At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good, 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. At this inspection we found the service remained Good.

Croham Place is a care home registered to provide personal care and nursing for up to 28 adults who have a range of complex needs. The service is divided into three separate units. The largest is The Manor which is a home for 14 physically disabled adults with complex care needs requiring nursing intervention. The Beeches is a house for 12 men with acquired brain injuries (ABI) and behaviours that may challenge others. The Nightingales is currently closed and is being rebuilt to accommodate nine people. The proposed date for it to re-open is September 2019.

Relatives told us they felt their family members were safe living at Croham Place. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage identified hazards to help keep people safe from harm or injury.

Appropriate staff recruitment processes helped to ensure people were protected. We saw there were enough properly trained and well supported staff to meet people’s needs.

People received their medicines as prescribed and staff knew how to manage medicines safely.

Relatives and social care professionals told us people received effective care. Staff had access to a wide range of training and they were supported with regular and structured supervision.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way. There were policies in place in relation to this and the service had ensured the local authorities had carried out the appropriate assessments for people who might have been deprived of their liberty. Staff supported people to make choices and decisions about their care wherever they had the capacity to do so.

People were supported to have a varied and balanced diet and food that they enjoyed and they were enabled to eat and drink well and stay healthy.

Staff supported people to keep healthy and well through regular monitoring of their health and wellbeing.

Relatives and social care professionals told us staff were kind and caring. We saw staff treated people with dignity, respect and compassion. Staff understood people’s needs and helped them to express their views and wishes where ever possible.

People were encouraged to maintain relationships that were important to them. Relatives said they were made to feel welcome when they visited the home.

Care plans were in place which reflected people’s specific needs and their individual choices. Relatives of people were involved in reviewing their relations’ care plans and we saw people were supported to make decisions about their care and support.

People had access to their local community and could choose to participate in a variety of in-house and community based social activities. We also saw staff encouraged and supported people to be as independent as they could and wanted to be.

People using the service and their relatives were encouraged to give feedback on the service and there was an effective complaints system in place.

Relatives said the registered manager encouraged feedback and sought to develop and improve the service for p

We carried out a focused inspection of Croham Place on 22 February 2017. The inspection was unannounced.

At our previous inspection in June 2016, we found a breach of legal requirements because the provider did not have appropriate arrangements in place to ensure people were protected from the risk of abuse. The provider sent us a report stating what they would do to meet legal requirements in relation to the breach.

Our inspection on 22 February 2017 was carried out to check the provider was now meeting the legal requirements. This report only covers our findings in relation to this topic. You can read the full report from our last comprehensive inspection, by selecting the 'All reports' link for Croham Place on the Care Quality Commission (CQC) website.

Croham Place is a home which is registered to provide nursing and personal care for adults who have a range of complex needs. The service is divided into three separate units. The largest is the Manor which is home to 13 physically disabled adults with complex needs requiring nursing intervention. The Beeches is a house for eleven men with acquired brain injuries (ABI) and behaviours that may challenge others. The Nightingales is a bungalow shared by two people with autistic spectrum disorders. At the time of our inspection there were 26 people living in the home.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are "registered persons". Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection on 22 February 2017, we found the provider had made the required improvements and the legal requirements were met. The provider had appropriate arrangements in place to help ensure people were protected from abuse. The bank and agency staff we spoke with understood their responsibility to protect people from abuse and had good knowledge of how to do so.

We inspected Croham Place on 23 June 2016. The inspection was carried out by an inspector, a specialist advisor and an expert by experience. The inspection was unannounced .

Croham Place is a care home that is registered to provide personal care and nursing for up to 23 adults who have a range of complex needs. The service is divided into three separate units. The largest is The Manor which is a home for 14 physically disabled adults with complex care needs requiring nursing intervention. The Beeches is a house for seven men with acquired brain injuries (ABI) and behaviours that may challenge others. The Nightingales is a bungalow shared by two people with autistic spectrum disorders (ASD).

At our inspection in May 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to how the provider supported staff, met people’s needs and managed the service. We asked the provider to tell us how and when they would make the required improvements. These actions have now been completed.

During this inspection we found that the provider was meeting the regulations in relation to how it supported staff, met people’s needs and managed the service.

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 2008 (Regulated Activities) Regulations 2014 about how the service is run.

People were cared for by a sufficient number of staff. However, there was a shortage of permanent employed staff so the provider used agency staff to fill the gaps in staffing. The agency staff did not have the required knowledge to help keep people safe.

People told us they were safe. This was also the view of their relatives. People were protected from avoidable harm. Staff were supported by the provider to deliver effective care through relevant training, supervision and appraisal.

People received their medicines safely because there were appropriate procedures in place for ordering, storing, administering and recording medicines which were consistently followed by suitably qualified staff.

People received the help they needed to maintain good health and had access to a variety of healthcare professionals. Employed staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care.

People were protected from the risk and spread of infection because staff understood their responsibilities in relation to infection control and followed the procedures in place. All areas of the home were clean and well maintained. The premises were of a suitable layout and design for the people living there. Equipment was regularly service and well maintained.

People were satisfied with the quality and quantity of food they received. People were treated with respect, compassion and kindness by staff. They were involved in making decisions about their care and where appropriate, their relatives were also involved.

People were encouraged and supported to be as independent as they wanted to be. People had the opportunity to participate in activities within the home and were supported to access the community.

People knew how to make a complaint and felt able to do so if the need arose. People were willing to express their views on the care they received and had their comments listened to and acted on.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being a lack of staff knowledge on how to protect people from the risk of abuse.

You can see the action we have asked the provider to take at the back of the full version of this report.

At our previous scheduled inspection of Croham Place, which we carried out on 29 April 2013, we found that although most people were happy with the care and support they received at the care home; we felt the provider needed to take action to ensure people were given more support to promote their independent living skills and involvement in the local community.

During this follow up inspection we spoke with eight people who used the service, a visiting relative, the newly registered manager, a team leader, six care workers and the maintenance person. People who lived at Croham Place and a visiting relative told us that overall they were satisfied with the care and support provided at the care home. For example, people said most of the staff that worked at the home were kind and caring. One person told us “the staff teat me well here. Another person said “the staff are very kind and patient and they treat my relative extremely well. I’m very happy with care home; it’s one of the best I’ve seen, and don’t want to see my relative moved again”. We saw the way most staff interacted with the people who used the service was characterised by warmth, kindness and respect.

We found evidence that indicated the provider had taken appropriate action to improve the opportunities people had to develop their independent living skills as well as engage in meaningful activities in the wider community.

We spoke at length to three people who used the service when we visited Croham Place. They told us that staff were kind and caring, and that they felt safe living there. One person told us “It’s not perfect living here, but it’s not too bad either. Overall it’s alright". Another person said “the staff are a lot better than they were before. I like all of them now”. Throughout our inspection we saw staff always treated people who used the service with respect and courtesy. We also saw staff encouraged people to take decisions and make informed choices about how they lived their lives. The provider had effective systems in place to obtain the views of people who used the service, as well as routinely assess and monitor the quality of the care and support they received.

However, although people told us they were happy and we saw they were well supported by staff; we found that failures by the provider to promote independence meant people who lived at Croham Place may not have sufficient opportunities to maintain their independent living skills, as well as learn new ones. We also found people's social needs and wishes were not being fully met. This was because people were not always given enough appropriate opportunities and support to participate in meaningful activities both at home and within their local community. The provider may also wish to note that mealtimes could be made a more positive experience for all concerned.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help us understand the experience of people who could not talk with us. We also looked at a sample of records the provider is required to keep, which included care plans, weekly menus, the homes complaints procedure, and staffs personal files.

Most people told us they felt the overall standard of care and support they received at Croham Place was good. However, we did receive a few negative comments from people about the lack of opportunities they had to participate in meaningful social and recreational activities either within their home or the local community. The comments we received from people were mixed and included, “most of the staff that work here are nice", “there was nothing to do at Croham Place”, and “the food is always served hot, but there’s not much variety”.

Due to their needs, many people that we met during our visit were unable to share their views about the standards of care. The views of people who were able to comment on their experience can be summarised as follows. “there are not enough staff”, “there is nothing to do here”, “staff are friendly as much as they can” and “I would like the odd English person”.

We inspected Croham Place on 30 April and 1 May 2015. The inspection was carried out by two inspectors and was unannounced .

Croham Place is a care home that provides personal care and nursing for 24 adults who have a range of complex needs. The service is divided into three separate units. The largest is the main house which is a home for 14 physically disabled adults with complex care needs requiring nursing intervention. The Beeches is a house for eight men with acquired brain injuries (ABI) and behaviours that may challenge others. The Nightingales is a bungalow shared by two people with autistic spectrum disorders (ASD).

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 2008 (Regulated Activities) Regulations 2014 about how the service is run.

People told us they were safe. This was also the view of their relatives. Care was planned and delivered to ensure people were protected against abuse and avoidable harm. People were cared for by a sufficient number of suitable staff to help keep them safe.

People received their medicines safely because there were appropriate procedures in place for ordering, storing, administering and recording medicines which were consistently followed by suitably qualified staff.

People were protected from the risk and spread of infection because staff understood their responsibilities in relation to infection control and followed the procedures in place. All areas of the home were clean.

The premises were of a suitable layout and design for the people living there. Equipment was regularly serviced and well maintained.

Although staff received regular, relevant training, some staff were not adequately supported by the management because they did not receive regular supervision or appraisal.

People received the help they needed to maintain good health and had access to a variety of healthcare professionals. Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care. People were satisfied with the quality and quantity of food they received.

People told us they were treated with respect, compassion and kindness by staff, but three people commented that some staff were rude.

Seven of the ten people we spoke with were satisfied with the care and support they received and told us it met their individual needs. They were fully involved in making decisions about their care and where appropriate, their relatives were also involved. However, some people and their relatives felt that care was not always delivered in the way they preferred. This was particularly in relation to the activities they were enabled to participate in and how often they were supported to go out into the community.

People knew how to make complaints and where they did so, the complaints were dealt with appropriately and to their satisfaction. People who were willing to express their views on the care they received or whose relatives were in regular contact with staff had had their comments listened to and acted on. However, people who needed support to express their views were not adequately supported to do so. Although the manager conducted an annual quality survey they did not have other systems in place to regularly obtain feedback from people living in the home on the care they received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to how the provider supported staff, met people’s needs and managed the service. You can see what action we told the provider to take at the back of the full version of this report.

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