The inspection of The Croft Care Home took place on 8 and 9 October 2018 and was unannounced on both days. The home had previously been inspected in January 2018, rated requires improvement and found to be in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which assesses the suitability of premises and equipment. Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions in the safe and well led domains to at least good.

The Croft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Croft accommodates 29 people in one adapted building and provides personal care support, but not nursing care. On the days we inspected there were 20 people living in The Croft.

There was no registered manager in post. They had left the service in June 2018 and an acting manager had been appointed to provide interim cover. The provider had appointed a management consultancy firm to assist the acting manager. However, the acting manager had left the service on 5 October 2018 and there was no operational management cover in place when we arrived on the first day of our inspection. The provider advised us mid-morning on the first day the management consultancy firm had been requested to provide operational management cover. 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 not safely supported in the home as there were insufficient, experienced staff. Staff did not work as a team and did not effectively manage risk. Risk assessments were out of date and incidents were not analysed to reduce the risk of potential harm being repeated. It was unclear if all safeguarding concerns had been reported or investigated properly due to a lack of records.

Medicines were managed, for the most part, safely but there were issues with ‘as required’ medication where there was insufficient guidance for staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The service was not working in line with the requirements of the Mental Capacity Act 2005.

Staff were not adequately supported as they did not receive regular supervision and due to lack of records, it was difficult to determine how current training was. Staff were overworked and some displayed a complete lack of empathy for the people they were supporting. There was little promotion of dignity or respect as people’s needs were openly discussed. There was limited evidence of people deciding how to spend their day and there was insufficient activity to engage them.

As stated above, the service had no registered manager and the acting manager had also left. There was limited quality assurance and what audits had been completed, were not followed up with actions to resolve the issues. The management consultancy firm had been appointed from 8 October 2018 to provide operational cover but this was limited due to their availability.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: 9 (person-centred care), 10 (dignity and respect), 11 (need for consent), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 14 (meeting nutritional and hydration needs), 15 (premises and equipment), 17 (good governance) and 18 (staffing).

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The inspection of the Croft Care Home took place on 16 and 24 January 2018 and was unannounced on the first day. The home had previously been inspected in October 2016 and was rated as requires improvement. There was a breach of Regulation 12 as people’s care and treatment was not always provided in a safe way. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question, safe, to at least good.

The Croft Care Home is a ‘care home’ for up to 29 people. On the day of the inspection there were 22 people in the home. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 and their relatives told us they felt safe and we found accidents and safeguarding concerns were well managed. Risk management had also improved with person-centred risk reduction measures in place.

Staffing levels were mostly acceptable although we observed there were times of the day where extra staff would benefit the people living in the home.

Medication was administered safely, but there was an issue with stock control which was immediately investigated. The registered manager took prompt action to address this with the staff and implement more robust procedures for auditing medication. We recommended the provider reviews the medication audits weekly until they are satisfied the practice is consistent.

We had concerns about infection control practice in the home as certain areas were unclean and this had not been identified in recent audits.

Staff had received regular supervision and training.

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 had appropriate support with their nutritional and hydration needs, and were supported to access other external health and social care services as needed.

Staff displayed compassion and kindness, and were empathetic if people became anxious or distressed. They respected people’s privacy and promoted their dignity.

Care plans were person-centred and identified people’s abilities and preferences. We saw these were met on a number of occasions during the inspection visit.

Complaints were managed with apologies if necessary, and remedial action. We checked the outcome of one and saw the improvements had been sustained.

There was a pleasant atmosphere in the home and people spoke positively of the recent changes. The registered manager had a clear vision for the home and this was reflected in staff and resident meetings. However, the quality assurance processes were not sufficiently robust to identify the areas of concern noted above.

We found a breach of regulation in relation to premises and equipment and have made a recommendation in relation to governance. You can see what action we told the provider to take at the back of the full version of the report.

The inspection of The Croft Care Home took place on 19 October 2016 and was unannounced. We also visited on 20 October 2016, this visit was announced as we wanted to ensure the manager would be available to meet with us. One inspector also visited the home on 2 November 2016, this visit was unannounced.

We previously inspected the service on 8 and 22 February 2016 and 17 March 2016. We rated the home as inadequate overall and placed it in special measures. We also took enforcement action by serving the provider with notice of our intention to de-register and close the home if significant improvements were not made. This inspection was to see whether the issues we identified had been resolved. At this inspection we found there had been improvements which were sufficient for the service to be rated as requires improvement overall with no inadequate domains. This meant the service could come out of special measures.

The Croft Care Home is located in a residential area of Wakefield. The home provides accommodation for up to 29 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. On the first day of our inspection 21 people were living at the home. Following the previous inspection the registered provider voluntarily agreed to an embargo on admitting future people to the home; this was to enable them to concentrate on addressing issues identified at the inspection.

The service had a registered manager in place but they were not present during the inspection. An external management consultant and a manager, who had only commenced employment with the registered provider approximately three weeks before the inspection took place, were present on each day of the inspection. 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 manager and staff were aware of their responsibilities in keeping people safe.

Improvements had been made to the management of medicines, for example the implementation of medicine profiles for people and a system of auditing. However, we noted a controlled medicine was not stored within the controlled drugs cabinet, we also saw staff had made an entry on a topical medicines record chart but a medicine administration record was not available.

Risk assessments were in place but they did not address all aspects of people’s care. One person was at risk of harm due to unsafe bed rail bumpers.

There had been a number of improvements made to the environment, including redecoration, replacement of some carpets and hot water was available in people’s bedrooms. Cleaning schedules were in place but we found the conservatory lounge was not clean on the first day of our inspection. Since our last inspection a second shower facility had been provided at the home. Action was being taken to address the shortfalls identified at a recent environmental health inspection.

Staff had been recruited safely and there were enough staff on duty during our inspection to meet the needs of the people who were in the home at that time.

There were a number of people who used the service who had been assessed as not having capacity to make major decisions. Staff were aware of the need to ensure peoples care and support was only provided with the consent of the relevant person. However, the relevant documentation was not yet in place to support this aspect of peoples care.

People were encouraged to choose their meals and were supported to eat in a dignified manner. They were offered a choice of hot and cold drinks and there was the option of a hot meal at both lunch and evening time. The meal time experience was calm and relaxed.

Action

The inspection of The Croft Care Home was completed over three days, 8 and 22 February and 17 March 2016. We previously inspected the service on 4 November 2014, at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, premises and equipment and good governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

The Croft Care Home is located in a residential area of Wakefield. The home provides accommodation for up to 29 older people, some of whom are living with dementia. The home has communal living areas on the ground floor and bedrooms are located on the ground and first floor. On the first day of our inspection 28 people were living at the home.

At the time of our inspection the service had 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.

Although people told us they felt safe, we saw examples of poor moving and handling and we found risk assessments did not fully address people’s needs. In a bedroom where oxygen was in use, the bedroom door was wedged open. The window restrictors which were fitted were weak and would not be resistant to the use of force. People’s medicines were not managed safely. Where people had lost weight, their risk assessment and relevant care plan did not reflect the level of risk and support they required. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The premises were not adequately maintained. Some people told us they had no hot water in their bedrooms. A number of light bulbs were in need of replacement. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw there were not sufficient numbers of adequately deployed staff to meet people’s needs and keep them safe from the risk of harm. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw evidence new staff received an induction to their role and staff received ongoing training and supervision.

Where people lacked capacity to consent to the care and support their received staff were not complying with the requirements of the Mental Capacity Act 2005. Capacity and best interest decision making were not clearly evidenced in care plans and Deprivation of Liberty Safeguards authorisations were not requested in a timely manner. This was a breach of Regulation 11 and Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s choices and personal preferences were not consistently respected. People were limited in their freedom to choose the components of their meals. People were not provided with the option of a hot drink with their lunchtime meal. People’s dignity was not always respected and we could not clearly establish whether people received regular baths or showers in line with their preference. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us, and we observed, there was little to engage people with during the day. The activities which did take place were not structured around people’s individual preferences or previous interests. People’s care plans were not person centred and lacked the necessary detail to ensure people who may have limited communication abilities or have memory impairment received the care they required and preferred. This was a breach of Regulation 9 of the Health and Social Car

The inspection was unannounced and took place on 4 November 2014. At the last inspection in June 2014 we found the provider was breaching Regulations 10, 11, 12, 15 and 22 of the Health and Social Care Act. The breaches related to assessing and monitoring the quality of service provision, safeguarding people who use services from abuse, cleanliness and infection control, staffing and safety and suitability of premises. At this inspection we found the provider had made some improvements and was meeting some of the regulations. However, the provider remained in breach of regulation 10, assessing and monitoring the quality of service provision and regulation 15, safety and suitability of premises. During this inspection we found the provider was also in breach of regulation 13, management of medicines.

The Croft Care Home is registered to provide accommodation and personal care for up to 29 people. The service did not have a registered manager. However, since our inspection the new manager has become registered 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.

The service did not have effective systems in place to monitor the quality of care provided. The provider had carried out monthly ‘management visits’, however we did not see any audits of medication, infection control or the safety of the premises.

We found areas of concerns raised at our last inspection with regard to water temperatures were still of concern during this inspection. Our specialist advisor found water temperatures were a scalding risk to people who used the service and presented a serious health and safety issue. The provider told us that after our last inspection water temperatures had been professionally checked.

We looked at the administration of medication and found the recording of medication did not always match what was in stock. We saw some confusing recordings for some medication which meant we could not be sure people’s medication was being administered as prescribed.

People told us they were happy living at The Croft Care Home and they and their relatives said they were well cared for. People told us they felt safe and were treated with respect by staff.

We found there was little opportunity for people to be involved in any stimulating or meaningful activity, although one person told us they often went out with a member of staff.

Staff had a good understanding of safeguarding and knew what to do should they suspect any form of abuse was occurring.

We found there were sufficient staff to meet the needs of the people who used the service. Staff told us there were plenty of staff.

We observed the lunch time meal and found the food was plentiful and appetising. People who used the service told us they enjoyed the food.

Care plans contained some good information, although there were some sections that had not been completed fully. However, we were able to navigate around the care plans easily and staff were able to confidently talk to us about people and their care needs.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which has since changed to 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.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

This inspection visit was completed by a team consisting of two inspectors and an expert by experience. This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

Safeguarding procedures were not robust and staff did not understand how to safeguard the people they supported. We found incidents had taken place that had not been reported to the local safeguarding authority. This meant people were not provided with appropriate protection plans where safeguarding incidents had taken place.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The manager explained they would consider recent legal judgements. This meant that people were safeguarded as required.

The environment was safe, but was not always clean and hygienic.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People’s health and care needs were assessed with them or their relatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. Some areas had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

We saw that care workers showed patience and gave encouragement when supporting people. One relative commented, “The carers are really nice, lovely people. Very friendly and generally very good with (my relative)”.

Although people’s preferences, interests, aspirations and diverse needs had not always been recorded their care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s needs were assessed before they moved into the home. Relatives told us they were involves in care planning.

People were involved in a range of activities.

Although no complaints had been received in 2014 people told us they could raise any concerns with the manager and they were confident they would be addressed.

Is the service well-led?

At the time of our visit the manager had recently registered with the Care Quality Commission. They explained that although they had just completed the application process to become registered manager they had resigned from their post and were working their notice period.

The service did not have effective systems for quality assurance. This meant shortfalls had not always been identified and addressed. Where actions had been identified these had not always been completed.

During our previous inspection of this service in August 2013 we found the provider was not compliant with Outcome 1 (Respecting and Involving People), Outcome 7 (Safeguarding People from Abuse) and Outcome 10 (Safety and Suitability of Premises). We judged non-compliance with Outcomes 7 and 10 had a minor impact on people who lived in the home and issued compliance actions. With regard to Outcome 10 we judged the non-compliance had a moderate impact on people who lived in the home. We issued a formal warning telling the provider they must improve by 7 October 2013. Following that inspection the provider sent us an action plan telling us what they would do to achieve compliance. During this inspection we checked to make sure the required improvements had been made.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

A new manager had been employed since the last inspection. We found improvements in the environment meant people’s privacy and dignity was respected. For example, shelving and storage space had been provided and was utilised to store people’s toiletries and other personal products they required. We saw people were dressed in clean clothes and appeared well groomed. We found a range of activities were provided. One person we spoke with said: “There’s more going on now, not just the TV”. We saw residents meetings were being held which showed people were involved in decisions about the home.

We found safeguarding policies were in place. Staff we spoke with showed a good understanding of safeguarding procedures and had received recent training. People we spoke with during the visit told us they felt safe in the home.

We found significant improvements had been made to the environment. Many areas of the home had been redecorated and refurbished. Maintenance issues identified at the previous inspection had been addressed and environmental checks were being carried out regularly. We found the home was clean and odour control had improved significantly. People we spoke with who lived in the home told us they were pleased with the improvements made to the environment. Comments included:

“It’s much better now – cleaner and brighter”

“There’s been a lot of changes since you came last time and it’s all good”

“It’s so much better than it was. Just nicer to be here”

During our inspection of this service on 20 March 2013 we judged the provider was not compliant with Outcome 10 (Safety & Suitability of Premises), Outcome 16 (Assessing & Monitoring the Quality of Service Provision) and Outcome 21 (Records). Following that inspection the provider sent us an action plan telling us what they would do to achieve compliance. During this inspection we checked if improvements had been made.

We spoke with people who used the service, their relatives, staff and the registered manager. People we spoke with praised the staff and described them as; “very nice”, “good” and “lovely”.

There were no activities taking place during our visit. People told us they were bored and there was nothing to do. We saw some practices which we considered showed a lack of respect for people who used the service. For example in some en suite facilities people’s toiletries were stored either on the floor or on top of the toilet cistern as there were no shelves or storage space.

People we spoke with who used the service said they were satisfied with the care they received and said they felt safe. We found improvements had been made to the care records which were now personalised and more detailed.

We found staff had limited knowledge and understanding about safeguarding, which we considered placed people who used the service at risk as abuse may not be identified or responded to appropriately. We found safeguarding policies and procedures needed updating.

We found maintenance issues were not always identified and addressed promptly. We found some areas of the home were not clean and there were offensive odours.

We found there were systems in place to monitor and assess the quality of service.

At the time of our visit there were 21 people living at The Croft Care Home. We spoke with five people living at the home and two relatives.

One person told us how they liked living at the home and really enjoyed the food, particularly the fried breakfast they had in the morning. Another person said they got on really well with the staff, who they described as very good. Everyone we spoke with said the staff were good and all said they enjoyed the food and there was always a choice. One person said they liked to get up early in the morning as this was something they’d always done and were pleased that they could continue to do so.

One relative told us how they were happy with the care their family member received and said they were able to visit at anytime.

We saw that staff were patient, attentive and kind when speaking to people and providing care and support.