The Croft 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. The Croft is part of a larger site called Heath Farm, which consists of five other homes, an activity resource centre and a main administrative office. It provides accommodation for people living with a learning disability. The home can accommodate up to six people. At the time of our inspection there were six people living in the home.

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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’. At the last inspection the service was rated, ‘Good’. At the present inspection the service deteriorated to ‘Requires improvement’.

The quality assurance systems in place were not effective as they did not always identify where improvements were required or lead to the action required to ensure good quality care. For example, the provider had not ensured that there was sufficient staff on duty.

Medicines were managed safely. Where people were unable to make decisions for themselves arrangements had been made to ensure decisions were made in people's best interests.

People received person-centred care. There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible and the policies and systems in place supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. There was a positive culture in the service that was focused upon achieving good outcomes for people. People had been supported to access activities. People had access to lay advocates if necessary. Confidential information was stored securely.

Information was provided to people in an accessible manner.

The registered manager recognised the importance of promoting equality and diversity.

The provider had taken steps to enable the service to meet regulatory requirements. The provider had put in place arrangements across their services to involve people, in the running of the service. There were arrangements in place that were designed to enable the service to learn and innovate and for working in partnership with other agencies to support the development of joined-up care. People’s concerns and complaints were listened and responded to in order to improve the quality of care.

Further information is in the detailed findings below.

We inspected The Croft on 30 September 2015. The inspection was unannounced. The last inspection took place in July 2014 and we found the provider was compliant with all of the outcomes we inspected.

The Croft provides personal care and support to people who live with complex needs related to the autism spectrum, and learning disabilities. The service can accommodate up to six people and there were six people living there when we visited. The Croft is part of a larger site called Heath Farm, which consists of five other homes, an activity resource centre and a main administrative office. It is located within the Scopwick area of Lincolnshire.

There was not a registered manager in post at the time of the inspection. 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 and associated Regulations

about how the service is run. An experienced manager was in post, who had applied to be registered with us and was awaiting the outcome of the registration process. We refer to this person as ‘the manager’ throughout the report.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection six people who lived within the home had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS legislation.

People were treated with care and thoughtfulness by staff who were trained and supported to carry out their job roles. Staff also helped them to stay safe in a way that minimised risks to their health, safety and welfare.

People’s privacy was maintained and they were supported to engage in a range of personalised activities and social interests. They also had access to a range of appropriate health services and their nutritional needs were met.

There was an open culture within the home. There were enough staff, who were recruited appropriately to ensure people’s needs, wishes and preferences were met.

People were supported to be as involved in their care as they could be and make their own decisions and choices wherever they could do so. Where people could not do this staff used the principles of the MCA effectively to ensure decisions were taken in their best interests and legal frameworks were followed.

The provider recognised that not all of the systems in place to enable people to express their views and raise concerns or complaints were effective for people who had different ways of communicating. They told us they were taking action to improve this.

Systems were in place to assess and monitor the quality of the service provided for people and actions were taken to address any issues arising from audits. The provider ensured that the care and support provided for people was based on up to date care approaches and took account of lessons learned from analysis of events and incidents.

At our last inspection of The Croft in May 2014 we found the provider was not compliant with three regulations of the Health and Social Care Act, 2008.

We found the accommodation did not provide a dignified setting and people were not always supported to access the community on a regular basis. We found this had a minor impact on people.

We found there were not enough qualified, skilled and experienced staff to meet people’s needs. We found this had a moderate impact on people.

We found the provider did not have effective systems to regularly assess and monitor the quality of the service people received.

Before we visited the home this time we saw the provider’s action plans, which showed how they were going to address the issues.

Two inspectors carried out this inspection. We found that improvements had been made in regard to all of the issues we highlighted at our last inspection and in line with the provider’s action plan.

During this visit we observed how the five people who lived in the home were cared for. This was because some people had different ways of communicating and could not tell us directly about their experiences of the care they received.

We looked at two care plans in detail. We spoke with the provider’s operational manager, the manager of the home, the deputy manager and two members of staff. We also spoke with a relative and a healthcare professional.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people told us.

Improvements to staffing levels and the numbers of staff who could drive the provider’s vehicle, meant people were able to engage in more community based activities. People’s activity plans were based on what people liked to do and what the person would accept given their complex needs within the autistic spectrum.

The provider had commenced a programme of refurbishment and enhancement for the environment which was on-going and carried out at a pace which was suitable for the people living in the home. The environment and furniture remained at a functional level to meet people’s needs but had been enhanced. For example, art work had been applied to walls.

The provider had reviewed arrangements for the recruitment of new staff. This meant that new staff were able to start work in the home in a more timely way. Because they had done this, and improved the way they monitor staffing levels, they were able to consistently provide the correct numbers of staff to meet people’s support needs.

The provider had reviewed the way they assessed and monitored the quality of service people received. We found they had developed a new system for recording audits which included action plans for identified shortfalls. We also found the provider was reviewing the way they gathered people’s views as written questionnaire’s did not always meet people’s communication needs.

The summary is based on our observations during the inspection, speaking with two people who used the service, two parents and three support workers. In addition we spoke with four care managers (social workers) who represented local authorities that paid for people to use the service. We looked at the records of the support provided for three people, observed support being delivered and examined the accommodation.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

All of the people who used the service had complex needs for support. They used a combination of words, sounds and gestures to communicate. People said and showed us by their relaxed manner that they considered staff to be caring and attentive. We observed staff speaking to people in a courteous and polite way. However, the accommodation was unnecessarily bare and did not provide a homely and inviting space in which to live.

Is the service responsive?

We saw that people's individual needs for support and healthcare had been assessed and met. Staff knew about each person’s individual support needs, choices and preferred routines. People received the support they needed to do personal and household tasks. However, both of the parents and three of the care managers we spoke to thought that people were not being sufficiently supported to be involved in social and occupational activities and to access the community.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. There were policies and procedures to guide staff in the correct application of Mental Capacity Act and Deprivation of Liberty Safeguards. These measures are designed to protect people who are unable to make decisions for themselves. We found when people lacked capacity their best interests had been considered

Is the service effective?

The provider had not employed enough staff and had not ensured there were sufficient staff on duty to enable people to always receive the individual attention they needed. In addition, the support some people received had not been reviewed and evaluated as frequently as necessary. Furthermore, some people had not been supported to develop personal goals to enable them to pursue their interests and acquire new skills. These shortfalls had increased the likelihood that people would not receive all of the support they needed and wanted.

Is the service well led?

The manager had been in post for approximately two months. We noted that the provider had started an application process for him to be registered with us. The law says that the provider is required to have a registered manager. This is because we need to establish that there is someone in charge who has the knowledge and skills necessary to ensure that the service is caring and meets people's support needs.

There was a clear line of management. This meant that important decisions about organising people’s support were made by managers while support workers could use their own judgement to provide a flexible service. However, other aspects of the management arrangements were not robust. The system used to consult with stakeholders about the development of the service was not wholly effective. This was because some of the information was inaccessible and there was no clear system to implement suggested improvements.

Some quality checks had been completed to ensure that important measures such as the management of medication, fire safety and infection control were in place. However, other required checks had not been completed at all. In addition, some of the quality checks that had been completed were of limited value. This was because when problems had been identified effective and timely action had not been taken to address the shortfalls. These problems reduced the provider’s ability to ensure that people reliably received the support they needed in a safe setting.

We used a number of different ways to help us understand the experiences of people who were available at the time of our inspection visit. This was because some people had complex needs which meant they were not able to tell us directly about their experiences of care and support.

Before we undertook our visit we reviewed all of the information we had about the service. During our visit we observed the support people received and spoke with one person, staff and a visiting professional Deprivation of Liberty Safeguards (DoLS) assessor. We also looked at a range of records kept in the home.

We observed people were supported in a respectful and dignified way. Staff were responsive to each person's way of communicating their needs, wishes and choices.

One person told us how they looked forward to going out for a day trip with staff to Rutland Water. The person said, “I am going to a café and will have a fry up breakfast.”

Staff had been given training and support that helped them to understand peoples' complex needs. Staff told us this helped them feel confident in carrying out their roles.

The statement of purpose reflected the current service provision and there was a procedure and policy in place to respond to any concerns or complaints received. Overall we found the service was well led and the manager and home owner regularly checked and monitored the services provided.

We used a number of different ways to help us understand the experiences of people who used the service. This was because they had complex needs which meant that they were not able to tell us about their experiences. We looked at records, including personal care plans. We spoke to the manager and staff who were supporting people, and we observed how they provided that support. We also spoke to other professionals who were visiting the home on the day of the inspection.

We saw that staff supported people in a respectful and dignified way, and that they closely followed the care that was set out in people’s plans.

We saw that people were given support to make choices and decisions for themselves wherever they could do so, and staff clearly understood each person’s way of communicating their needs wishes and choices.

During the visit people who used the service were not able to tell us about their experiences and views in a direct way. However we used different ways to observe how they were experiencing their care and support.

We saw that people were encouraged to make their own choices whenever they were able to, and they were supported to develop their independence.

We saw that the communication between people and the staff supporting them was respectful, and consistent. The support also followed exactly what people’s care plans said should happen for them.