This inspection took place on 12 and 16 April 2018 and was unannounced. This meant the provider did not know we would be visiting.

The Croft Residential Care Home 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 Residential Care home provides residential care and support for up to 33 people, some of whom are living with dementia. At the time of our inspection 31 people were living at the home.

A registered manager was in place. 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.

At the last inspection in January 2016, the service was rated good. At this inspection we found the service remained Good.

Medicines were managed safely. Staff had a good understanding of safeguarding and how to report concerns. The home continued to have a robust recruitment process. Sufficient appropriately trained staff were available to support people’s needs. Personal emergency evacuation plans were not up to date.

Accidents and incidents were recorded and analysed. Risks to people were identified and plans were in place to help manage and minimise risks.

People told us they enjoyed their meals. People’s preferences were catered for and people were supported to manage their weight. People were supported to engage in activities and interests of their choice. The home was proactive in making activities suitable for all.

Relatives and people told us staff were kind and caring. People were treated with dignity and respect. Staff had a sound knowledge of the people they supported, their likes and dislikes.

The home sought feedback from people, relatives and staff in order to develop and improve the home. Relatives were made welcome and were involved in their family member’s care.

People and relatives we spoke with knew how to make a complaint. They told us they would speak to the registered manager if they had any issues.

People, relatives, staff and external healthcare professionals spoke positively about the registered manager. Staff told us they felt supported by the registered manager and enjoyed working at the service.

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.

The registered manager ensured statutory notifications had been completed and sent to the CQC in accordance with legal requirements.

The inspection took place on 18 January 2016 and was unannounced. A second day of inspection took place on 26 January 2016 and was announced.

We previously inspected the service on 30 March 2015 and found the service was meeting the requirements of the regulations we inspected.

The Croft Residential Care home provides residential care and support for up to 33 people, most of whom are living with dementia. At the time of our inspection there were 31 people using the service.

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 2008 and associated Regulations about how the service is run.

Staff had a good understanding of safeguarding and were confident in their role in safeguarding people. Any safeguarding concerns were investigated with the outcomes fed back and practices changed if necessary in order to prevent reoccurrences.

Records were kept for all accidents and incidents including details of investigations, outcomes and action taken. Lessons were learnt from accidents and incidents and improvements made.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

Medicines were managed effectively with safe storage and appropriate administration. All records were complete and up to date with regular medicine audits being carried out.

Staff were recruited in a safe and consistent manner with all necessary checks carried out. Staffing requirements were assessed in line with peoples’ needs. From staffing rotas we saw staffing levels were consistent and staffing cover was provided by staff within the home and deputy managers. Agency staff where used on occasion to cover staff recruited to provide one to one care.

Staff had up to date training and competency assessments were carried out in relation to specific areas, including the management of medicines. Regular knowledge tests were carried out in supervisions and staff meetings.

Staff told us they felt supported in their roles and they received regular supervisions, as well as annual appraisals. Records we viewed reflected this.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place for every person who used the service.

We observed during mealtimes that people were enjoying their meals, some independently and others with support from staff. There were choices available for people and support provided by staff was gentle and at an appropriate pace to each individual.

The registered manager was passionate and pro-active about raising the awareness of dementia within the home. They had adapted the home to be more dementia friendly, had arranged high level training for staff and had held training sessions with relatives to improve their understanding of dementia. The registered manager had also developed a dementia file for relatives to read which contained the policy of the home as well as other useful information and publications.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

There was a wide range of activities available both within the home and in the community for people to become involved in and enjoy. The home had three activities co-ordinators who worked with people, family members and staff to design activities programmes tailored to people using the service both as a group and individually. People were encouraged to access the community but all the while remaining safe.

The service had initiatives in

We carried out an unannounced comprehensive inspection of this service on 20 and 24 October 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation relating to the management of medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Croft Residential Care Home on our website at www.cqc.org.uk.

We found the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations. The quality of medicines administration records (MARs) had improved. We found the provider had reviewed the quality assurance processes and had implemented a more robust system of checks on medicines records. We saw from viewing records of previous checks that these had been successful in identifying concerns with medicines records. Records we viewed confirmed that gaps had been investigated and action taken to prevent the situation happening again.

We spoke to people and their relatives and they told us they were happy with the service. One person said “It is very good living here, the staff are nice and we go out. Yesterday we went out for a Christmas meal”. Another person said “They know me well here and if something is not right they will put it right”.

One relative said the care home is “Excellent, staff are polite.” Another relative said “I am happy with The Croft, it is nice and homely”. One relative told us they would have no hesitation in recommending the care home to other people.

We found that people were involved in deciding what care and support they needed. The provider ensured that people were protected against the risks of unsafe or unsuitable premises. Appropriate checks were carried out on staff prior to commencing employment and the provider had systems in place to identify risks and monitor the quality of service provided.

Some of the people using the service were not able to give us their views about their experiences of the service due to memory problems. However others were able to speak to us about their experiences and expressed their views about the home.

People told us that they had information about the home and knew what was going in the home. One person told us about the information leaflets in the foyer. One person said, “They tell us what is going on here.”Another person told us, “We were told about the carpets being replaced today.” People told us the staff involved them in some aspects of the running of the home.

People also told us staff treated them with respect and dignity. One person told us, “They always lock my bedroom door and no one comes in without knocking.”

We observed staff interacting with people who used services. Staff were respectful in their interactions with people. We saw that staff had a good understanding of the complex and varied needs of the people they cared for.

People told us The Croft care home was a safe and comfortable place to live. People also told us that if they had any concerns they would raise it with the manager. One person told us, “I don’t have any concerns but if I do I will speak with the manager about it. They are always there for us and I am grateful.” Another person told us, “People are treated well here and I have no worries at all.”

The inspection took place on 20 and 24 October 2014. This was an unannounced inspection. We last inspected The Croft Residential Care Home in December 2013. At that inspection we found the home was meeting all the regulations that we inspected.

The Croft Residential Care Home provides residential care for up to 33 people, most of whom are living with dementia. At the time of our inspection there were 30 people living at the home. The home 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.

We found the provider had breached Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the provider did not have accurate records to support and evidence the safe administration of medicines. We found gaps in medicines administration records (MARs) for seven out of the 30 people who used the service where medicines had not been signed for to confirm it had been given. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with told us they felt safe living at the home. Their comments included, “I am not worried about anything”, and, “I am not scared anymore, it is topper.” Family members also confirmed that they felt their relative was safe. Their comments included, “I have no concerns with safety”, “[My relative is] definitely safe”, and, “Safe and well looked after.” People were also happy with the condition of the home. Their comments included, “Always spotless”, “Nice and warm”, and, “Beautiful rooms.”

Staff undertook risk assessments where required and people were routinely assessed against a range of potential risks, such as falls, mobility and skin damage.

Staff we spoke with had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding concerns.

Staff had a good understanding of how to manage people’s behaviours that challenged the service and had individualised strategies to help them manage people’s behaviours that challenged.

People who used the service, family members and staff all told us they felt there were enough staff to meet people’s needs. The registered manager monitored staffing levels to ensure there was enough trained staff available to meet people’s needs. There were systems in place to ensure that new staff were suitable to care for and support vulnerable adults.

Staff were well supported to carry out their caring role and received the training they needed. Training records confirmed that staff training was up to date at the time of our inspection.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make a specific decision. The registered manager had also made DoLS applications to the local authority where required. People confirmed that they were asked for permission before receiving any care. One person told us staff, “Ask you what you want always.”

People and family members were happy with the food provided. People said, “We get well fed”, and, “Can’t fault the food.” Family members said, “[My relative] needs coaxing to eat. They [staff] are very patient”, “Food is fine”, and, “[My relative] is eating properly now.” The provider had systems in place identify and support people who were at risk of poor nutrition. Where people had lost weight unexpectedly, action was taken to keep them safe.

We observed over the lunch-time that staff made sure people were safe and had support if they needed it, such as prompts and encouragement to eat their lunch. We also observed that staff interaction with people was warm, kind and caring.

People were supported to maintain their healthcare needs. One person said, “My family don’t worry about me now, they know that if I took bad there is somebody on hand.” One family member told us that staff supported their relative to attend health appointments. They said, “If [my relative] needs to be taken anywhere they take her.”

People and their family members told us they were well cared for and were treated with dignity and respect. They said, “Can’t fault it.” “We like our care home.” Family members’ comments included, “Very good care, absolutely amazing”, “They look after [my relative] brilliantly”, and, “It’s great in here.”

The provider had adapted the service to meet the needs of people who were living with dementia. Doors had been painted orange and dementia friendly signage was used to help aid orientation. There were designated quiet areas and brightly coloured crockery and specialist cutlery was available. The home had involved family members in ‘life history’ work and care records contained detailed information about people’s preferences.

People had their needs assessed and the assessments had been used to develop individual care plans. Care plans had been evaluated consistently each month. Where people’s needs had changed action was taken to keep them safe.

The home’s complaints procedure was available in different formats. None of the people or family members we spoke with had made a complaint about the care they received.

People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service.

The provider undertook a range of audits to check on the quality of care provided. Medicines audits had not been successful in identifying gaps in medicines records. Information was analysed to look for trends and patterns and to identify learning to improve the quality of the care provided.