Croft House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Croft House is registered to provide accommodation and personal care to up to 67 people. The home specialises in the care of older people including people who are living with dementia.

The building is split into four separate areas. Two provide care to people living with dementia and the other two support people with more general personal care needs. At the time of this inspection there were 64 people living at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

Why the service is rated good.

People received safe care and looked relaxed and happy with the staff who supported them. One person said, “I feel safe. Nothing worries me because there are always people about.”

The provider had systems and processes which helped to minimise risks to people and took swift action if concerns were raised with them. Where individual risks were identified, action was taken to minimise these risks whilst encouraging people to maintain their independence.

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. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

The registered manager was committed to providing person centred care which was respectful and enabled people to live life as they chose, and to be happy. Comments from people and visitors showed this ethos was embedded in day to day practice. One person said, “I look forward to every day. I refuse to die whilst I’m having fun.” A visitor said, “I just can’t praise the place enough. They adapt and change to suit whatever they want at the time.”

People had their needs assessed and met by staff who were well supported and competent. Assessments of people’s care needs took account of their individual beliefs, culture and lifestyle choices. People were able to make decisions about their day to day care and their views were sought regarding the running of the home.

People told us staff were kind and patient and our observations during the inspection confirmed this. Staff knew people well and provided care in accordance with their individual needs and preferences.

People could be assured that at the end of their lives they, and their families, would be cared for with compassion and kindness.

People’s privacy and dignity was respected. Each person had a single room where they could spend time in private if they wished to. Staff always knocked on doors before entering people’s personal space. Where people required support with personal care this was provided discreetly to promote people’s dignity.

People could be confident that any complaints or concerns raised would be fully investigated and responded to. People and staff told us they felt able to share their concerns because the management of the home was very approachable.

Further information is in the detailed findings below

This inspection was unannounced and took place on 10 May 2016

Croft House is registered to provide care and accommodation to up to 67 people. The home specialises in the care of older people including people living with dementia. The home is divided into four units. Two units provide care to people living with dementia and the other two care for people with more general personal care needs. At the time of this inspection there were 48 people living at the home.

The last inspection of the home was carried out in July 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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 registered manager had been in post for approximately six months but was already well respected by people using the service and staff. They were described as open and approachable and keen to listen to people’s views. People said they could make suggestions and would be comfortable to make a complaint if they needed to.

There was a stable staff team who people told us were kind and caring. People felt safe at the home and with the staff who supported them. One person said “Staff are always kind and friendly. They treat you right.” Another person told us “I feel safe and happy in this home.” Staff showed patience and kindness when they assisted people.

There were sufficient numbers of staff to meet people’s needs safely. Staff received appropriate training to carry out their roles and sought advice from outside professionals when required. Staff liaised with healthcare professions to make sure people received prompt care and treatment to meet their physical and mental health needs.

People had their nutritional needs assessed and were provided with a diet which met their needs and preferences. People were complimentary about the food and told us there were always choices of meals.

Care and support was personalised to each individual to enable people to maintain their routines of daily living. Staff had a good knowledge of each person which enabled them to provide care in manner that respected their wishes and preferences.

Staff sought people’s consent before carrying out any care. One person told us “Staff would do anything for you but they don’t make you do anything.” Staff knew what to do if people lacked the mental capacity to make a decision.

People’s independence was promoted and risk assessments were carried out to enable people to take part in activities and receive their care safely. There was a variety of organised activities which people could join in with or they could choose to pursue their own interests and hobbies.

People received their medicines safely from staff who had received specialist training in this area. People were offered prescribed pain relief regularly to maintain their comfort.

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with five members of staff and eleven people who used the service. We also reviewed six people’s care records and four staff members’ personnel records. There were sixty five people in the service at the time of our inspection.

Is the service safe?

People told us they felt safe.

There were sufficient numbers of staff on duty to meet the needs of the people in the service.

The provider could demonstrate staff were suitable and had the skills and experience needed to support people who used the service. Staff personnel records contained all checks required to keep people in the service safe. Staff described to us how they would recognise safeguarding alerts and said they were confident to raise any concerns to the manager.

The environment was clean and hygienic. The premises were secure from anyone entering unannounced. Care records were held securely and were only accessed by authorised staff.

Is the service effective?

People can be reassured their needs will be met at this service. People told us they were happy with the staff support they received from the staff team. Staff members we met had a good understanding of people’s care and welfare. One staff told us, "We make sure people are treated properly, as we’d like to be treated.”

There was a safe procedure for recruiting staff and for making sure they had the skills and knowledge to support people in this service.

Each person had well written care records that described how their care needs were to be met.

Is the service caring?

People were supported by kind and patient staff. Staff were professional when interacting with people. We saw staff gave people sufficient time to make their own decisions. People told us they were not hurried. One person told us, “I need to take my time to get things done.” Our observations throughout the visit confirmed this.

A survey sent to families and healthcare professionals was complimentary, with comments such as, “The home is wonderful” and, “The nicest place I’ve seen.”

Is the service responsive?

People’s individual care needs were assessed before they arrived at the service. The manager ensured people were supported in the best possible way.

People in the service had regular access to any healthcare professional, such as a doctor or optician, when they needed.

People had access to activities that were important to them and were supported to maintain relationships with friends and relatives.

People told us staff discussed their care records with them monthly and updated the contents where necessary.

Is the service well-led?

There were well defined quality assurance processes in place, including regular feedback by way of audits, monitoring of complaints and annual surveys.

Staff told us they were clear about their roles and responsibilities. Staff we met had a good understanding of the aims of the service and were regularly supervised by senior staff.

The service has developed strong links with the local community, especially schools and local businesses, in order to provide more awareness for people in the service with dementia.

People’s personal care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Our inspection was unannounced and lasted approximately nine hours. We were accompanied by an expert by experience. During the inspection we spoke with the registered manager and seven other care staff. We spent time in communal areas observing care and spoke with ten people who lived at Croft House, as well as five relatives/ friends who were visiting at the time. In addition, we spoke with one external training provider and one health care professional on the day and one other health care professional following the inspection. We looked at six care records and six staff recruitment files.

People told us they were very happy about how care and support was provided to them, and with the staff who provided that care. We were told that they had the help and assistance they needed. We observed that people had good relationships with the staff, people and staff interacted well. There was a friendly and welcoming atmosphere. People told us that they liked living in the home. One said “I don’t think you could get better. It’s a smiley place. People smile here” Another added “Everybody tries very hard to make you happy. There’s a lot of kindness here.”

We found staff worked in co-operation with others, and that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We looked at records relating to the people who lived at Croft House, at staff records and records relating to the management of the services and saw they were accurate and fit for purpose.

This unannounced inspection visit was carried out to check concerning information we had received about the service. We had been told of concerns about the levels of staffing during the early morning period in conjunction with high dependency needs of the people living in one part of the home. The home was divided into four units over two floors and we visited one of these units which specialises in providing support for people with long term mental health needs. We found the home was fully compliant at the last inspection visit of the service in May 2012. We found the service compliant at this visit to the service.

We spoke with six of the 13 people who were living in this part of the home, eight staff and one visitor. We reviewed care records for four people and carried out an observation of activities in the communal area before and during breakfast time. We also looked at care records and other documents relating to the administration of the service.

We (the Care Quality Commission) carried out this unannounced inspection on 24 May 2012 as part of our planned inspection programme.

Croft House provides ‘specialist residential care’ for people with dementia in association with Somerset Partnership NHS Foundation Trust. The service had been commissioned specifically to meet the long term care needs of older people with dementia and was supported by the Community Mental Health Teams.

On the day of our visit there were 65 people living at the home. We met or spoke with eight people who lived at the home as well as three relatives, three visiting health professionals, and 10 members of staff, including the registered manager. Following the inspection we spoke with two other visiting health professionals.

Many people that lived at Croft House had dementia and were unable to tell us fully about their experiences. We spent time observing the care delivered to people living on the two dementia units at the home, looking at what support people got and whether they had positive experiences.

We looked at some of the key records kept by the home. These included care plans, risk assessments and staff training records. This helps us to better understand how well the home is run. We looked at the care records of five people; where possible we spoke to the individual and/or their relative.

People we spoke with who were able to share their experiences of living at the service were positive. Comments included, “It is very nice here, very nice indeed”, “I feel very good being here, I feel really lucky…”, “You have got to go a long way to beat this place…” and “I have lots of freedom here…”

Visiting relatives told us that they were very happy with the care and support their family member received. One relative told us, “I can’t fault it…I go home with peace of mind…” another relative told us, “I can’t speak more highly of the home…everyone is treated so well, no discrimination…”

Visiting health professionals told us that overall the care provided at Croft House was good. One said, “The staff are brilliant…”, another told us, “On the whole the care is very good. The atmosphere is calm and peaceful”. A third professional told us, “The dementia care is especially good…”

We saw that people enjoyed taking part in various activities throughout the day. Activities included painting, cooking with local school children, visiting the garden, board games and one to one sessions for people. People told us they were happy with the variety of activities on offer. One person said, “There is always something to do here…” People were also very satisfied with the food provided, which was described as lovely, delicious and varied.

People told us that the home was always clean and tidy. Visiting relatives and health professionals also told that the home was always clean and free from offensive odours.

People told us they felt "safe" at the home and would report any concerns. People living at the home and visitors to the home said they knew to report any concerns to the senior staff or the manager. People living at the home and their visitors told us they were asked their opinions about aspects of the service provided and that they had seen improvements made in response to their suggestions.