This was an unannounced inspection carried out on 29 January 2015. The Croft provides privately funded personal care and accommodation for up to ten people. Nursing care is not provided. At the time of our visit eight people lived at the home.
The Croft is a single storey house set in its own grounds in Heswall, Wirral. Accommodation is single occupancy. There is a communal lounge and dining room for people to use and specialised bathing facilities are available. A small car park is available at the front of the property.
In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at the 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 registered manager was appointed to manage the home in January 2015.
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.’
At the time our inspection, the registered manager had only been in post as registered manager of this location for two weeks. The home manager had been in post for approximately six months. The home manager supervised the day to day running of the service and reported directly to the registered manager who managed the service. We last inspected The Croft on 22 November 2013 and the home was found to have met all of the regulations we inspected.
At this inspection we spoke with two people who lived at the home, two relatives and one care staff. We also spoke with the registered manager and the home manager who worked at the home. We reviewed a variety of records including care records, policies and procedures, staff records, medication charts and audits.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
We found people’s care plans did not cover all of people’s needs and lacked clear information about people’s risks. Risk assessments were not always updated and changes to people’s care needs were not always reflected within their care plan. Where people’s risks had increased, these had not always been acted upon to ensure people received the support they required.
We reviewed accidents and incident information and found that several people had experienced numerous falls over a 12 month period. We found that no appropriate referrals to the Falls Prevention Team had been made to access specialist preventative advice so the risk of further falls could be managed and prevented.
Some people who lived at the home had short term memory loss or dementia type conditions. The home manager told us that no-one lacked the capacity to make decisions or required the protection of a Deprivation of Liberty Safeguard (DoLS). The Deprivation of Liberty Safeguards (DoLS) came into force on 1 April 2009 and ensures people are looked after in a way that does not inappropriately restrict their freedom.
The home in accordance with the Mental Capacity Act 2005 (MCA) had assessed and regularly reviewed each person’s mental capacity and routinely sought their consent. We found however that where people’s behaviour was affected by a decline in their mental health, any unwanted behaviours were not appropriately risk assessed and care planned.
Staff were not always recruited in line with the provider’s own recruitment policy. Employer based references were not always sought to check staff had the necessary skills and abilities for their job prior to employment. Staff had also not consistently received the supervision and training required to do their jobs effectively.
The home was clean and well maintained with ten individual bedrooms. Some bedrooms had an ensuite bathroom. There was a communal bathroom with specialised bathing equipment and a communal shower room. On the day of our visit, the shower room was being used as a storage facility which meant it was not available for people to use. This was rectified by the registered manager the next day. There was also a laundry on site.
We saw that the provider had an infection control policy and risk assessment in place to minimise the spread of infection. We found some of the infection control procedures relating to the laundering of people’s clothes and personal items were not followed. There was also a lack of available hand hygiene facilities. This meant there was a risk of cross infection. Staff knowledge about how to prevent the spread of infection in respect of laundry was also poor.
The providers had a range of audits in place to check the quality and safety of the service. None of the systems however identified the issues we noted during our inspection. This meant that the systems were ineffective. Where issues were identified for example the provider’s infection control audits, no appropriate action had been taken. This demonstrated that the management of the service required improvement.
On a positive note, people who lived at the home were happy and said they were well looked after. Our review of people’s care records and from our observations it was clear that people were able to choose how they lived their lives at the home. We saw that the culture of the home was to support people to do things for themselves by encouraging and reminding them of everyday personal tasks. This promoted people’s independence.
Staff were caring and respectful and the home provided a range of activities to occupy and interest people. This promoted their well-being. Interactions between people and staff were positive and the home had a relaxed, comfortable atmosphere.
People had access to sufficient quantities of nutritious food and drink. They were given a choice of menu options or, offered an alternative, if the options weren’t suitable. People’s meals were served promptly and people were offered additional portions. We observed a medication round and saw that it was administered safely. Medication administration records were completely accurately and properly signed for.
The number of staff on duty was sufficient to meet people’s needs. People told us they felt safe and comfortable with staff. Staff we spoke with were knowledgeable about types of potential abuse and what to do if they suspected abuse had occurred.
We saw people had prompt access to their GP when they were ill and were supported to access any hospital or other medical appointments to meet their ongoing healthcare needs.
The people and relatives we spoke with had no complaints. They were really positive about the staff. Everyone we spoke with said the home manager and staff were approachable and they would have no worries about approaching them if they had any concerns. People views were sought through the use of satisfaction questionnaires and resident meetings. We saw that people were given relevant information about the home and their care and that their suggestions and opinions on the service were sought.