Croft House provides accommodation and nursing care for up to 38 older people, some of whom are living with dementia. The service is spread across two floors and includes a communal lounge and dining areas. On the day of the inspection there were 25 people living in the service.

At the last inspection on 18 November 2014 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service had recently recruited a new manager who was in the process of registration with the Care Quality Commission. 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 were supported by staff who knew how to recognise the signs of abuse and who were confident about how and whom to report any concerns to.

There were enough suitably qualified staff available to effectively meet the needs of people. Staff were recruited safely and medication was well managed.

Systems were in place to record and monitor accidents and incidents and we saw evidence that the service put actions into place to mitigate the risk of reoccurrence.

Staff supported people in line with the principles of the Mental Capacity Act 2005 (MCA). 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 were encouraged to express their views and had completed surveys. Consequently, they felt listened to and were confident that any concerns or issues they raised would be promptly addressed.

People continued to have their nutritional needs met and were supported to have their healthcare needs met.

People were supported by staff who knew them well and who were kind and caring when supporting them. A variety of activities were available which were inclusive, stimulating and prevented social isolation.

The management team were visible and supported staff to undertake their roles. The service continued to have a relaxed and homely feel.

Further information is in the detailed findings below.

This inspection took place on 12 November 2014.

Croft House is registered to provide accommodation for 38 older people who require personal and nursing care. There were 29 people living in the home on the day of our inspection.

The last inspection of Croft House took place on 4 June 2014, during which we found the provider was not meeting the requirements of the law in relation to the accuracy and content of some records. At this inspection on 12 November 2014 we found that the required actions had been taken and the provider was meeting legal requirements.

The home had a registered manager who was registered with the commission in September 2013. 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 and associated Regulations about how the service is run.

People told us they felt safe living at the service. Staff had attended training on safeguarding people. They were knowledgeable about identifying abuse and how to report it. Information on how to report any concerns was displayed in the home and recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the home.

Medicines were safely stored, recorded and administered in line with current guidance so as to ensure people received their prescribed medicines. People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet their needs effectively. People’s dignity and privacy was respected and they all spoke in a complimentary way about the kind and caring approach of the staff. Visitors felt welcome and people were supported to maintain relationships and participate in social activities and outings.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions for themselves and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. Staff were aware of the requirements of the MCA and DoLS and had acted in accordance with the law. Assessments of people's capacity to make decisions about their care had been completed to protect people's rights. At the time of our inspection no applications had been made to the local authority in relation to people who lived in the service.

Care plans were regularly reviewed and showed that the person, or where appropriate their relatives, had been involved. They included people’s preferences and individual needs so that staff had clear information on how to give people the care that they needed. People told us that they received the care they needed.

The service was well led. People knew the manager and found them to be a strong presence in the home. People and staff had opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response. The provider and registered manager had robust systems in place to check on the quality and safety of the service provided, to put actions plans in place where needed, and to check that these were completed.

We spoke with five of the 31 people who were using the service at the time of our inspection. We also spoke with one person's visitor and eight staff members. We looked at five people's care records. We also looked at staff records, health and safety checks, staff and resident meeting minutes and records of checks that the provider’s representative completed to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us about the security at the service and told us they felt safe living there. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded from abuse.

Selection and recruitment processes were thorough to protect people who used the service from being cared for by unsuitable people. Staff attended training to support them to care for people safely.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care at the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

We found that care records were not always complete, accurate and fit for purpose. This meant that care was not accurately planned for the individual to limit the risks to their safety and well-being.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care records, and the improvements they will make in relation to their accuracy and completeness.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, “It is very good here, the care. If I want to go out, someone will take me as I am a bit wobbly. I cannot think of anything they could do better.”

The outcome of the most recent survey of people who used the service confirmed that people were satisfied with the service provided to them at Croft House.

Our observations and discussions demonstrated that people who used the service received regular support from a variety of health and social care services and professionals as their conditions and circumstances required.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. One person said, “It’s as good as a cruise for the food, it is very good. The other day we had Pimms at lunch as it was a hot day, and later staff brought us an ice lolly, they are very thoughtful and caring”.

We observed and listened to daily life and interactions in the home and noted that staff were kind and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. Information was provided in a way that made it easy to see and understand. People's choices were taken in to account and listened to.

People had opportunities to express their views and these were listened to and acted upon. Records showed that the provider had responded to people’s views about the temperature of the food served and preferences to be included in the menu.

Staff monitored people’s health and responded promptly to changes to ensure their well-being.

Is the service well-led?

The service had a registered manager in post, who, because they did not have a clinical background, was supported by a deputy manager who was a registered nurse. Staff had clearly defined roles and responsibilities so that all aspects of the service were effectively managed.

Staff said that they felt well supported and able do their jobs safely.

The service had a quality assurance system in place. Records showed that where shortfalls were identified, actions were set with timescales for completion to ensure quality of the service continuously improved.

We spoke with six people who used the service, five members of staff and one visitor. One person told us, "I am very happy here, the staff are great." "The food is very good, we always get a good choice." Another person told us, "I have been so well looked after, we are all so happy with the staff." We found staff had a good knowledge of the people they cared for, their preferences, likes and dislikes. We saw that people were given time to make choices, were cared for in an unhurried way and supported to continue their interests.

We found that care plans were not always sufficiently detailed and risk assessments were not always appropriately completed or acted upon.

The service was clean and well maintained. Staff demonstrated a good knowledge of infection control and used gloves and aprons appropriately.

People were cared for by sufficient numbers of staff with an appropriate skill and who had received appropriate training. We found that there were two registered nurses on duty and six care staff.

We found that care plans and service records were kept securely, were up to date and easy to locate.

We spoke with nine people who used the service. People told us that they liked living in Croft House. One person said “It’s lovely here, It’s a happy place to live." Another person said that the staff "Were very caring." Three people said they sometimes had to wait for help at busy times of the day, and one person said "I have to wait to get up." People told us there had been admissions in the weeks before our visit and that all rooms were occupied. The manager told us that more staff were being recruited to maintain the level of service.