We inspected Croftdown House on 13 September 2016. The inspection was unannounced. Croftdown House is a home which is registered to provide nursing or personal care for up to ten adults with mental health conditions. At the time of our inspection there were eight people living in the home.

We previously inspected Croftdown House in November 2014 and found the provider was meeting all the legal requirements and regulations we inspected.

The home had a registered manager. 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.

The registered manager had worked in adult social care for many years and had a good understanding of what was required to provide good care. The service was well managed. We requested a variety of records relating to people living in the home, staff and maintenance of the home. The records were promptly located, up to date and well organised.

Appropriate assessments were conducted before people began to use the service. Care was planned and delivered to ensure people were protected against abuse and avoidable harm. People felt safe from abuse and knew who report any concerns to. Staff had been trained in safeguarding adults. They knew how to identify abuse and how to report any concerns.

There was a sufficient number of suitable staff to help keep people safe and meet their needs. Staff had been recruited using a thorough recruitment process which was consistently used by the registered manager. Appropriate checks were carried out before staff were allowed to work alone with people. This helped to ensure that people were supported by staff who were suitable for the role. The provider supported staff to deliver effective care through regular training, supervision and performance review.

People were satisfied with the quality of care they received and felt that it enhanced their quality of life. People were treated with respect, compassion and kindness. Staff knew people well. They knew people’s routines and preferences and understood what was important to them. They also knew how to recognise the signs that a person’s mental health was deteriorating and the action to take.

Staff understood the relevant requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and how it applied to people in their care. People’s individuality was at the centre of how their care was delivered. They were fully involved in making decisions about their care including what they ate and how they spent their time day-to-day.

People had a sufficient amount to eat and drink. Staff knew what constituted a balanced diet and supported people to have a choice of well balanced meals. People received the support they needed to maintain good health and had access to a variety of healthcare professionals. People’s medicines were appropriately managed so they received them safely.

Staff understood their responsibilities in relation to infection control. People were protected from the risk and spread of infection because staff followed the infection control procedures in place. The home was clean and well maintained.

There were systems in place to assess and monitor the quality of care people received. People felt able to express their views and told us the management and staff were responsive to their comments and suggestions.

We inspected Croftdown House on 24 November 2014. The inspection was unannounced.

Croftdown House is a care home which is registered to provide personal and nursing care for up to fifteen adults with long term mental health issues. At the time of our inspection there were three people living in the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously inspected Croftdown House in June 2014. We found that it was not meeting all the legal requirements and regulations that we inspected. People were not adequately protected from abuse. Appropriate checks were not carried out on staff before they began to work alone with people using the service. We were also concerned that staff did not receive regular, relevant training.

After the inspection in June 2014, we asked the provider to take action to make improvements to the way they protected people from abuse, recruited and supported staff. The provider told us the improvements would be made by August 2014. This action has now been completed.

During our inspection on 24 November 2014 we found the service was meeting all the required standards. People told us they felt safe. Relatives also told us people living in the home were safe. Staff were knowledgeable about how to recognise the signs of abuse and how to report any concerns.

Staff obtained people’s consent to before they delivered care. The manager and staff understood the main principles of the Mental Capacity Act 2005 and the specific requirements of the Deprivation of Liberty Safeguards (DoLS).

People had comprehensive risk assessments which gave staff detailed information on how to manage the risks identified. There were plans in place to keep people safe in the event of an emergency. There were a sufficient number of suitable staff to keep people safe and meet their needs.

There were appropriate arrangements in place for the storage, administering, recording and disposal of medicines. Staff received training in administering medicines and knew how to do so safely. All areas of the home were clean and well maintained. Staff controlled the risk and spread of infection by following the service’s infection control policy.

People were satisfied with the quality of care they received. Care plans provided detailed information to staff about how to meet people’s individual needs. People were supported by staff who had the knowledge, skills and experience to deliver their care effectively.

People received a nutritious and balanced diet and had enough to eat and drink throughout the day. Staff worked with a variety of healthcare professionals to support people to maintain good physical and mental health.

People using the service and staff related well with each other. People told us the staff were kind and caring. People were treated with respect and were at the centre of decisions about their care. The provider listened to and learned from people’s experiences, concerns and complaints to improve the service.

Staff had clearly defined roles and understood their responsibilities. People felt able to discuss their care with staff and management. There were systems in place to assess and monitor the quality of care people received.

Our inspection team was made up of an inspector who answered our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

During the inspection we spoke with people using the service and five members of staff including two members of the management team. We also reviewed records, policies and procedures.

Is the service safe?

People using the service told us staff treated them with respect and that they felt safe. People told us that if they had any concerns about their safety, they would tell the manager or their care co-ordinator. The service had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although at the time of our inspection no applications had needed to be made. The manager was aware of the Deprivation of Liberty (DoLS) legislation and how it applied to the people in their care.

However, we found that staff had not received training in safeguarding vulnerable adults. Staff had limited knowledge on the issue of abuse and the procedures they needed to follow to ensure that people were safe. This meant the provider did not have suitable arrangements in place to ensure that people using the service were protected from the risk of abuse.

We have asked the provider to improve the arrangements they have in place to protect people from abuse and keep them safe.

Is the service effective?

People had individual care plans which set out their care needs. People told us they were involved in the decision making about their care, treatment and support and knew what was in their care plan. One person told us, “I know what is in my care plan and the staff do what they should be doing"

The care files we reviewed contained comprehensive risk assessments which were reviewed monthly. People using the service had a health action plan and were registered with a local GP practice. Staff worked well with other health professionals such as the district nurse, community psychiatric nurse and physiotherapists. We saw evidence that people were encouraged and supported to attend medical appointments. People were supported by staff to participate in their social interests.

Is the service caring?

We observed that staff treated people with respect. We spoke with people who use the service and they were satisfied with the quality of care they received. Their comments included, “the carers treat me well"

The care plans we looked at reflected people's personal preferences. People's care files contained their views on the information in their care plan and detailed their expectations of the service.

Is the service responsive?

People’s needs were assessed before they began to use the service and were reviewed on a regular basis. People told us the service was delivering the care they needed and was flexible where there was a change in their needs or preferences.

People felt able to express their views and told us their comments and suggestions were acted on by staff. The service sought the views of people using the service as part of their care planning but also by conducting satisfaction surveys.

Is the service well-led?

The manager of the service had been in post for three weeks at the time of our inspection. The manager knew the systems that had to be in place to ensure the service offered the quality of care people required. The provider had appropriate policies and procedures in place in relation to care planning and review, keeping people safe, staff recruitment and development and monitoring the quality of service people received.

However, we were concerned that some of these policies and procedures were not being applied. Records we reviewed demonstrated that appropriate checks were not always carried out on job applicants before they were employed and allowed to work with people using the service. Once employed, staff were not given appropriate training in areas relevant to their role such as, mental health awareness, medicines administration, infection control, and safeguarding vulnerable adults.

This meant there was a risk of people being cared for by staff who lacked the necessary knowledge, skills and experience to do their job and therefore receiving care and support which was inappropriate or unsafe.

We have asked the provider to improve the checks they carry out before staff begin to work with people using the service and to improve the way it supports its staff.