Archived: The Croft Care Home

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'New National Restrictions'. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

We noted good practices in all of the areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

The provider and manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in the event of infection outbreak, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

Visiting rules and process were communicated effectively to people using the service and their relatives.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The manager insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by innovative use of social media so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Areas of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.

Policies and infection control processes were regularly reviewed when guidance changed. The home was clean and hygienic. A designated cleaner was working during the inspection. All staff had received Covid-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well-led to at least good. This inspection was carried out to check the required improvements had been made.

The Croft 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. The home is registered to provide accommodation and personal care for up to a maximum of 26 people. At time of the inspection there were 23 people accommodated in the home.

The service was managed by 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 registered manager was supported in the day to day running of the home by a deputy manager.

People told us they felt safe in The Croft. Our observations showed people were treated with kindness, care and respect. Staff understood their responsibilities to safeguard people from abuse. There were appropriate arrangements in place in relation to the safe handling of medicines. New staff were recruited safely.

Risks to people's health, welfare and safety were managed well. The service was safe, clean, well maintained and suited to the needs of the people who lived there. People enjoyed a varied and healthy diet and changes in their health were monitored and acted on. People had access to a GP and other health care professionals when they needed them.

Staff had the knowledge and skills required to meet people's individual needs effectively. New staff completed an induction when they started work at the home; this was to ensure they were familiar with the routines and people’s individual needs. Staff spoken with told us they received appropriate support and training and felt valued and respected by managers in the service.

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.

Care records we reviewed were personalised and provided a good level of detail for staff to follow. The initial assessment, completed before people were admitted to the Croft, was used to formulate care plans and risk assessments; these records had been regularly reviewed and updated when people’s needs changed.

People’s communication needs were documented within care plans as well as how staff should support them to express their views and wishes. Staff spoken with demonstrated a good understanding of people’s diverse needs and preferences.

People who lived in The Croft and their relatives knew about the home’s complaint’s procedure. All said they were confident any complaints would be fully investigated and action taken if necessary to rectify matters.

The registered manager and provider conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. Staff said they enjoyed working at the home and that the registered manager set high standards in relation to the care they were expected to deliver.

The Croft Care Home is a two storey detached property, close to the centre of Whalley. All the bedrooms are single occupancy; some have en-suite facilities. There are two lounges, the main lounge is a on the ground floor and has an adjoining ‘quiet area’. The second lounge/sensory room, is smaller and is located on the first floor. There is also a large separate dining room. A small passenger lift provides access to the first floor and a stair lift is available. There are garden areas and lawns, garden furniture is provided. A small number of car parking spaces are available in the grounds. The service provides accommodation and personal care for up to 26 older people and older people living with a dementia. At the time of the inspection there were 26 people accommodated at the service.

The service was managed by 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 the previous inspection on 29 and 30 September 2015, we asked the provider to make improvements in relation to monitoring and improving the quality of the service provided. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made on this matter. However further progress was needed with provider oversight and checking systems. We have therefore made a recommendation on this matter.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to a lack of robust recruitment procedures prior to staff working at the service. You can see what action we told the provider to take at the back of the full version of this report.

We have also made recommendations for improved practice in relation to the assessment and management of individual risks to people and care planning.

We found there were management and leadership arrangements in place to support the day to day running of The Croft Care Home.

People were happy with the accommodation at the service. We found some facilities had been upgraded and bedrooms redecorated in response people’s preferences.

There were some good processes in place to manage and store people’s medicines safely. We found some improvements were needed; these were put right during the inspection.

There were enough staff available to provide care and support and staffing arrangements were kept under review. There were systems in place to ensure all staff received regular training and supervision.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns about people’s wellbeing and safety.

The service was working within the principles of the MCA (Mental Capacity Act 2005). During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

People were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

There were opportunities for people to engage in a range of suitable group and individual activities. People were keeping in contact with families and friends. We found visiting arrangements were flexible.

People were happy with the variety and quality of the meals provided at the service. Support was provided with specific diets. We found various choices were available. Drinks were readily accessible and regularly offered.

People spoken with had an awareness of the service’s complaints procedure and processes. They said they would be confident in raising concerns. We found records were kept of the complaints and the action taken to rectify matters.

Arrangements were in place to encourage people to express their views and be consulted about The Croft Care Home, they had opportunities to give feedback about the service.

The inspection team consisted of one inspector. During this two day inspection we spoke with six people who used the service, nine relatives, five members of staff, the registered manager, area manager and a district nurse. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

People who used the service told us they were satisfied with the support and care they experienced at The Croft. One person said, 'It's nice they are looking after us' and a relative said, "There have been some improvements with the care'. People using the service did not express any concerns about the care and support they received. One person told us, 'Of course I feel safe here'. However, we found some practices were lacking in promoting the delivery of safe, effective care to meet people's needs.

A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

Following our last inspection, the providers had provided us with a report which told us they would achieve full compliance with the risks associated with unsafe or unsuitable premises by January 2015. However, during this inspection we found some health and safety risks had not been rectified in a timely way.

Is the service effective?

Processes were in place for staff to attain nationally recognised qualifications. Staff spoken with, told us of the training they had received. They had an awareness of people's needs and gave examples of how they delivered support.

Arrangements were in place to assess people's needs and abilities prior to them moving into the home. However, we found some processes for assessing; monitoring and responding to people's needs were inconsistent. This meant there was a risk people's needs may not be effectively identified and managed. We found people and their relatives were not properly involved in planning and agreeing their support, which meant care may not be provided in line with their wishes. A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

Arrangements were in place to provide staff with suitable training. However we found the programme of one to one staff supervision was not being effectively implemented. This meant arrangements were not in place for managers to properly supervise staff on their work practice, conduct and development needs.

Is the service caring?

People who used the service told us they were mostly happy with the care they experienced at The Croft. We observed staff treating people in a kind, friendly and respectful way. However, we found some aspects of care delivery were lacking in promoting safe effective care. A compliance action has been set in relation to this matters and the provider must tell us how they plan to improve.

Is the service responsive?

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they moved into the home.

Records and discussion showed people were getting attention from healthcare professionals.

The service had a complaints process in place and we were told the manager was approachable and listened to concerns. However, some concerns had not been responded to using the complaints procedures and relatives expressed a lack of confidence in the complaints processes.

Is the service well-led?

The service had a registered manager responsible for the day to day running of the home. Staff and relatives spoken with described the manager as supportive and approachable.

There were some systems in place to assess and monitor how the home was managed and to evaluate the quality of the service. However we found these systems had not been effective in identifying non-compliance with the regulations. This meant there had been a failure to identify significant shortfalls and make necessary improvements, for the well-being and safety of people using the service.

A compliance action has been set in relation to these matters and the provider must tell us how they plan to improve.

It was apparent progress was being made to make improvements, for the well-being of people using the service. However, we found some matters were in need of attention to ensure people were protected against the risks from unsafe or unsuitable premises.

Although we found people experienced some good care and support, progress was needed with care planning and care delivery to make sure this is more effective.

People were getting support with their healthcare needs and they had ongoing attention from health care professionals.

We found arrangements were in place to support people with their medicines. However, better records needed to be kept to make sure people are getting the support they need and staff should be aware of the service's medicine guidelines so that they follow the correct procedures.

We found there were enough experienced and skilled staff available to provide care and support. At the time of the inspection, action was being taken to review staffing levels and shift patterns, to ensure there are sufficient staff on duty in the evenings.

We found people experienced some good care and support. They told us they were treated with respect. People were getting support with their healthcare needs and they had ongoing attention from health care professionals. However, we found some progress was needed with care assessments and care planning to make sure people receive effective care and support.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them. People were encouraged to maintain and develop their independence skills.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff. We found there may be insufficient staff in the evenings, but the manager was looking into this matter.

People were being consulted about their experience of service. We found that some checks on practices and systems were being carried out.