Croft Care Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults living with disabilities. There were 167 people using the service at the time of inspection.

The inspection of Croft Care Services took place on 17 July 2018 at their offices and was followed by telephone calls to people using the service and care staff between 19 and 24 July 2018.The provider was given short notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager would be available.

At our previous inspection in April 2017 we rated the service as ‘Requires Improvement’. We identified two regulatory breaches which related to safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions – safe, effective, responsive and well led, to at least good. This inspection was to check improvements had been made and to review the ratings.

There was a registered manager in post and available at the time of the inspection. 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 improvements had been made in regard to risk management and medicines. Risk management plans were person-centred and contained information in relation to equipment and method, including pictorial guidance for staff to follow. Risk reduction measures were reflective of individual need. Medicines management was safe as staff were able to explain the process in detail and audits ensured effective oversight was in place.

People told us they felt safe with care staff, and we were confident staff knew how to recognise safeguarding concerns and what action to take in the event of having such a concern.

However, we did find some issues with call times from both the recipient and staff perspective. This was not across the whole service but some people felt staff were often late and problems only usually arose in the absence of their regular care assistant. This showed much of the care delivery was consistent but covering absence needed further consideration. Staff had a mixed experience where some felt their workload was appropriate but others felt rushed, with little time to travel between calls. Most staff told us they stayed the full duration of the call and analysis of call times confirmed this. We recommend the registered manager reviews the rotas to ensure staff have sufficient time to complete the required tasks and travel between calls.

The registered manager displayed a sound knowledge of current practice based on a number of sources and was keen to maintain this. This was enhanced by the provider who also took a pro-active approach to ensuring knowledge and policies were current.

Staff received an induction, supervision and training and people felt staff were confident in their duties. Staff felt their colleagues were supportive of each other.

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

People had appropriate nutritional support and were supported to access other services as required if their needs changed. We saw some pro-active involvement by the service when one person’s mobility changed.

We found people spoke positively of the care staff, describing them as kind and friendly. There was evidence of some strong relationships between people and care assistants, and compliments w

The inspection of Croft Care Services took place on 3 and 13 April 2017. We previously inspected the service on 24 August 2016 at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, supporting staff and governance. We rated the service as inadequate overall and placed it in special measures. This inspection was to see whether improvements had been made.

Croft Care Services is registered to provide personal care. Care and support is provided to people who live in their own homes within the Wakefield area and the locality of south west Huddersfield. On the day of our inspection 225 people were receiving support with personal care.

The service had a manager in place but they were not yet registered with the Care Quality Commission (CQC). 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 told us they felt safe and staff knew what action to take if they were concerned a person was at risk of harm or abuse.

Improvements had been made to people’s moving and handling records but four of the records we reviewed did not contain either sufficient or consistent information to enable staff to provide safe care.

Staff were recruited safely however, there were a number of staff vacancies that the registered provider was recruiting for. People we spoke with did not raise concerns regarding missed calls but said staff were sometimes late. Staff were unhappy that they would often only receive their rotas the evening prior to their shift.

Improvements had been made to the management of medicines. Staff had completed relevant training and a system was being implemented to ensure staff had a regular assessment of their competency to administer people’s medicines. An external audit had been recently carried out to review the organisations regulatory compliance. However, not all the records regarding medicines were robust, we saw a number of unexplained gaps on the MAR for one person and the MAR for another person did not record the maximum dose staff could administer.

The registered provider had an induction programme to support new staff. There was also a system in place to ensure staff were up to date with their training requirements although there was a lack of documentary evidence in regard to staffs practical moving and handling training.

Not all staff had received a recent supervision or field based assessment of their performance but the manager had implemented a spread sheet so they were aware of which staff still needed this to be competed. This would also enable the manager to ensure regular management of staff performance was maintained in the future.

The manager had begun to audit people’s care records to ascertain who needed a mental capacity assessment; however, at the time of the inspection people’s records did not evidence compliance with the Mental Capacity Act 2005.

People told us and records evidenced, staff supported them to access meals and drinks.

People and their relatives told us staff were caring, kind and treated them with dignity and respect. The staff we spoke with were knowledgeable about people’s support needs. Staff were able to tell us how they enabled people to make choices and the steps they took to maintain people’s privacy and dignity.

People told us they had a care plan at their home. Staff told us a number of care plans were being reviewed and updated. We found updated care plans were detailed and person centred. The manager had begun to take action to identify shortfalls in people’s care plans and related documentation.

We found the manager had begun to take a pro-active approach to identifying complaints, reviewing the issues raised and ta

The inspection of Croft Care Services took place on 24 August 2016. We previously inspected the service on 12 November 2015, at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, supporting staff and good governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Croft Care Services is registered to provide personal care. Care and support is provided to people who live in their own homes within the Wakefield area and the locality of south west Huddersfield. On the day of our inspection 217 people were receiving support with personal care.

The service had a registered manager in place. 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.

Staff we spoke with were able to tell us what action they would take if they were concerned a person was at risk of harm or abuse however, not all staff had completed refresher training in this topic. When we spoke with a relative they told us about a potential safeguarding incident which had not been reported to either the local authority safeguarding team or to the Care Quality Commission (CQC).

Not all staff had completed training in medicines, there was no evidence staff’s competency to administer medicines was assessed and no audits were completed on medicine administration records. We looked at the medicine records for eleven people and found they did not provide a clear and accurate record of the medicines staff had administered to people. The risk assessment for one person had not been updated since 2005. This demonstrates a continuing breach of Regulation 12 (1) (2)(a)(b)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 201.

People who used the service said staff did not miss their calls and the regular staff turned up on time. Staff told us they usually provided care to a regular group of people although staff said they often did not receive their rota until Sunday, to commence on Monday morning. We saw systems were in place to ensure pre-employment checks were completed on potential employees.

There was a system in place to support new staff. Where staff required refresher training the time frames specified by the organisation where not adhered to. The provision of ongoing supervision and performance management for staff was not consistent. This demonstrates a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18 (2)(a)

Where people were living with dementia, there was no evidence of either mental capacity assessments or best interest’s decision making. Where family members had signed to consent to the care and support of their relative, the reason for this was not evident.

People who used the service told us staff were caring and kind. Staff took steps to maintain their privacy and dignity, such as closing doors and curtains. Staff also offered people choices, for example what they a wanted to eat and drink. We saw evidence people were encouraged to maintain their independence where possible.

People told us their needs were assessed by Croft Care services prior to any care being provided. People said they had care plans but not all the staff we spoke with said peoples care plans were up to date. The office manager confirmed the service was behind with reviewing care plans but a plan was in place to address the shortfall.

There was a system in place to manage complaints however; we saw two issues which had not been logged as complaints due the registered manager not being aware of them.

When we rev

The inspection of Croft Care Services took place on 12 November 2015 and was announced. We previously inspected the service on 15 August 2014 and, at that time we found the registered provider was not meeting the regulations relating to care and welfare of people who use services and assessing and monitoring the quality of service provision. We asked the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Croft Care Services is registered to provide personal care. Care and support is provided to people who live in their own homes within the localities of Kirklees and Wakefield. The company had completed the purchase of another care agency in the Wakefield area during September 2015 and in October 2015 the two services amalgamated.

The service had a registered manager in place. 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 told us they felt safe. The staff we spoke with were aware of what constituted abuse.

People told us staff were regularly late for their allocated call although we saw evidence this had shown signs of improvement in recent weeks.

Risk assessments in care plans had not been reviewed and lacked details about the equipment and methods for staff to use which would keep people safe. We were unable to evidence staff were competent to administer peoples medicines and the system for recording the administration of medicine was not robust. People’s safety and welfare was not protected. These examples demonstrate a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all staff training was up to date and staff did not receive regular management supervision. Not all the staff files we reviewed evidenced staff had received induction when they commenced employment. This demonstrated a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although staff expressed an understanding of people’s capacity only 19 of the 65 staff had completed training in the Mental Capacity Act 2005.

People told us the staff at Croft Care Services were kind, caring and treated them with dignity and respect.

There was not a system in place to ensure peoples care plans were routinely reviewed. Care records were not always reflective of the care and support people received and archived records were not returned to the office promptly. This demonstrated a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

One person told us they had raised two complaints but these were not logged in the complaints file.

Staff had not received regular spot checks on their performance and staff meetings were not held on a regular basis. The service did not have an effective quality assurance and governance system in place to drive continuous improvement. Feedback from people who used the service had not been sought since March 2014. This evidence demonstrates a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we looked for the answers to five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We were told by staff that one person who used the service had their cigarette intake monitored by staff. We could not see detailed information about this in the person's care plan; we were therefore unable to assure ourselves this was what the person wanted. We were told by a member of staff the person was at risk of falling asleep with their cigarette and therefore the fire service had been contacted and a special blanket had been supplied to try and reduce the risk of a falling cigarette causing a fire. This was not documented in the person's care plan and we could not see a risk assessment on this subject.

People who used the service and some of their relatives told us they had no concerns about their safety. One person said, "Don't worry if they ever did anything wrong I would report them."

We spoke with staff about their understanding of safeguarding. Staff confidently spoke about the types of abuse and what they would do should they have any concerns.

Is the service effective?

We visited a person who used the service in their home. It stated in their care plan that care staff should administer the person's eye drops. We watched the member of care staff administer the person's medication; however, they did not administer any eye drops. We asked why this was and we were told the person no longer required them.

We visited another person who used the service and saw in their care plan that their hearing was good. We noted this person wore a hearing aid and the person was having difficulty hearing the member of staff. There was no mention of the hearing aid in the person's care plan.

We saw a person who used the service had a catheter and a stoma bag, the recording of the assistance to the person was very good. We could see when the bags had been changed and details about the stoma site and how often the site was cleaned. Staff we spoke with told us they had received specialist training and were confident in their abilities to manage the catheter and stoma safely.

Is the service caring?

Throughout our visits to people's homes we saw staff were friendly and supportive in their approach to people. They treated people with respect and it was clear they knew people well. Most people who used the service told us they were happy with service provided by Croft Care Services. One person said, "I couldn't wish for anything better." Another person said, "They do everything for me." and "If I need it they spend more time with me than they should."

Is the service responsive?

We saw the results of the most recent survey and found the results were mostly positive. For example one person had said, "Both carers should be commended on how they do their job and that is brilliantly." Another person had said, "I am very happy with my regular carers but when they are off others are not as prompt." Other comments included, "They were so late I'd gone to bed", "A more regular review would be helpful" and "One carer comes when she wants to come, anytime up to 9.10 a.m." We could not see evidence of what had been done with regard to negative comments.

Is the service well led?

We asked people who used the service to tell us about their experience of the management team at Croft Care Services, one person said, "The staff are lovely. The only problem is the management. They don't know where the places they send the staff are." Another person said, "If you phone the office you don't seem to get anywhere.

All the staff we spoke with were very complimentary about the service and the management team. One person said, “I wouldn’t change anything.” Another person said, “I feel very supported by the managers.” Someone else said, “They are a really good company to work for” and “People are asked for their opinions and the managers listen.”

We did not speak with people who used the service at this inspection. This was because the issue identified at the last inspection was in relation to records.

At this inspection, we reviewed the care record documentation and spoke with staff and the manager.

We reviewed six people's care records and found these provided more detail and were personalised. We saw moving and handling risk assessments had been put into place for people who were immobile or had restricted mobility. The assessments showed how people should be moved safely and what equipment was required.

We spoke with two members of staff who told us they found people's care plans were detailed and easy to follow. One staff member said of the care plans: “They’re very good. You know from them what people like and how things should be done”.

Overall, we found people were protected from the risks of unsafe or inappropriate care and treatment.

During our visit we spoke with five people who used the service, five care workers, one of the co-ordinators and the manager.

People who used the service told us they were happy with the support they received. They said they usually had the same care workers which was important to them. They told us they would raise any concerns they had with the manager. One person said, “If I wasn’t happy I’d tell them, I have done in the past and they sorted it out.” Another said, “The carers I have are both great. They know what I like and do it my way.”

Staff told us people were involved in planning their care. This was not confirmed in the care records we reviewed which lacked detail, were not personalised or up-to-date.

Staff had a good knowledge and understanding of safeguarding procedures. We found systems were in place and were being used to report any allegations of abuse.

We found satisfactory staff recruitment processes were in place.

Staff told us they had a comprehensive induction and shadowing programme before they started working on their own. There was a programme of staff training and staff were updated to ensure their skills and practice were up-to-date.

We found that the quality of service was being assessed and monitored.