Archived: Croft Dene Care Home

Updated 16 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection site visit took place on 22 and 27 March 2018 and was unannounced. The inspection consisted of one adult social care inspector and one expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed all of the information we held about Croft Dene Care Home, including any statutory notifications that the provider had sent us and any safeguarding and whistle blowing information we had received. Notifications are made to us by providers in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. These are records of incidents that have occurred within the service or other matters that the provider is legally obliged to inform us of.

Additionally we liaised with the local authority contracts monitoring and safeguarding adults teams and the local NHS clinical commissioning group (CCG) to gather their feedback about the service.

During the site visit we spoke with five people who used the service and one visitor to gain their opinion. We also spoke with five members of staff, including the registered manager, two care managers, one senior care worker and one care worker. After the site visit we contacted several relatives by telephone and email. Two relatives shared their feedback with us. We also contacted the local NHS Infection Prevention and Control Nurse who also conducted a site visit and shared their findings with us.

We reviewed a range of care records and the management records kept regarding the quality and safety of the service. This included looking at four people’s care records in depth and reviewing eight people’s medicine records.

Updated 16 May 2018

Croft Dene 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. At the time of our inspection 38 people were using the service who had physical and mental health related conditions.

This unannounced comprehensive inspection took place on 22 and 27 March 2018. This meant that the staff did not know we would be visiting the home. At the last inspection in November 2017, we identified breaches of regulations which related to safety, person-centred care, staffing and governance of the service. After the last inspection we told the provider that we were considering serious enforcement action and gave them a period of time to fully address all of the issues. The provider voluntarily suspended admissions to the home until they had taken action to alleviate the concerns raised.

Prior to our inspection, we reviewed the provider’s action plan which had been shared with us, the local authority and the Clinical Commissioning Group (CCG). We saw all of the actions had been completed or there was satisfactory on-going progress being made.

This service has been in ‘Special Measures’. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had taken immediate action to rectify the shortfalls with the leadership of the service. Two new temporary care managers were in post who managed the service on a daily basis and reported to the registered manager. The established registered manager of the service told us they had been able to spend more of their time at this service. 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 been strongly supported by the provider during the past four months to ensure that compliance with the regulations was achieved. They had both concentrated on the safety, governance and leadership of the service and implemented the improvements and changes required.

The two new care managers had ensured that checks on the service were in operation and recent robust audits showed that the service was being monitored to ensure its safety and quality. However, this needed to be evidenced over a longer period of time to ensure sustainability.

All of the environmental safety risks which we highlighted at the last inspection had been removed or reduced and were now closely monitored by the new care management team.

Medicine audits had recommenced and we saw that any issues identified were addressed by the care management team. Medicines were managed well. People received their medicines safely and at the right time. The records kept to monitor medicine administration were completed to a satisfactory standard. We noted some minor issues related to ‘as required’ medicines which the registered manager told us would be addressed immediately.

There was an outbreak of Norovirus at the service, which limited the areas we could observe on the second day of the inspection; however, we liaised with a local infection prevention and control nurse who told us they had concerns about the cleanliness of the service. The registered manager took immediate action to address these and we were satisfied the actions taken were sufficient.

The activities coordinator post had been filled since the last inspection but had recently become vacant again. The care management team had taken proactive steps to manage this whilst recruitment started over. We saw there was information on display about planned meaningful activities. People told us they enjoyed the activities on offer but still felt there was room for improvement. An activities coordinator from one of the provider’s other care homes was spending two days per week at Croft Dene to assist the care staff. Designated care staff were arranging stimulating activities on the days we visited and they told us they had been allocated time to socialise with people. Records to show that people had participated in activities had improved.

Since our last inspection, staff had completed their mandatory training. A training plan was now in place to develop staff skills with awareness courses being organised in topics which would be beneficial to the staff.

Staff recruitment continued to be safe and pre-employment checks were in place to ensure staff were suitable to work with vulnerable people. All staff had taken part in a formal supervision meeting with the care management team and a plan was in place to complete annual appraisals over the forthcoming year, which the registered manager had started to conduct. Competency checks had been carried out with care and nursing staff to ensure they were supported in their role and were competent to carry out the tasks they were responsible for.

We observed people enjoying a pleasant mealtime experience. We saw staff were more organised and relaxed throughout mealtimes and they were deployed correctly to ensure people who required one to one assistance were supported in a timely manner. We found that staff made an effort to create a homely environment for people to enjoy their meals in.

The cook was aware of people’s dietary requirements and their nutritional and hydration needs. We saw the cook came out of the kitchen at mealtimes and engaged with people and staff. Special diets were catered for and all meals were well presented, including food which had been pureed. People had a choice of meals and alternatives were made available.

People told us they felt safe living at Croft Dene. The relative and visitor we spoke with confirmed this. Staff were able to demonstrate their responsibilities with regards to protecting people from harm and they had received the appropriate training. The provider had up to date policies and procedures in place to support staff to deliver the service.

Accidents and incidents continued to be recorded, investigated and monitored by the care management team. The action taken to minimise the likelihood of a repeat incident were recorded. All incidents had been reported to the appropriate external agencies as necessary.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of most people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.

Staff displayed approachable and caring attitudes and people told us staff were kind to them. We saw people enjoyed a positive relationship with staff and it was apparent they knew each other well. We saw all staff treated people with dignity and respect.

Individual care needs were assessed and regularly reviewed. Support plans were person-centred, informative and reviewed as necessary. Risks which people faced in their daily lives had been evaluated and measures were in place to reduce these.

An established system for monitoring complaints was in place. This had continued from our last inspection. This meant the provider was now able to look for trends and identify areas of the service which may need further improvement and development.