The Croft Residential Home

The Croft Residential Home is a care home without nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 18 people living at the service. People living at The Croft were older people, some were living with dementia. The service is an older detached building set over three floors with a lift to access bedrooms on the first floor. Rooms on the second floor and some on a mezzanine level were accessed via a chair lift.

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

Since the last inspection a new manager had been appointed. They had worked in partnership with the local authority quality assurance and improvement team (QAIT) to review and improve all aspects of the service in response to the concerns raised. As a consequence, the service was no longer in breach of regulation and the overall quality and safety of the service had improved significantly. A relative told us, “Since the new manager has been appointed, there has been such a marked improvement. She is very responsive and brilliant at implementing changes and I cannot fault the way she deals with any concerns. She is making a real difference.”

There was a robust and effective quality assurance programme in place. This enabled the registered manager to identify issues and take prompt action to address them, for example in relation to potential skin breakdown, or concerns and complaints from people using the service.

Staff told us the registered managers door was ‘always open’ and they felt very well supported by the management team and providers. They had received the coaching and mentoring they needed since the new manager had come into post and there had been several promotions as a consequence. This had contributed to the improved quality and safety of the service.

The management team were committed and passionate and continue to drive service improvement for the benefit of people, staff and the wider community. They had been part of a pilot project for a piece of equipment to raise non injured people off the floor following a fall. The number of emergency calls from the service had reduced significantly as a consequence. The registered manager and had been invited to share their learning with other services at a care homes forum.

People felt safe living at The Croft. Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. There were systems in place to ensure the safe administration of medicines.

People's needs were robustly assessed before they moved into the service. Person-centred care plans were developed with people and their families, this included people's life stories and wishes. A relative said, “They know her as an individual, it is brilliantly matched in the care plan.”

Staff ensured people were seen by healthcare professionals where needed. Visiting healthcare professionals spoke highly of the staff and the care they delivered to people.

People were supported by a stable and consistent staff team who knew them well. We saw kind and caring interactions during the inspection. Staff were supporting people in line with their care plans, for example comforting a person who was distressed by singing with them and talking about their family.

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.

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 requires improvement (published 02 November 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 18 and 25 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve receiving and acting on complaints and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well Led.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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 service, which will help inform when we next inspect.

The Croft Residential Home is a care home without nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 17 people living at the service. People living at The Croft were older people, some were living with dementia. The service is an older detached building set over three floors with a lift to access bedrooms on the first floor. Rooms on the second floor and some on a mezzanine level were accessed via a chair lift.

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

We identified concerns over some aspects of quality assurance, reviews and record keeping. This was a continued breach of the good governance. Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the services provided. However, improvement was needed in some areas to make them more effective and meaningful. The provider and registered manager were responsive to feedback and started to address concerns after they were raised at the inspection. They have since participated in a local authority quality assurance meeting to look at ways of improving the service and people’s experience. On this inspection, the previous breach linked to recruitment had been met.

People received their medicines as prescribed, and there were safe systems in place to manage the storage, administration and disposal of medicines. Systems were in place to safeguard people; staff knew people well and picked up in changes in their mood.

People and relatives were positive about the staff group, for example “They look after you extremely well here and I have no worries” and “The staff are kind and caring.” We saw people had good relationships with staff. People and relatives told us staff provided good care and support. We saw good practice during the inspection, when people were supported by staff, with sensitivity and compassion.

Some improvements were needed in recording people’s complaints and concerns who lived at the home. Further action was needed on pre-admission assessments to ensure people’s individual social needs were considered to ensure their well-being could be maintained at the home.

Staff said it was a good place to work because of the teamwork. Staff interactions with people showed they enjoyed their job. They worked well together to monitor people’s health and well-being, flagging risks in handovers to monitor during the shift.

Since the last inspection, the manager has registered with the Care Quality Commission and met regularly with the providers to discuss the running of the home. The home was well-maintained; the providers continued to invest in its upkeep and checks were in place to ensure equipment and the home environment was safe. The home was clean, and staff followed infection control guidance.

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 September 2019). There were two breaches of regulation. At this inspection we found improvements in recruitment, although there remained an on-going breach in good governance. We also judged there was a breach in receiving and acting on complaints.

Why we inspected

This was a planned inspection based on the previous rating.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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.

We undertook this inspection to check they had made improvements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating of requires improvement remains the same. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Croft Residential Home on our website at www.cqc.org.uk.

The Croft is a care home without nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 20 people living at the service. People living at The Croft were older people, living with frailty or dementia.

The service is an older detached building set over three floors with a lift to access bedrooms on the first floor. Rooms on the second floor and some on a mezzanine level were accessed via a chair lift. The service is a long-established care home, which was newly registered for this provider on 28 September 2018.

People’s experience of using this service:

On the inspection we identified concerns over a lack of robustness over the operation of the staff recruitment systems. We also found concerns over the assessments and guidance for staff over risks associated with long term health conditions. These amounted to breaches of legislation, although we did not identify anyone had suffered harm as a result. The provider and manager commenced immediate action to resolve these.

Other risks to people, such as from falls, choking, poor nutrition or pressure ulcers had been assessed. Actions had been taken to mitigate risks where possible. People told us they ate well. Where there were concerns over people’s nutrition or hydration appropriate actions were taken.

We have made a recommendation over the storage of gluten free products.

Care plans were based on up to date assessments of people’s needs and were updated on a computerised care planning system. This meant details of people fluid intake or repositioning needs were updated throughout the day. Plans contained details about people’s wishes and communication methods, and guided staff on how the person’s care should be delivered. We saw people’s care plans were being followed in practice. Staff knew people well, including information about their personal history and things of importance to them.

The manager was newly appointed, and although not registered yet had made an application to do so. They had commenced a review of all systems at the service and were making improvements, with the support of the registered providers and local authority quality improvement team. Staff told us they were appreciative of the changes being made.

People told us they were happy living at The Croft. People and relatives told us they received good care and support. We saw good practice during the inspection, when people were supported well by staff, with sensitivity and compassion.

Quality assurance systems and regular audits were in place to assess, monitor and improve the quality and safety of the services provided. These included feedback from people using the service or their relatives. The registered provider and manager were committed to making improvements at the home, and ensuring effective systems were in place. They had a comprehensive service improvement plan, and were involving relatives, people living at the service and staff in the changes they were making. For example, an assessment of the adaptation of the environment for people living with dementia was under way.

Systems were in place to safeguard people from abuse, and the service responded quickly to any concerns or complaints about people’s wellbeing. The service learned from incidents to prevent a re-occurrence, and incidents were audited to check for any patterns. People’s rights were being respected, and decisions had been made and recorded in people’s best interests where they were not able to make these decisions themselves. The service respected and supported individual people’s equality and diversity.

Staffing tools ensured enough staff were in place to meet people’s needs, and staff received the training and support they needed to carry out their role.

People received their medicines as prescribed, and there were safe systems in place to manage the storage, administration and disposal of medicines. This was also on a computerised system, which gave alerts if additional medicines were due.

Rating at last inspection

The last rating for this service was Good (Inspection of 6 April 2016). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected: This inspection was scheduled based on the date of registration of the new provider. The second day of the inspection was prompted due to concerns received about staff recruitment practices. These were received following the first day. A decision was made for us to return to inspect and examine those risks.

Follow up:

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of the full report which is on the CQC website at www.cqc.org.uk