Crofton Lodge

Crofton Lodge is a residential care home providing personal care to up to 10 people. The service provides support to people with mental health conditions and learning disabilities. At the time of our inspection there were 8 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were supported to develop their independence. Staff were able to tell us about skills they were supporting people to develop to promote their independence. People had access to the community if they wished, with or without support from staff. We observed people being supported to choose and plan activities they wanted to do.

We observed, and staff could demonstrate, people were supported to have control and choice over their lives and staff supported them in the least restrictive way possible. However, the records did not always reflect or demonstrate this and so we could not be fully assured people were supported to have maximum choice and control of their lives and staff supported them in their best interests. We have made a recommendation about the recording of mental capacity assessments, best interest decisions and deprivations of liberties and safeguards.

Since the previous inspection the provider had reviewed and updated people’s care planning documentation. Individual risk assessments identified potential risks and provided information for staff to help them avoid or reduce the risk of harm to people. However, further improvements were required to the electronic care planning documentation. For some people some of their risk assessments required additional detail to provide clearer guidance to staff. People’s care planning documentation was in the process of being updated at the time of the inspection.

Right Care: People’s needs were reviewed regularly to ensure staffing levels were safe. The provider had adjusted staffing levels when people’s needs had changed. People confirmed staff were trained and knew how to support them. We observed people being supported by staff who knew them well and staff demonstrated their knowledge of people and their likes and dislikes. Staff spent time getting to know people and were able to recognise any signs that may indicate a decline in their mental health. They understood how best to respond when people were upset or anxious.

People were kept safe from avoidable harm. People told us they felt safe and were happy living at the home. People confirmed they knew who they could talk to if they had any concerns.

Since the previous inspection the provider had made changes to their medicines systems and processes. We found further improvements were required as these were not always effective. We have made a recommendation about medicines quality assurance. Staff files mostly contained all the information required to aid safe recruitment decisions. We have made a recommendation in relation to ensuring recruitment processes are compliant with legislation.

We observed people received person-centred care and support. People were not rushed; staff were ensured they listened to people and supported people at their preferred pace. Staff worked collaboratively with health and social care professionals to ensure people received good quality of care which suited their needs.

Right Culture: People were provided with opportunities to feedback about their care and the service. People told us they could give their views on what they wanted and confirmed they felt listened to. People were happy with the service.

At the last inspection we had identified there were areas of the home which had been poorly maintained. We found some improvements had been made. The provider had a programme of planned environmental improvements which when complete would enhance the environment.

Since the previous inspection the provider had implemented more robust quality assurance processes and systems. We found these were mostly more robust and effective with actions taken to drive improvements. This was a work in progress and time was needed for these to become fully embedded within the service. The registered manager had oversight of accidents, incidents, complaints and safeguarding concerns within the home. These were monitored regularly to identify any patterns, trends or areas for development. The registered manager was open and transparent during the inspection process. They told us of the lessons they had learned, staffing changes they had made and the improvements in progress as well as the challenges they were working on.

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 5 August 2022) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Recommendations

We have made recommendations in relation to medicines, recruitment and mental capacity assessments, best interest decisions and deprivation of liberties and safeguards.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Crofton Lodge is a residential care home providing care and accommodation for up to 10 people who are living with a learning disability or mental health condition. At the time of our inspection there were eight people using the service.

Crofton Lodge comprises of two apartments with their own external doors, kitchen, lounge and bathroom, and six en-suite bedrooms all with kitchenettes and space for seating. There is also a shared kitchen, lounge, bathroom, activities room and dining area.

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

People told us they felt safe and liked living at the home. People knew who they could talk to if they had any worries or concerns. There were appropriate policies and systems in place to protect people from abuse. People were involved in managing their own risks whenever possible. Staff anticipated and managed risk in a person-centred way, there was a culture of positive risk taking.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The ethos, values, attitudes and behaviours of the management and staff provided support in the way each person preferred and enabled them to make meaningful choices. People had care plans in place. However, there was a lack of detail and care plans had not always been updated to reflect the current support people were receiving. People told us they felt additional training would enable staff to be able to support them more fully with their emotional wellbeing and mental health.

Risks to people were mostly recorded in their care plans. However, care plans and risk assessments had not always been updated to reflect changes in people’s support. The provider was prioritising updating records. Staff demonstrated their knowledge of people and how to support them to manage their individual risks.

People and staff told us there were enough staff to meet people’s needs. Staffing levels were based on the needs of the people living at the service. We observed safe staffing levels throughout the inspection and staff appeared unhurried and responsive to people. Safe recruitment processes were mostly in place.

People received their medicines in line with their preferences by staff who knew people well. Staff mostly followed systems and processes to safely administer, record and store medicines. The provider was carrying out a review of their medicines processes following the inspection. Improvements were needed to ensure medicines were managed in a way that ensured the best possible outcomes for people.

Systems and processes to monitor the service were not always robust. This meant they were not always effective, did not drive improvement and did not identify some of the issues we found at this inspection. Checks to ensure that records were effective and up to date were not always completed appropriately. The provider had identified some of the concerns prior to the inspection and had started to take action to address them.

Since the last inspection the service had experienced some management and staffing changes which had caused some destabilisation within the staffing team. The registered manager was open and honest about the challenges the service had experienced, both in relation to changing the culture of the service, and the impact of COVID-19. They were working alongside staff to promote a positive culture and embed good practice.

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

Rating at last inspection

The last rating for this service was good (published 06 April 2018).

Why we inspected

We received concerns in relation to safeguarding, cleanliness and record keeping. As a result, we undertook a focused inspection to review the key questions of safe and well led well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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 take further action if needed.

We have identified a breach in relation to record keeping, assessing and monitoring risk and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Measures were in place, and clearly communicated, to prevent relatives, professionals and others visiting from spreading infection at the entrance and on entering the premises. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home.

People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection. Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using telephones, regular e-mails to family members and visiting in the communal garden.

A testing scheme for all people and staff had been implemented, known as ‘whole home testing’. The provider had tests for regular 'whole home testing' as well as tests for any suspected or symptomatic residents or staff.

People had been supported to make informed choices in relation to vaccinations, and for those who consented, vaccinations had been made available to them. People and staff had individual risk assessments in place, and adjustments had been made.

Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading to other people and staff members. Staff had received training from an IPC specialist. Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

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.

We previously inspected Crofton Lodge on 11 April 2017 and rated the home as requires improvement. We found a breach Regulation 12 Health and Social Care Act Regulated Activities Regulations 2014 Safe care and treatment. The management of medicines was not always safe as records and auditing had not been effective and temperature checks of medicines storage did not consistently take place.

At this inspection we found improvements had been made and the provider was no longer in breach of the HSCA.

People were safeguarded from potential harm and abuse. Staff undertook safeguarding training and any issues raised were fully investigated. The service was homely and maintained to make sure it remained a safe and pleasant place for people to live.

Care and treatment was planned and delivered to maintain people’s health and safety. During the inspection people's needs were met by sufficient numbers of staff.

Safe arrangements were in place to reduce the possibility of infection in the service.

The provider had learned lessons from previous inspections, accidents and incidents and use this to drive improvement.

Documentation was created in a format suitable to support people to make decisions.

The registered manager and staff had created a culture of promoting independence.

Recruitment processes remained robust. Medicines were administered by staff who had received training to undertake this safely.

Staff were provided with training to help them care for people effectively. They received supervision and appraisal, which helped to develop the staff's skills.

People’s dietary needs were known and if staff had concerns people were referred to relevant health care professionals to help to maintain their well-being.

People’s rights were protected in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood their responsibilities regarding this.

Staff supported people with kindness, dignity and respect. People were supported to undertake a range of activities at the service and in the community.

People received the care and support they required and their needs were kept under review.

People were asked for their views about the service and feedback received was acted upon. The registered manager, staff and senior management team undertook checks and audits of the service.

Crofton Lodge provides care and accommodation for up to 10 people who are living with a learning disability or mental health condition. On the day of the inspection nine people were living in the home.

The service did not have a registered manager at the time of our inspection. The previous registered manager had cancelled their registration in February 2017. A person was employed to manage the service on a day to day basis and they had plans to make an application to become the 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 management of medicines was not always safe. Records and auditing procedures had not been effective and temperature checks of medicines storage did not consistently take place.

People told us they felt safe at the home and staff had a good understanding of their roles and responsibilities in protecting people from abuse. They knew what to look for and the action to take if they were concerned.

Staff were aware of risks associated with people’s care and knew the action to take if the risks presented. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Staff received training and supervision to make sure they had the skills and knowledge to support people.

People were supported to be independent and valued members of the community. They were supported to make informed decisions and choices. They had access to health professionals when they needed it and enjoyed their meals. They were supported by staff who knew them well, were kind, caring and proactive in their support approaches.

Support plans provided guidance to staff and people were involved in the development of these. The manager was aware that these required updating and was working through these at the time of the inspection.

Systems and processes were in place to monitor and assess the service, and to drive improvement. A plan was in place to address maintenance concerns as the home was not always well maintained. However at times action plans lacked clear direction and timescales. We have made a recommendation about this. People and staff spoke positively about the manager who was described as approachable and supportive.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the report.