Little Croft Care Home

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

We identified through our inspection that the home did not have safe staffing levels during the night. The registered manager told us a minimum of three staff were required each night. We identified on a number of occasions that staffing levels fell short to two staff. Some people required two staff to safely support them. This meant some people had to wait to receive care and experienced delays.

We found shortfalls in relation to the management of people’s medicines. Medicines trolleys were left locked but unattended in the dining room. Medicines administration records were not up to date and accurate. They were not double signed by two members of staff when medicines records were handwritten and checked into the home.

The providers systems used to monitor and audit the home were not effective and had not identified the improvements that were required. The provider visited the home, but no formal audits were completed which would have helped to identify any shortfalls. The Quality assurance systems the provider had in place were not robust. Action had not always been taken when staff had raised issues and made suggestions about the running of the home, during staff meetings and when they completed staff surveys.

Staff were employed following a safe recruitment process. Staff had received training to keep people safe and knew what action to take in response to any allegations of abuse. The home was clean and tidy throughout. The premises was safe, with regular health and safety and maintenance checks carried out.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection

The last rating for this service was good (published 10 June 2022). At this inspection, the rating had changed to requires improvement.

Why we inspected

We carried out a focused inspection of the home, due to concerns that had been shared with us. We had written to the registered manager and provider to seek assurances. We used this information to help us plan this inspection. We have found evidence that the provider needs to make improvements. . We have identified some shortfalls relating to managing people’s medicines, staffing levels at night and around good governance. Please see the safe and well-led sections of this report.

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

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.

Little Croft Care Home is a residential care home providing accommodation and personal care for up to 41 people. At the time of the inspection there were 38 people living at the home. There were communal lounges and dining areas. People also have access to a garden area.

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

People were protected from the risk of avoidable harm. People were supported by enough staff to ensure their needs were safely met. Accident and incidents were reported, recorded and analysed with lessons learnt shared with staff to prevent recurrences. Medicines were managed safely, and people received their medicines as prescribed. The home was clean, and staff followed appropriate infection prevention and control practices to minimise the spread of infections. People felt safe living at the home. The home followed appropriate recruitment practices and ensured staff were properly checked before they began working at the home.

People were supported to eat and drink and to maintain a healthy diet. Where required people had access to specialist diets and assistance was offered at mealtimes. Menus were planned to include people's food preferences. People were supported to access appropriate healthcare services.

People’s needs were assessed, and personalised care and support was provided by staff. Staff were caring, kind and treated people with respect. People's personal and health care needs were met and care records guided staff on how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the home supported this practice.

The provider and registered manager had good oversight of the home. Quality assurance systems were in place to assess and monitor the quality of care that people received. They helped to identify any areas that required improvement and helped to drive improvements.

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 taken over by another provider and registered with us on 31 March 2021. This is their first inspection.

Why we inspected

This was a planned inspection to check whether the provider was meeting legal requirements and regulations, and to provide a rating for the service as directed by the Care Act 2014

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.

Follow up

We will continue to monitor information we receive about the home until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

On our arrival we were greeted by a member of staff and had our temperature taken, we were asked to provide our Covid Pass to show our vaccination status and evidence that we had completed a Lateral Flow Test (LFT) prior to our visit. Everyone visiting provided contact details to support the track and trace system. Vaccination status was checked for all contractors and health and social care professionals in line with legislation that had come into effect in November 2021. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

We were introduced to people as we walked around the home. They were happy and relaxed, and the atmosphere was calm and peaceful. The emotional wellbeing of staff, people and their families had been supported throughout the pandemic. Each person had been individually risk assessed to ensure visits were person centred. This helped ensure their visits were meaningful whilst maintaining everyone’s safety. The registered manager ensured the current government guidance was being followed to support visiting in the home when there wasn’t an outbreak.

During a recent Covid outbreak the registered manager had ensured people had access to a nominated Essential Care Giver (ECG). This was usually a family member, but an alternative significant other would be nominated for those who did not have family. Enhanced risk assessments ensured this was managed safely and that all relevant testing and the use of PPE was maintained at all times. One person had been supported with their mental health needs which had deteriorated in recent weeks. It was evident that a visit from their ECG had been imperative in ensuring they felt their emotional wellbeing had been respected. End of life visits had also been supported and respected so that people could spend time with those people who were important to them.

Staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The registered manager spoke with us about the continued commitment and team work from all their staff. They met with staff individually and they had access to a wellbeing questionnaire. The questions supported addressing concerns about the pandemic and how this was effecting them on a personal level and within the workplace. The registered manager said this had helped to reduce anxiety and it had been important to recognise success to ensure staff felt valued.

At the time of this inspection the home was coming to the end of an outbreak. The providers workforce contingency plan had ensured people’s safety and quality of care had not been compromised. People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained strong. When people were admitted to the home, risk assessments were completed, and people isolated in line with current guidance. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

Audits were undertaken, and actions would be taken to ensure improvements were made if necessary. Staff had received IPC training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of PPE and infection prevention and control practices. There was effective, supportive communication between the provider, registered manager, staff, people living at the home and their relatives.