The inspection took place on 20 and 24 October 2014. This was an unannounced inspection. We last inspected The Croft Residential Care Home in December 2013. At that inspection we found the home was meeting all the regulations that we inspected.
The Croft Residential Care Home provides residential care for up to 33 people, most of whom are living with dementia. At the time of our inspection there were 30 people living at the home. The home had a 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.
We found the provider had breached Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the provider did not have accurate records to support and evidence the safe administration of medicines. We found gaps in medicines administration records (MARs) for seven out of the 30 people who used the service where medicines had not been signed for to confirm it had been given. You can see what action we told the provider to take at the back of the full version of the report.
People we spoke with told us they felt safe living at the home. Their comments included, “I am not worried about anything”, and, “I am not scared anymore, it is topper.” Family members also confirmed that they felt their relative was safe. Their comments included, “I have no concerns with safety”, “[My relative is] definitely safe”, and, “Safe and well looked after.” People were also happy with the condition of the home. Their comments included, “Always spotless”, “Nice and warm”, and, “Beautiful rooms.”
Staff undertook risk assessments where required and people were routinely assessed against a range of potential risks, such as falls, mobility and skin damage.
Staff we spoke with had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding concerns.
Staff had a good understanding of how to manage people’s behaviours that challenged the service and had individualised strategies to help them manage people’s behaviours that challenged.
People who used the service, family members and staff all told us they felt there were enough staff to meet people’s needs. The registered manager monitored staffing levels to ensure there was enough trained staff available to meet people’s needs. There were systems in place to ensure that new staff were suitable to care for and support vulnerable adults.
Staff were well supported to carry out their caring role and received the training they needed. Training records confirmed that staff training was up to date at the time of our inspection.
Staff followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make a specific decision. The registered manager had also made DoLS applications to the local authority where required. People confirmed that they were asked for permission before receiving any care. One person told us staff, “Ask you what you want always.”
People and family members were happy with the food provided. People said, “We get well fed”, and, “Can’t fault the food.” Family members said, “[My relative] needs coaxing to eat. They [staff] are very patient”, “Food is fine”, and, “[My relative] is eating properly now.” The provider had systems in place identify and support people who were at risk of poor nutrition. Where people had lost weight unexpectedly, action was taken to keep them safe.
We observed over the lunch-time that staff made sure people were safe and had support if they needed it, such as prompts and encouragement to eat their lunch. We also observed that staff interaction with people was warm, kind and caring.
People were supported to maintain their healthcare needs. One person said, “My family don’t worry about me now, they know that if I took bad there is somebody on hand.” One family member told us that staff supported their relative to attend health appointments. They said, “If [my relative] needs to be taken anywhere they take her.”
People and their family members told us they were well cared for and were treated with dignity and respect. They said, “Can’t fault it.” “We like our care home.” Family members’ comments included, “Very good care, absolutely amazing”, “They look after [my relative] brilliantly”, and, “It’s great in here.”
The provider had adapted the service to meet the needs of people who were living with dementia. Doors had been painted orange and dementia friendly signage was used to help aid orientation. There were designated quiet areas and brightly coloured crockery and specialist cutlery was available. The home had involved family members in ‘life history’ work and care records contained detailed information about people’s preferences.
People had their needs assessed and the assessments had been used to develop individual care plans. Care plans had been evaluated consistently each month. Where people’s needs had changed action was taken to keep them safe.
The home’s complaints procedure was available in different formats. None of the people or family members we spoke with had made a complaint about the care they received.
People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service.
The provider undertook a range of audits to check on the quality of care provided. Medicines audits had not been successful in identifying gaps in medicines records. Information was analysed to look for trends and patterns and to identify learning to improve the quality of the care provided.