croft RCH on our website at www.cqc.org.uk.

The Croft (RCH) Limited is a residential care home that provides accommodation and older people and adults living with a mental health condition. The service is registered to accommodate up to 21 people. At the time of our inspection, there were 16 people living at the service.

People’s experience of using this service and what we found

Medicines were not always managed safely. Poorly completed records of when ‘as required’ medicines had been administered placed people at risk of not receiving medicine when required or receiving doses too close together. Medication stock records did not reflect the amount of medication in stock. Therefore, we could not be assured that medicines administration records (MAR) were completed correctly or that people received their medicines as prescribed.

Recruitment practices were not safe as some recruitment checks for new staff had not been completed. Therefore, the service could not be assured that staff recruited were of good character or suitable to work at the service. There were sufficient numbers of staff available to people. Staff had the time they required to provide people with responsive and effective care in a relaxed and unhurried way.

Some people’s care records did not contain detailed risk assessments and risk management plans. However, when discussing people’s specific risks with staff they were aware of risks and able to describe action they would take to mitigate and manage risks.

There were quality assurance procedures in place, however, these were not always robust in certain areas of the service. They had not clearly identified where improvements were required to address the concerns we found.

People were happy living at The Croft and told us they felt safe. All people said they were well supported by staff who understood their needs. Appropriate safeguarding procedures were in place to protect people from the risk of abuse. Staff knew how to report concerns and were confident that anything they raised would be taken seriously by management. Infection control risks were managed appropriately.

The management team were open and transparent. They understood their regulatory responsibilities. People and staff felt the management team were open, approachable and supportive. Everyone was confident the manager would take the necessary action to address any concerns promptly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The service was rated as Good at the last full comprehensive inspection, the report was published in July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines, staffing levels and skills and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this report.

Enforcement

We have identified breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Croft (RCH) Limited is a residential care home that provides accommodation and older people and adults living with a mental health condition. The service is registered to accommodate up to 21 people. At the time of our inspection, there were 16 people living at the service.

People’s experience of using this service:

People were happy living at The Croft and felt safe.

There were enough staff to meet people’s needs and they had been recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively.

Appropriate safeguarding procedures were in place to protect people from the risk of abuse. Staff knew how to report concerns and were confident that anything they raised would be taken seriously by management.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately.

Staff sought people’s consent and supported people to make choices about their care. However, where people lacked capacity to make certain decisions, this was not always assessed and recorded appropriately in line with legislation.

Staff treated people with kindness and compassion. Staff had developed positive relationships with people and knew what was important to them. People were treated with respect and dignity.

People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them.

There was a clear management structure with staff being supported by the registered managers and provider. People, staff and professionals commented positively about the management of the service and felt that it was well-led. The provider was engaged with the running of the service and staff and people told us they were approachable.

Quality assurance systems were not always completed in a robust and consistent manner. They had not clearly identified where improvements were required to address the concerns we found.

Rating at last inspection:

The service was rated Requires Improvement at the last full comprehensive inspection, the report for which was published on 20 June 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following our inspection in September 2016, where we identified concerns in respect of medicines management, quality assurance, recruitment and records we told the provider they must send us an action plan each month telling us what they were doing to ensure people received a safe and effective support which met their needs. The provider sent us monthly evidence. On our last inspection in March 2017 we found the provider had addressed these concerns and but these practices were not fully embedded into the service. Therefore, the service was rated Requires Improvement in Safe and Well-led domains and overall.

At this inspection we found the service remained Requires Improvement in Safe and Well-led domains and overall.

There was no 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 informed Care Quality Commission earlier this year that the registered manager left due to personal reasons and the service was managed in the interim by two acting managers who planned to register in due course.

At this inspection we found concerns about the records, the effectiveness of the quality assurance systems and the governance of the service. We identified that the provider’s own medicines audits were not always effective as these failed to identify issues that we found. The provider’s own quality assurance also did not identify concerns around water risk assessment and the lack or the records of the fire drills. We found some of the provider’s policies still needed updating and that the staff did not always follow the provider’s policy.

People’s medicines were administered and stored securely. However, we found concerns regarding stock keeping and we identified there were no protocols surroundings ‘as required’ medicines. We also found there was not always evidence available that environmental risks were managed safely. For example, there was no evidence that regular fire drills took place. We also found there was no system in place to assess and manage potential risks relating to water safety. Following our inspection we asked the provider to take action to address these concerns. The provider promptly responded and advised they were going to review and implement a new water safety policy and risk assessment.

People told us they were safe. Staff knew how to report safeguarding concerns and they were confident any concerns would be followed up by the management promptly. People’s care files contained individual risk assessments surrounding people’s well-being and individual conditions. Where people had been identified as at risk, management plans guided staff on how to keep the person safe and staff knew people’s needs well. People were supported by sufficient numbers of staff and received support in an unhurried manner. Staff had ongoing training and told us they were well supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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. People’s rights to make their own decisions were respected.

People were assessed prior to coming to live at the service and staff knew people’s needs well. People's care plans gave details of the level of support required, people's wishes and choices and demonstrated people’s involvement in care planning process. People were supported to maintain good nutrition and access health professionals appropriately.

People were treated with dignity and respect by kind and compassionate staff. Staff had a good understanding of the needs of people and had developed meaningful, caring relationships with people. People were supported to be as independent as possible.

People had access to activities of their choice. Information on how to complain was available to people and the provider had a complaints policy in place.

Throughout our inspection there was a positive atmosphere at the service and people complimented the service and how it was run. There was a positive approach and responsiveness demonstrated by acting managers and the provider. They had a clear vision of achieving good outcomes for people. They acknowledged the improvements needed and were keen to address the concerns that we found.

The service worked in partnership with a number of external professionals and commissioners to ensure good outcomes for people. We received positive feedback from a professional who was very complimentary about personalised care and approach people had at the service. The provider had a whistle blowing policy in place that was available to staff. Staff were aware of the whistle blowing policy.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken in the full version of this report. We also reviewed the condition we imposed after our inspection in September 2016 when we told the provider they must send us an action plan each month telling us what they were doing to ensure the service was meeting the requirements. As this is the provider's third consecutive overall Requires Improvement rating a decision has been made to keep this condition in place so the progress of making the necessary improvements around safety and governance of the service can continue to be closely monitored.

The Croft did not have a registered manager, however the manager had commenced the process to register with the commission. 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 the last inspection in September 2016, we asked the provider to take action to make improvements in relation to areas of the service including medicines management, record keeping, risk assessment and care planning, ensuring people’s legal rights to make decisions were assured, recruitment procedures and infection control. We told the provider they must send us an action plan each month telling us what they were doing to ensure people received a safe and effective service which met their needs. Action plans have been received each month and show the manager has been working with a range of professionals to make the necessary improvements. Most areas have now been completed and the service is now embedding these in practice. The manager was aware of remaining action that is required such as ensuring the policies and procedures were up to date and a business continuity plan was in place.

The manager and provider were aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and manager with people, relatives and staff.

Care plans provided comprehensive information about how people wished to be cared for and staff were fully aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. Systems to manage medicines safely were in place although staff did not have individual information as to when ‘as required’ medicines should be administered.

People and external health and social care professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet. People were supported and encouraged to be as independent as possible and their dignity was promoted. Staff followed legislation designed to protect people’s rights and freedoms.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work. Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care.

People were offered an extensive range of activities suited to their individual needs and interests providing both mental and physical stimulation.

People and relatives were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Improvements had been made to the homes environment which was clean and safe for people. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

At our previous comprehensive inspection in November 2015 we found the provider did not have an effective system to ensure the safe management of medicines and people’s legal rights had not always been assured when care was provided. At this inspection we found adequate action had not been taken or not maintained to ensure medicines were managed safely and additional concerns were identified regarding records and management quality monitoring systems were not robust.

The home did not have 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. The manager told us they were planning to register with CQC and initiated the process to do this soon after the inspection.

The management team had taken action to address immediate concerns when they took over the running of the home in May 2016 and were committed to rectifying the situation and ensuring people received a service which met their needs. The previous management team had left without notice and removed or deleted electronic records. There were limited formal quality assurance systems. This meant that whilst some areas of concern had been identified and action was planned other areas of concern had not been identified and people may not have received the care they required.

Many records relating to the safe organisation and running of the home were inadequate or not present. Staff shortages meant the manager had been working some care shifts. This impacted on their ability to undertake all of their management functions.

Medicines were not always managed effectively meaning that people had not always received all medicines as prescribed by their medical practitioner and their health needs were not being met. Although, staff were aware of people's individual care needs and preferences the care plans and related records of the care people had received were incomplete. They did not provide information about how people wished to be cared for, or how their health care needs should be met. The manager regularly worked with care staff providing informal monitoring of the care people received.

The recruitment process did not ensure that all necessary pre-employment checks had been completed to ensure staff were suitable for their role. Training for all staff was planned via an external training provider. Staff were not receiving formal supervision or appraisals although they had regular support from the manager who often worked directly with them.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was informally followed although formal mental capacity, best interest and consent assessments had not been documented. This meant people’s legal rights may not be assured in respect of decisions made on their behalf. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

People and relatives were positive about the care people received. People were positive about meals and the support they received to ensure they had a nutritious diet.

People and relatives were able to complain or raise issues on a formal and informal basis with the manager and were confident these would be resolved. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together, which created a relaxed atmosphere that was reflected in people's care.

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

We spoke with two members of staff including the person in charge at the time of the inspection. Staff told us there was a range of training provided and there were systems in place to ensure support was available. Formal appraisal and supervision procedures were now in place.

Adaptations to the environment had been made to ensure the safety and suitability of the environment for the people living there.

We spoke with care staff who were aware of how people should be supported, their individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people's needs. Staff also told us they had attended relevant training and had all the necessary equipment to care for people safely.

We spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and the care we observed corresponded with care plans and risk assessments viewed.

Staff were receiving training and were generally available to meet people's needs however, there was a need to implement plans for supervision and appraisals.Concerns about security and fire exits identified previously had not been addressed. A range of quality monitoring procedures were in place.

People told us that they were treated with well and 'it was all right' when asked about what it was like living at the home. We observed that the staff behaved in a respectful manner when speaking to people. A visiting healthcare professional told us that they visited one of the people regularly and found that they had settled at the home. We found that although initial assessments were completed, people care plans did not reflect their current needs and how these would be met. Where risks were identified such as falls, there were limited action plans to show how these would be effectively managed.

Healthcare professionals advice were sought and detailed guidance was provided to staff . These were not always followed by the staff which meant that people did not receive the care they needed. People were not always supported to be able to eat and drink sufficient amounts to meet their needs.

We found that the arrangements for the management of people's medicines were not adequate and action was needed. There was not always adequate staff and staffing hours were eroded by non care duties. There was a lack effective system to monitor the quality and service delivery.