The Croft

The Croft is a residential care home providing personal care and support and is registered to support up to 8 people. The service provides support to people with a learning disability, autistic people, as well as support for people's mental and, or physical healthcare needs. At the time of our inspection there were 7 people living at 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. We were not confident people had received a well-planned, safe service over the last twelve months.

Right support: Incidents had occurred over a period of time which had not upheld people’s rights, safety and dignity. Safeguarding procedures had not been stringently followed in a timely way to ensure people were properly protected. The governance systems in place were ineffective in identifying and improving the service in a timely way to ensure people always received good outcomes of care.

Systems were now in place to ensure any allegation was effectively dealt with and staff responsible held to account. A newly created management team was now in place and care outcomes for people were improving with a greater accountability and improvements in people’s care.

Improvements in staff recruitment meant the reliance on agency staff was reducing and shortfalls in training were being addressed. We found however recent concerns had highlighted staff working in an unsupported way without the necessary skills and training to meet people’s needs safely.

Staff recruitment was ongoing and staff induction and training was being revisited to ensure all staff had the necessary competencies and attributes to meet people’s needs.

Recent care reviews had helped to identify gaps in service provision. Additional hours had been agreed for one person and were being sought for another to enhance their experiences, safety and opportunity.

Right care: Improvements were still necessary to enhance the quality of people’s lives and ensure that progress towards goals and outcomes were effectively measured to show how people’s wider social, cultural and physical needs were being met.

People have lived together for a long time and as their needs had changed reviews have been held to consider the continued suitability of the service. We discussed this with the manager in relation to the environment and the need for people to have sufficient space and a low sensory environment which was not always achieved.

A recent reduction of incidents between people could be attributed to more regular staffing and staff having a better understanding of people’s needs and creating a more predicable environment for people. However further thought should be given to people’s sensory and communication needs and how staff could offer meaningful choices and reduce people’s anxiety through greater continuity of care.

Right culture: People were not fully supported to have maximum choice and control of their lives. Staffing levels were in line with people’s needs and there was a staff member employed specifically to coordinate and plan activities. People’s records inspected showed some activities taking place and the scope of activities was improving since the lifting of COVID 19 restrictions and an improving staffing situation.

The overall governance and oversight of this service had been weak and a number of recent changes in management had affected the growth and stability of the service and resulted in poor outcomes for people living here. An experienced manager had come into post since May 2022 and was making significant improvement.

The current management team were helping to shape a more positive culture. Some of the changes were still being embedded. Better communication, support, training and organisation of shift patterns had given staff more coping strategies and reduction of their stress levels. This was resulting in improved care outcomes for people using the service.

The manager had built confidence within their teams and were open and visible. This helped ensure that past poor practice could be quickly identified and stamped out.

Audits helped to determine shortfalls within the service and the provider was listening and seeking formal feedback from relatives and staff. A visiting professional form had been developed but was not being effectively utilised to source feedback. The provider told us they encouraged and sought feedback from professionals.

Experiences of people needed to be captured in more detail and records needed to show how people were being supported in line with their assessed needs.

Overall improvements were still necessary, and we identified a breach of regulation 12 Safe care and treatment and regulation 17 Good governance.

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 good and the report published (21 August 2018.)

Why we inspected

This inspection was carried out to follow up on concerns raised by the local authority as part of their ongoing monitoring of the service. Action plans had been received from the provider and CQC had sought assurances from the local authority and provider prior to inspecting.

This was a focused inspection that considered safe and well led, we found both key questions required improvement. The overall rating for the service has changed from good to requires improvement with breaches of the regulations, based on the findings of this inspection.

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.

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

Follow up

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

The service had been developed and designed in line with the values that underpin the CQC guidance, Registering the Right Support, and other best practice guidance. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism who lived in the home could live as ordinary a life as any citizen.

At our last inspection we rated the service Good overall, however we rated the key question of effective ‘Requires Improvement’ because there had been a lack of consideration to the restrictions on people’s freedom because of locked doors within the service. We found that improvements had been made at this inspection and people had increased freedom to move around their home.

At this inspection we found the evidence continued to support the overall rating of Good. There was no other evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were supported by sufficient numbers of staff that had been recruited safely and had checks undertaken to ensure they were suitable for their role.

People were provided with a choice of meals which considered their likes and dislikes and were encouraged to eat a varied diet that took into account their nutritional needs. People were supported to access healthcare professionals when needed to maintain their health and wellbeing.

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

People received a service that was caring. Staff knew people's needs well and were responsive and supportive. Staff treated people with dignity and respect. Staff sought to gain people's views.

Good leadership continued to be in place that provided staff with the necessary support and training to make sure people received good quality care.

Further information is in the detailed findings below.

The Croft is a care home which provides accommodation, care and support for up to eight adults with a learning disability. Eight people were living at the service on the day of our inspection.

There was 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.

The registered manager had made applications to the local authority to ensure restrictions on people’s ability to leave the service were lawful in accordance with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. However, the same approach had not been extended to the locked doors within the service which, restricted people’s freedom of movement around their home.

Procedures were in place for responding to emergencies and managing risks in the service. This included safeguarding matters, managing people’s finances and medicines. Environmental risks were being assessed and measures had been put into place to minimise risks to people’s safety.

People using the service at times behaved in ways that were challenging to others. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Behavioural support plans were detailed and gave staff clear direction as to what action to take to minimise risk. This was done in a consistent and positive way.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.

People experienced a good quality of life because staff received training that gave them the skills and knowledge to meet each person’s assessed needs.

Staff talked passionately about the people they supported and knew their care needs well. People were involved in determining the kind of support they needed. Different communication methods had been used to support people to understand information about their care. Staff offered and respected people’s choices on how they spent their day. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.

People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.

There was a strong emphasis on promoting good practice in the service. A number of schemes were in place to motivate staff and drive improvement, such as staff excellence awards. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect.

The provider had a range of systems in place to assess, monitor and further develop the quality of the service. This included quality monitoring visits of the service and monitoring of incidents, accidents, safeguarding concerns and complaints.

There was an emphasis on fairness, transparency and an open culture within the service and throughout the organisation. Senior managers and the chief executive were contactable for staff to talk to openly whether they wanted to complain, raise concerns, or compliments or to share ideas to improve the service. Staff were encouraged to take part in the organisations’ ‘working groups’ to understand and have a say on changes to working conditions.

We discussed with the registered manager how they ensured that people consented to their care and treatment and they explained the procedures followed which were in accordance with legal guidelines.

We examined a range of records which were all readily available, accurate and fit for purpose. These included care records, staff recruitment records, medication records and maintenance records.

We were therefore satisfied that the service offered safe and effective care, was well managed and responded quickly to situations that arose.

We found that care plans were comprehensive, containing details of the needs of people who used the service and how those needs were met. The care plans all contained detailed risk assessments to minimise the risks around daily living and events and activities.

The staff team had received a range of training to equip them to carry out their role and were well supported by the service.