Little Croft Care Home provides accommodation and personal care for up to 41 people. At the time of our visit there were 31 people living at the service.

At the previous inspection carried out 29 June 2017 and 4 July 2017 we rated the service as Requires Improvement and identified concerns around medicines, compliance with the Mental Capacity Act 2005 (MCA), recording of information and ineffective quality monitoring audits. The registered manager had submitted an action plan to the Care Quality Commission so that we could monitor the improvements made.

At our inspection on 3 and 4 July 2018 we found that the provider had made some improvements. However further improvements were still needed.

During this inspection, we found that the registered provider was in breach of multiple regulations 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. We rated the service overall Requires Improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Risks to people had not been assessed and the appropriate action had not been taken to reduce or eliminate risks to people.

People were at risk of harm as the appropriate checks of people’s wellbeing had not been undertaken by staff to ensure people were safe at the service.

People’s ability to consent to care and support had not been assessed in line with legislation and guidance.

We identified concerns where people lacked capacity. When applications had been submitted for assessment under the Deprivation of Liberty Safeguards the appropriate action had not been taken to ensure these people were safe.

People’s care records were not always up to date or a reflection of their needs. There was a risk that people were not receiving the care and support that they needed.

Quality monitoring systems were not in place to identify, monitor, manage and mitigate risks. Audits undertaken were not effective and had not identified the shortfalls which we found at the service.

People told us they felt safe living at the service. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse.

People were provided were cared for by adequate numbers of appropriately skilled. Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate people were employed to work at the service.

Medicines were handled appropriately and were now stored at the right temperature. Medicine Administration Records (MAR) were now appropriately signed to indicate people's prescribed medicine had been given. Clear protocols were in place for as required medicines.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively.

People were supported to meet their dietary needs and preferences. They also received the support they needed to stay healthy and to access healthcare services.

People said they were treated in a kind and caring manner. People's privacy and dignity was respected.

People's wellbeing was supported by the activities. The service had a range of activities for people to take part in.

The inspection took place on 29 June and 4 July 2016. Little Croft provides accommodation and personal care and support for up to 41 older people. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. At the time of the inspection there were 38 people living at Little Croft.

The previous inspection was completed in June 2016. At that inspection we found a breach of regulation in relation to ensuring people’s mental capacity was assessed to ensure they were following the principles of the Mental Capacity Act. This is important where a person lacks the mental capacity, without this information there was a risk that people’s rights were not protected. At this inspection we found these mental capacity assessments had been completed for people.

There was 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.

People’s medicines were not always managed safety. Medicine audits had not identified these shortfalls. Care plans did not always include how to support people with their medical condition such as diabetes. We have asked the provider to make improvements to the audit systems to ensure these shortfalls were identified and addressed.

There were mixed messages from health and social care professionals in respect of the admission process. Assurances were given by the registered manager that they took into consideration the needs of the people already living in the home and the needs of the new person to ensure they could respond to their needs effectively and responsively. There was a staffing tool used to calculate the staffing based on people’s needs and this was kept under review. Feedback from people and staff said the home was very busy. They felt people were safe.

People’s nutritional needs were being met. Where there were risks to people there were clear plan of care in place. These plans identified the additional monitoring required and how good communication between the care and catering staff would be maintained. However, improvements were needed to ensure that fluid charts were clearer and that any concerns could be rectified where a person had not drunk sufficient fluids.

The home was clean and free from odour. There had been an occasion when a member of staff had not worn the appropriate protective clothing when supporting a person. This had been discussed through supervisions with staff and team meetings as a reminder of the importance of ensuring risks in relation to cross infection were minimised.

People were involved in structured activities in the home. These were organised taking into consideration the interests of the people and were organised in small groups or an individual basis. People were treated with dignity and respect and were involved in decisions about their care. Whilst improvements had been made in relation to best interest decision recording this was not consistent. Where sensor mats and door alarms were in place more information was needed on who was involved in the decision and why the decision was made. This should be kept under review to ensure they were the least restrictive options.

People were treated with kindness and compassion by staff. The atmosphere was relaxed and we saw that staff knew people well. People appeared relaxed around staff. People’s views were sought during care reviews, resident meetings and annual surveys. Complaints were responded to and, learnt from to improve the service provided.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure peopl

The inspection took place on 22 and 23 June 2016. Little Croft provides accommodation and personal care and support for up to 41 older people. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. At the time of the inspection there were 37 people living at Little Croft.

The previous inspection was completed in May 2015 and there were two breaches in regulation. This was because there were concerns about the staffing levels at night and care plans did not fully capture the needs of people. The provider sent us an action plan telling us how they were going to ensure on-going compliance. We found at this inspection there was enough staff working in the home. Care plans had been reviewed and updated as people’s needs had changed and included information on specific health conditions. The provider had demonstrated compliance.

There was 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.

People’s consent was sought before any support was given. However, there was a lack of information about whether people had mental capacity to make decisions about their care and treatment. A new form was devised during the inspection. The registered manager told us they would be completing this with each person involving their family and the GP. However, without this information there was a risk that people’s rights were not protected especially where they lacked capacity.

People were receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people. Safe systems were in place to ensure that people received their medicines as prescribed. Improvements were made during the inspection on the recording of controlled medicines.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management.

Staff were caring and supportive. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings, daily handovers. One to one meetings were not happening at the required intervals. The registered manager during the inspection devised a new audit tool to enable these to be monitored with assurances this would be addressed.

People’s views were sought through care reviews, meetings and acted upon. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

People were provided with a safe, caring and responsive service that was well led. The provider had systems to assess, monitor and improve the quality of care.

We found there was a breach 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 this report.

People told us they were happy living at the home and spoke highly of the care staff. Visitors we spoke with also spoke highly of the home and care staff and this was reflected in the recent friends and relatives satisfaction survey.

People had person centred care plans and assessment of individual risks had been carried out, however daily notes were not always person centred. People's care plans contained information about activities they liked and their interests but we did not see anybody engaged in an activity during the morning.

Medicines were managed safely and the premises were safe and in good condition. People had the equipment they needed to support them and this was serviced regularly.

The home undertook appropriate checks before employing new staff. We found that sometimes the home was short of staff and did not have robust arrangements in place to cover staff sickness or unexpected absence.

The provider had a system in place to monitor the quality of the service and planned to introduce systems to increase feedback from people living at the home.

People were treated with respect, kindness and consideration. We observed a warm and friendly relationship between people who lived at the home and members of staff.

People were supported at their own pace and their independence was promoted.

People’s care and support needs were assessed and care plans were individualised. Where appropriate people’s families were involved in the planning of care and important decisions.

Staff had received appropriate training and were knowledgeable about how to keep people safe. Staff told us that they enjoyed working at the home and felt supported in their role,

The home was clean and there was a relaxed atmosphere. We observed that staff spoke to people with respect and warmth. People made many positive comments to us about the staff team

This inspection was conducted over two days on the 11 and 16 June 2015 and was unannounced. Little Croft Care Home can accommodate up to 37 people. At the time of the inspection there were 34 people living in the home. Little Croft Care Home provides a service to older people, some people were living with dementia.

Little Croft Care Home (part of Quality Care Homes Ltd) is situated in Oldland Common and is on a main bus route. All bedrooms are single occupancy with an ensuite facility. People can move freely around the home and the secure garden to the rear of the property. There was level access to the property and lifts to the first floor.

There was a registered manager working at the service. 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.

Care plans were in place that described how the person would like to be supported and these were kept under review. Some improvements were required to ensure that some people’s care and support was clearly described in relation to their medical condition. There was a lack of information about people’s past histories including employment, family, hobbies and interests.

Whilst people had not raised concerns about the staffing levels we found that there were risks at night as there were only two staff working. This was because of the layout of the building and some people required two staff to support them. We have asked the provider to make improvements to the staffing at night. The registered manager told us when new people were admitted to the home staffing levels would be reviewed and increased accordingly.

People received a safe service because risks to their health and safety were being well managed. Staff were aware of the potential risks to people and the action they should take to minimise these.

People’s medicines were managed safely. People were protected from abuse because staff had received training on safeguarding adults and they knew what to do if an allegation of abuse was raised. People were observed moving freely around their home.

People had access to healthcare professionals when they became unwell or required specialist help. They were encouraged to be independent and were encouraged to participate in activities both in the home and the local community.

People were treated in a dignified, caring manner which demonstrated that their rights were protected. People confirmed their involvement in decisions about their care. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This was done through involving relatives or other professionals in the decision making process.

Staff were knowledgeable about the people they were supporting and spoke about them in a caring way. Staff had received suitable training enabling them to deliver safe and effective care. Newly appointed staff underwent a thorough recruitment process before commencing work with people.

Systems were in place to ensure open communication which included team meetings and daily handovers. A handover is where important information is shared between the staff during shift changeovers. This ensured important information was shared between staff enabling them to provide care that was effective and consistent.

People were involved in a variety of activities in the home. We have asked the provider to make improvements in this area as some people told us there were very little activities taking place that they enjoyed.

People’s views were sought through care reviews, house meetings and surveys and acted upon. Systems were in place to ensure complaints were responded to.

People who used the service, their relatives and staff were positive about the management of the home, which was open and approachable. Professionals commented on the improvements which had been made over the last couple of months. This was because there was a senior carer on duty at all times which had improved communication.

We have made two recommendations that the service explores the relevant guidance on how to ensure activities are more meaningful for people and explores the relevant guidance on how to make environment used by people more ‘dementia friendly’.

We found two of breaches 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 this report.