Croft House Rest Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
The service was in breach of legal regulation in relation to consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not assess and review people’s health, care and wellbeing needs with them.
Assessments did not always consider people’s current health, care and wellbeing needs; there were concerns with the level of information and accuracy of several care plans we reviewed. For example, a person’s care plan stated they could mobilise with a walking frame, preferred finger foods and had no current pressure damage. However, at the time of our inspection they were being cared for in bed, required adapted food and fluid consistencies and were being treated for a pressure wound, due to deteriorating health.
People with health conditions such as epilepsy or diabetes did not have adequate information in their care plans to enable staff to fully understand how their condition affected them, the signs and symptoms of deterioration or how to respond to concerns. When asked if they were aware of the signs of high or low blood sugars, a staff member told us, “I don’t know the signs for [person] or [person]. I have never seen them (when they have high or low blood sugar levels) and don’t know any signs to look for.”
People’s care needs were not reviewed monthly or as people’s needs changed, as per the provider’s own policies. Some people had known distressed behaviours and care plans had not been reviewed or updated following incidents, to ensure information was up to date.
Staff did not complete care records in adequate detail to enable thorough reviews, and clinical assessment tools had not always been updated. Daily notes had not recorded specific details about when or what care was provided. One person’s food and fluid intake fluctuated, and records did not enable efficient monitoring; to help staff easily identify and escalate concerns, placing the person at increased risk of harm.
Following our inspection, the provider implemented a system to ensure documentation is updated by key workers following changes to people's needs.

The provider did not always provide care and treatment in-line with current evidence-based good practice and standards.
The provider’s policies had not been reviewed since 2021, meaning we could not be assured staff or managers were following guidelines and standards that were up-to-date with current best practice guidance. Systems in place did not ensure staff were fully trained to understand and comply with national legislation and the required standards in the different areas of people’s care.
However, staff had a good understanding of people’s dietary needs, and people commented positively on the food available. A person said, “The food wouldn’t go down as Cordon bleu but it’s good, homemade and fresh.” Another added, “I eat more here [than at home], I have put weight on.”
Following our feedback, the provider advised they would be reviewing their internal policies imminently and scheduled additional training.

The provider did not always work well across teams and services to support people.
Information was not always shared between teams and services to ensure continuity of care. A partner told us, “Some staff are more thorough than others in regard to the handover of information. There seems to be inconsistency between staff members. For example, a staff member will be concerned about [people’s] Behavioural and Psychological Symptoms of Dementia (BPSD) escalating, but when reviewing it with someone else, they are not concerned.”
Contact with healthcare partners was recorded in a central file, but we saw several gaps to records, and information was not transferred to people’s individual care plans.
Whilst the team discussed concerns in daily handovers, and there was a communication book in place; there was no evidence of regular team meetings. A staff member said, “The last meeting was a couple of years ago.”
However, staff we spoke to generally had a good knowledge of people and worked collaboratively to meet their needs.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control and staff did not always support people to live healthier lives.
The provider did not always focus on identifying risks to people’s health and wellbeing early, or on supporting people to prevent deterioration. Due to the lack of detailed records and poor monitoring systems; we could not be assured these risks were always identified or escalated at the earliest opportunity.
However, we saw evidence of input from healthcare partners and the home had weekly phone calls with the local GP practice in which people’s health and wellbeing was reviewed. A person said, “The opticians came here a couple of weeks ago, and although I can speak up for myself, if I need a doctor staff will contact them on my behalf.”
People were encouraged to make healthier choices to help promote and maintain their health and wellbeing. We observed a person returning from a walk and being praised by staff. The staff member told us, “We have been taking [person] out to build up their walking. This has been working; we went further today.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it and ensure outcomes were positive and consistent.
Approaches to monitor people’s care and treatment were ineffective, and people who used the service did not consistently experience positive outcomes. A person required regular repositioning, but despite current pressure damage charts had not been implemented to monitor this and ensure they were getting the necessary support. We saw several other instances in which people had experienced poor outcomes, because action had not been taken to continuously improve their care and treatment. Please see the ‘Learning culture’ section of this report for more information.

The provider did not tell people about their rights around consent and did not respect their rights when delivering care and treatment.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
The provider did not ensure decisions were always made within the requirements of the MCA. There was a lack of evidence to show best interest meetings had been held when decisions were made for people deemed not to have capacity. For example, during our inspection 1 person was placed on nil-by-mouth by the district nursing team, but this decision and the rationale for this decision had not been recorded anywhere. If this decision was misunderstood by staff due to the lack of appropriate recording, this may have left the person at risk of malnutrition.
Systems and processes to ensure people understood and consented to care and treatment being offered were not robust. We checked consent forms in 5 people’s care plans. Only 1 had been completed in full, and signed by the person receiving care or their next of kin.
However, staff gave examples of how they sought consent on a day-to-day basis, and relatives confirmed they were involved in decision making.