This inspection took place on the 22 June 2017. This was an unannounced inspection. Our last comprehensive unannounced inspection took place on the 20 and 25 January 2016 and we found that improvements were needed in the caring, responsive and well led key questions. We issued a requirement notice as the provider was in breach of the regulation regarding good governance. After the last comprehensive inspection visit, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection the 19 July 2016 and found improvements had been made but further improvements were needed. This was because the leadership of the home remained inconsistent. The systems in place to monitor the quality of the service had improved but further improvements were needed to ensure all monitoring records were accurate. At this inspection we found that improvements had been made in this area.

The Croft Care Home provides accommodation and personal care for up to 30 older people who may be living with dementia. There were 24 people using the service on the day of the inspection visit.

The service 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. The providers’ regional manager had registered as the manager of the home following the last inspection and was supported by the head of care, who managed the service in their absence.

At our last inspection staff were not always recording food and fluid intake charts in a timely way which did not guarantee the information was always accurate. At this inspection we saw that improvements had been made as records were completed after people had been supported to ensure accurate monitoring was in place.

Staff were available to support people and had knowledge about people’s care needs to enable support to be provided in a safe way. Staff understood what constituted abuse or poor practice and systems were in place to protect people from the risk of harm. Checks were made on staff before they started work to ensure they were suitable to support people.

People were supported by staff that received training and supervision and understood their needs and preferences. Staff gained people’s verbal consent before supporting them. Where people were unable to make decisions independently they were supported in their best interests. People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach and supported people to maintain their dignity and privacy. People were supported to maintain their social interests and relationships that were important to them. People knew how to complain and we saw when complaints were made they were addressed. Quality monitoring checks were completed; this included seeking the views of people and their representatives. When needed action was taken to make improvements.

The previous rating was displayed in the reception area of the home as required and on the provider’s website. The registered manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check that appropriate action had been taken.

We undertook this unannounced focused inspection visit on 19 July 2016 to check that the provider had addressed the breach in regulation identified at our last unannounced comprehensive inspection visit on the 20 and 25 January 2016. At our last visit we identified that further changes in management had led to inconsistent leadership for the staff team and insufficient quality monitoring. We issued a requirement notice as the provider was in breach of the regulation regarding good governance. We also found improvements were needed in the way complaints were managed and in how staff supported people to maintain their dignity. After the last comprehensive inspection visit, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

This report covers our findings in relation to the breach and other areas that required improvements at our last visit. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for the Croft Nursing Home on our website at www.cqc.org.uk

The home provides accommodation and personal care for up to 30 older people who may be living with dementia. There were 18 people using the service at this inspection visit. Since our last inspection the home no longer provides nursing care to people and to reflect this, the name of the home has changed to the Croft Care Home. The provider is in the process of changing their registration details with us to reflect these changes.

There was no registered manager in post at the time of this inspection visit. This 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. At the time of our inspection visit, plans were in place for one of the providers’ regional managers to apply for registration as the registered manager.

The previous registered manager had left the home two weeks prior to this inspection visit. In this time we had received concerns regarding the home. Some of these concerns were being investigated by Staffordshire safeguarding team at the time of this inspection visit. Other concerns related to the lack of leadership at the home and our findings are included in this report.

At our last visit staff were not consistently recording people’s daily monitoring forms At this visit we saw that improvements had been made but further improvement were needed. This was because although staff were consistently recording information, they were retrospectively recording food intake charts which did not ensure this information was accurate.

At our last visit staff were not provided with clear direction regarding their roles and responsibilities, which put people at risk of not having their needs met. At this visit, we saw that improvements had been made; staff confirmed and we saw that a clear structure was in place for staff to understand their delegated duties.

At our last visit we could not be assured that topical lotions such as creams were applied as prescribed, as staff were not consistently recording when they had applied these creams. At this visit, we saw that improvements had been made as topical lotions had been added to the provider’s electronic medicines recording system. Records were in place to demonstrate creams had been applied as needed.

At our last visit staff demonstrated a lack of awareness and consideration regarding promoting people’s dignity. We did not identify any concerns at this visit and saw that staff supported people to maintain their dignity.

At our last visit a system was in place to address complaints and people knew how to make a complaint but this had not been effective in ensuring all complaints rece

We inspected this service on 20 and 25 January 2016. The inspection was unannounced. At our previous inspection in January 2015 the provider was meeting all the regulations relating to the Health and Social Care Act 2008 but improvements were needed because the cleaning staff did not have the appropriate support and guidance to follow to ensure that standards of cleanliness were maintained in a consistent way. We also found that due to the changes in manager, the quality monitoring systems the provider had in place had not been undertaken regularly. At this inspection we found that some improvements had been made regarding guidance for cleaning staff but further changes in management had led to inconsistencies in leadership and quality monitoring.

The service provided accommodation, nursing and personal care for up to 30 older people who may have dementia. There were 20 people living at the home during our inspection. There was no registered manager in post at the time of our inspection, however a newly appointed manager was on duty and they were being supported by the operations manager during their induction. 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.

Further changes in management since our last inspection had led to inconsistent leadership for the staff team and insufficient quality monitoring. We saw that people’s daily records were not being consistently completed to demonstrate that their needs were being met and the support they received was monitored effectively. Although we did not identify that people were not supported, there is the potential that lack of recording puts people at risk of inconsistent care.

Staff understood people’s needs and preferences and we saw that people were supported. However staff were not provided with clear direction regarding their roles and responsibilities. This meant that people were at risk of not having their needs met.

We saw that people received their medicine as prescribed but we could not be assured that topical lotions such as creams were applied as prescribed. This was because care staff were not consistently recording when they had applied these creams.

A system was in place to address complaints and people knew how to make a complaint but this had not been effective in ensuring all complaints received were responded to in a timely way. People were happy with the care they received and told us they liked the staff. We saw that staff were caring but staff demonstrated a lack of awareness and consideration regarding promoting people’s dignity.

People told us they felt safe at the home. Staff were aware of the signs to look out for that might mean a person was at risk of harm. Staff were provided with the right information to ensure people could be evacuated safely if required. People were provided with the right equipment to meet their needs and staff knew how to use this equipment safely. Staff were suitably recruited which minimised risks to people’s safety and the staffing levels were sufficient to support people. Staff received training that was appropriate to meet people’s needs.

Where people lacked capacity in certain areas, capacity assessments had been completed to show how people were supported to make those decisions. When people were being unlawfully restricted this had been considered and Deprivation of Liberty Safeguards (DoLS) applications had been made to ensure people’s rights were protected.

People liked the meals provided and choices were available to them. People accessed the services of other health professionals and told us they saw health professionals when they needed to. People were supported to maintain and develop their social interests.

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We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people’s support needs and we saw the staff were respectful to people when providing this support.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

People told us they could make choices about their food and drink. People told us they were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

Staff told us they received training and support to enable them to meet people’s needs. Staff told us they enjoyed working at the home and people told us they were happy with the care provided. One person told us, “There’s always staff here, and they are only too ready to help. They’re lovely and always here to help.”

We carried out this inspection to check on the staffing provided at the service and to determine whether there were enough staff on duty to meet the needs of people using the service. The inspection was unannounced which meant the provider and staff did not know we were coming.

In this report the name of a registered manager, Gillian Harper appears, who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We observed staff working in the home and considered there were sufficient numbers of staff on duty during our inspection. We found staffing levels were sufficient for the number of people living in the home. This allowed staff to provide personal care in a timely and unhurried way.

We saw staff members were responsive to the needs of the people they were supporting, and were kind and patient. The people we spoke with said they were happy with the care and support they were receiving.

We inspected this service on 10 May 2012, and we found the service was not compliant with how people were supported to make decisions and the support provided for people with dementia. We carried out this inspection to check the improvements in this area. The inspection was unannounced, which meant the provider and the staff did not know we were coming. We spoke with four people using the service, and four staff about how the service was delivered.

We saw that where people were not able to make decisions, capacity assessments had been completed. Information about why others had made decisions on their behalf had been recorded to demonstrate why the decisions had been made. This meant people could be confident these had been made in their best interest.

We saw the staff provided sensitive support to people, and people were treated with respect. Personal care issues were discussed discreetly and staff could choose who they wanted to help them with their personal care. One person told us, “The staff help me to get ready for bed, they are always courteous and very respectful.”

We saw that some areas of the home were not used in the evening as the service was awaiting new heaters. This meant most people spent time in the main lounge which was noisy at times. Some people told us they would like to be in a quieter area to relax in the evening. The registered manager recognised this and was reviewing the environment to meet people’s individual needs.

We visited this service in December 2011 and a compliance action was made. This meant the home needed to improve how staff were trained and given the skills to manage complex behaviour. We carried out this visit as part of our planned reviews and also to check the improvements in this area. The visit was unannounced which meant the provider and the staff did not know we were coming.

We involve people who use services and family carers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using social care services, we have called them experts by experience. An expert by experience took part in this inspection and talked to the people who used the service. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found.

Some people who used the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views to us we observed interaction between people and staff. We also used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences where during the day. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This included looking at the support that was given to them by the staff.

We saw the staff provided sensitive support to people, and people were treated with respect. Personal care issues were discussed sensitively and discreetly. We spoke with eight people and three visitors who told us that they were happy with the care and support in the home. They said the staff were always available and responded promptly to any areas of concern. People who used the service and their relatives told us, “We can’t fault them, they can never do enough for you.” And “The staff here are lovely, very caring and attentive.”

We saw people were dressed in their own style and they told us if they needed support, the staff would help them to continue to take a pride in their appearance.

Family and friends could visit the home whenever they wanted, and family members were able to continue to provide care for a relative and spend time in the home. People told us that they go to family homes and continue to enjoy family events. Relatives and carers could accompany people on medical appointments if people wanted them to. When important things happened relatives told us that communication from the staff team was good.

We visited this service in June and September 2011 and compliance actions were made. This meant the home needed to improve outcomes for people in relation to how people were supported, the staffing provided and how medication was managed. We saw that there had been improvements to the staffing provided and management arrangements during our visit in September. We carried out this visit because we needed information about how people consented to care, how people were supported to manage any complex need, and how medicines were managed.

Some people who used the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views to us we observed interaction between people and staff.

We observed staff providing support in the home and saw people were treated with respect. Personal care issues were discussed sensitively and discreetly. There was information about people’s care needs including their preferences and how they wanted care provided. People said that staff were very kind and knew what they were doing and they had confidence that staff would do the right thing for them.

People were dressed in their own style and if they needed support, staff helped individuals to continue to take a pride in their appearance. People were able to have the hair cut and styled during our visit and people told us they like to look nice and were happy with the hairdressing service.

We saw staff listening to people and spending time with them, talking and carrying out activities, as well as providing care. A range of individual activities were available and people and their relatives told us activities were arranged over the Christmas period including a pantomime, having a Christmas meal at a restaurant and Christmas shopping.

Relatives were able to continue to play an active role and support people and provide care. When important things happened people told us that communication was good.

We visited this service in June 2011 and six compliance actions were made. This meant the home needed to improve outcomes for people in these areas to ensure compliance. On this visit we saw that there were improvements to the staffing provided and management arrangements, and some changes had been made to the environment to keep people safe. We needed more evidence to demonstrate how the service obtained consent of people in relation to the care and treatment they received, and how people were supported to manage any complex need. Improvements were needed for how medicines were managed.

The staff told us they enjoyed working at the home and there had been improvements. Staff said that having more staff on duty meant that they were able to spend more time with people and they didn’t have to rush tasks.

We spoke with six people who lived at the home and observed the way staff supported people and spoke to them. We saw staff were respectful and talked to people before offering care or support, and ensured people understood. People said that staff were very kind and knew what they were doing. People had confidence that staff would do the right thing for them.

People were dressed in their own style and if they needed support, staff helped individuals to continue to take a pride in their appearance. People told us they were able to choose how they wanted to be dressed and how to spend their day. We saw staff supporting people with hygiene and cleanliness after having a meal and asking people if they were happy.

People knew there was information held about them but were not actively involved in review of their plans and did not know how to access this information. People were confident the staff knew this information and said they received the care and support they needed and they felt safe and happy at the home. People told us, “They’re very good here, they know how to look after you” and “the staff here are really lovely, they can never do enough for you.” We saw staff interacting and communicating with people throughout our visit. The interactions were friendly, professional and relaxed and people were informed about what was happening and able to make choices.

People were dressed in their own style and if they needed support, staff helped individuals to continue to take a pride in their appearance. Staff listened to people and spent time with them, talking and carrying out activities. People told us they could decide how to spend their day and what activities to be involved in and liked the organised activities. People spoke positively about being able to leave the home and be involved in community activities such as visiting Stapenhill gardens, going shopping and sitting outside when the weather was pleasant. People shared recipes and cooking tips and told us they enjoyed baking cakes.

A relative we spoke with told us that the home had lost some members of the staff team and felt that the service needed to do more to retain their staff to ensure they promote consistency and continuity of care for people who live there. We identified that staffing need to be reviewed to ensure there was enough staff on duty to meet people’s needs.

Relatives were able to continue to play an active role and support people and provide care. When important things happened relatives told us that communication was good and staff would contact them.

We inspected this service on 12 and 13 January 2015. The inspection was unannounced. At our previous inspection in September 2013, the service was meeting the regulations that we checked.

The service provided accommodation and personal care for up to 30 older people who may have dementia. There were 23 people living at the home at the time of our inspection. There was no registered manager in post at the time of our inspection, however a newly appointed manager was on duty and they were being supported by the previous registered manager during their induction. 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.

People who lived at the home told us they felt safe and that the staff treated them in a respectful way. The staff understood their responsibilities to protect people from harm.

People were supported in a safe way because assessments were in place that identified risks to people’s health and safety. Care plans directed staff on how to minimise the identified risks. Plans were in place to respond to emergencies to ensure people were supported appropriately.

Care staff knew about people’s individual risks and told us they had all the equipment they needed to assist people safely. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff were suitably recruited which minimised risks to people’s safety.

The cleaning staff did not follow the correct procedure to ensure that standards of cleanliness were maintained in a consistent way.

Staff received training that was appropriate to meet people’s needs and the number of staff on duty was sufficient to ensure people could be supported in a safe way.

People told us that they liked the staff and confirmed they were supported to maintain their independence and make choices and decisions.

The provider had trained their staff in understanding the requirements of the Mental Capacity Act and records showed that they understood their responsibility to protect people’s rights by complying with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us they liked the meals and we saw that staff monitored any risks to people’s nutritional needs and took the appropriate action when required.

People were supported to maintain good health and accessed the services of other health professionals. People told us they saw health professionals when they needed to.

People told us that the staff were caring and supported them in a way that protected their privacy and dignity. We saw that staff treated people with consideration and respect.

People we spoke with told us they were involved in deciding how they were cared for and supported. We saw that people were supported to maintain their appearance and sense of style.

People were supported to access the local community and participate in social activities and events.

Due to the changes in manager, the quality monitoring systems the provider had in place had not been undertaken over recent months.