We inspected Croft House Care Home (called ‘Croft House’ by the people who live and work there) on 20, 22 and 26 July 2016. The first day of the inspection was unannounced. This meant they did not know we were coming. At the last inspection in November 2015 we rated the home as inadequate in every domain of care and 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.Croft House contains four units over two floors. Downstairs are two nursing units, one with 18 beds and one with 12 beds. On the first floor there is a small residential unit with 12 beds and a dementia unit that has 24 beds. On the days we inspected there were 27 people in the units upstairs and 18 people in the units downstairs. There are stairs and lifts to the first floor. The home has dining and lounge areas in each unit, four conservatory areas downstairs and a large garden which is accessible to the people.
The service did not have a registered manager in post. 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.
After the last inspection a ‘peripatetic’ manager had been appointed; their role was to make improvements at the home while the provider recruited a new registered manager. At the time of our inspection the peripatetic manager was still in post and a new manager had been recruited; they were in the process of transitioning into the role from their current home. The plan was for the new manager to apply to register with CQC when they became the home manager full time in August 2016.
We took enforcement action after the last inspection. At this inspection we checked to see if improvements had been made in all the areas we identified. We found that all aspects had been addressed either fully or partially. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
As the previous inspection in November 2015 rated the home as inadequate we placed it into ‘Special Measures.’ 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.
At the last inspection in November 2015 we identified issues with the accuracy of people’s risk assessments. At this inspection the quality of risk assessment was mixed. Some were completed properly and others were not, and some were missing entirely. This constituted a continuous breach of Regulation 12 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.
Recruitment records did not include prospective employees’ full employment history and this was not investigated with them and recorded at interview. This was a breach of Regulation 19 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.
Although pressure area care and pressure ulcer management had improved, we found issues with the adherence to pressure ulcer treatment and prevention care plans. This was a continuous breach of Regulation 12 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.
Feedback from people about the food was all positive and we saw food and fluid care plans and risk assessments were much improved. However, we found issues with the recording of food and fluids for people either losing weight or at risk of weight loss. This was a breach of Regulation 17 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.
There were ongoing problems with the quality and consistency of record-keeping in care files and in daily records. This was a continuous breach of Regulation 17 of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.
Records showed the provider had greater oversight at the home since the last inspection. However, concerns remained around the potential sustainability of improvements due to the upcoming change in manager and previous issues with provider oversight.
Most aspects of medicines management were done well. However, we identified some issues with medicine protocols that lacked detail or were missing and records showed there had been problems when people’s medicines had run out.
The recording and reporting of accidents and incidents was better, but not all reports contained the same level of detail.
We observed there were sufficient staff on duty to meet people’s needs and this was supported by a dependency tool which incorporated the number of staff people needed to support them. Care workers told us there were enough staff, although feedback from the people and their relatives about staffing levels was mixed.
Progress had been made to ensure all people who lacked capacity to make their own decisions had been assessed and any decisions made on their behalf were done according to the relevant regulations. However, some best interest decisions we saw were generic or had not followed the correct process.
People said they felt safe at Croft House. Staff awareness of safeguarding, its prevention and reporting, was improved. Care workers could describe the forms of abuse and said they would report any concerns appropriately.
We saw cleanliness at the home was much improved. Issues with broken equipment and facilities identified at the last inspection had all been addressed.
Care workers received the training they needed to meet people’s needs. Most staff had received supervision or an appraisal in 2016 and there were plans to ensure all staff would have one by the end of August 2016. Staff told us they felt supported by management.
Records showed people had access to a range of healthcare professionals. People said they could ask to see a GP if they wanted to and relatives told us they were informed if their family members’ health changed.
Environmental changes the home had made to become more dementia-friendly, particularly on the dementia unit, were impressive. Care staff had received dementia training and some had taken part in a dementia experience to help them empathise better with people who lived with dementia.
People and their relatives told us the staff were caring, promoted people’s independence and respected people’s privacy and dignity. Care workers felt the atmosphere at the home was much improved and staff were much happier.
People had access to advocacy services. Care files contained information on people’s end of life care wishes if they and their relatives (if relevant) had been happy to discuss this area of care.
We saw care plans were much improved. They were detailed and person-centred and regularly reviewed and evaluated. The home had made an effort to try and obtain people’s personal histories so care workers could interact with people better.
People now had access to meaningful activities. Their participation and enjoyment of activities was evaluated so care workers would know what people liked to do best.
The way the home recorded and responded to complaints had improved since the last inspection. We saw complaints received since the last inspection had been handled properly.
We received very positive feedback about the efforts of the peripatetic manager to improve the culture and atmosphere at the home. Levels of communication and team-working at the home had improved considerably.
An effective system of audit and quality assurance monitoring was now in place.