Croft House Rest Home

Croft House Rest Home is a residential care home providing personal care to up to 22 people. The service provides support to older adults. At the time of our inspection there were 21 people using the service, some of whom were living with a dementia.

People’s experience of using this service and what we found

Staff managed people’s medicines well. We have made a recommendation about documenting assessments of staff competence to administer medicines. Staff managed risks well and had plans to follow in case of emergencies. People were protected from the risk of abuse and improper treatment. Staff were recruited safely and there were enough staff on duty to meet people’s needs. Staff kept the home safe, clean and tidy.

The registered manager had fostered a culture that was open and inclusive, and put people at the centre of the care they received. Staff understood their roles and responsibilities and worked well with external agencies to meet people’s needs. The registered manager monitored the quality of the service using a range of systems. The service engaged with people, their relatives and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 14 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of medicines and staffing. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Croft House Rest Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Croft House Rest 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.

Croft House Rest Home can accommodate up to 22 older people. The home is in the centre of Freckleton village, close to shops, a library and public transport. Bedroom accommodation is situated over two floors and there is a stair lift. There are twenty single rooms and one double bedroom. All have a washbasin. There are three lounges plus a conservatory used for dining. The garden includes a patio, with tables and seating.

At our last inspection in November and December 2017 the service was rated as ‘Requires improvement.’ We identified a breach of Regulation 18 of the Health and Social Act Care Act 2008 (Regulated Activities) 2014 as staff were not always available to meet people’s needs. We also identified that people were not always lawfully deprived of their liberty. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, we found the registered provider had not always ensured that the premises were safe and were used in a safe way. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Audit systems had not identified the areas of concerns noted by us during the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took regulatory action and served requirement notices for these breaches in regulation. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by February 2018.

Following the last inspection, we met with the registered manager to confirm what they would do and by when to improve the key questions safe, effective, caring and well-led to at least good.

At this inspection in October 2018, we found improvements had been made. We found people were lawfully deprived of their liberty and staff were available to meet people’s needs. We saw the building was secure and refurbishment had taken place, with new flooring installed. We found fire doors were shut and chemicals were stored securely. Audits were carried out to ensure improvements required were identified.

We found documentation in respect of people’s end of life wishes was not always detailed. We have made a recommendation regarding this.

At the time of the inspection visit there was a manager in place who was 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 registered manager sought feedback from people who received support and meetings were held with them so they could express their views.

Recruitment checks were carried out to ensure suitable people were employed to work at the service and training was provided to enable staff to maintain and increase their skills and knowledge.

Care records contained information regarding risks and guidance for staff on how risks were to be managed.

People told us they were supported to access medical advice from external healthcare professionals and their healthcare needs were met. Documentation we viewed confirmed this. People and relatives told us they were happy with the care at support provided by Croft House Rest Home.

People told us they were happy with the meals provided and they had a choice of meals. We saw documentation which showed people were referred to dieticians if this was required.

Staff we spoke with knew the needs and wishes of people at the service. Staff spoke respectfully of the people they supported and said they cared about them and their wellbeing. We observed person centred and caring interactions between people who received support and staff. People told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and they were asked to consent to their care.

Staff we spoke with were able to describe the help and support people required to maintain their safety and promote their independence and people who received support told us they felt safe.

Staff told us they were committed to protecting people at the service from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure available at the service. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

People and relatives, we spoke with told us they were happy with the staffing arrangements at the service. People told us they received care and support at the times they agreed and they were not rushed or hurried in any way. Staff we spoke with told us they had the time to support people in a calm and relaxed way.

People told us they were supported to maintain their hobbies and interests if this was part of their assessed and funded needs.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The registered manager told us they were committed to improving the service they provided and they wanted people to be happy at Croft House Rest home and receive high quality care.

The registered manager spoke highly of the staff and praised them for the way they supported people and worked as a team. Staff told us they felt supported by the registered manager and the registered manager worked closely with them to achieve the best outcomes for people who received support.

The registered manager told us they placed people at the centre of their care and supported professional relationships between staff and external health professionals. Relatives we spoke with told us they could speak with the registered manager if they wished to do so and they found the registered manager approachable.

Croft House Rest Home can accommodate up to 22 older people. It is located in the centre of the Freckleton Village, close to the shops and public transport. Bedroom accommodation is situated over two floors and there is a stair lift for people who require support with mobility. There are three lounges and a dining area. There are gardens to the front of the home and a paved area to the rear. On the day of inspection there were 21 people living at the home.

We last inspected Croft House Rest Home in October 2016 and identified two breaches in Regulation. We found risks to people who lived at the home were not always assessed. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Safe care and treatment.) We also found audit systems used by the registered provider to identify shortfalls had not identified the shortfalls we had found on the inspection. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Good Governance.)

You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection in October 2016, the registered provider sent us an action plan outlining how they intended to make the required improvements. The action plan indicated improvements would be made by May 2017.

At this inspection carried out in November and December 2017 we found some improvements had been made. We found a range of individual risk assessments were in place to support people’s safety. Documentation reflected the action staff were expected to take and staff were knowledgeable of the assessments in place. However, we found the registered provider had not ensured the premises were safe for use and used in a safe way. We found the home was not always secure. We noted the back door was not always secured. We also saw some ground floor windows did not have restrictors in place. This posed a risk of illicit entry. We found cleaning products were not secured, a fire door was propped open and a floor was damaged. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Safe care and treatment.) We discussed this with the deputy manager and prior to the inspection concluding we saw action had been taken to minimise the risk of harm occurring. We also received written documentation confirming this.

At this inspection carried out in November and December 2017 we found a range of audits were in place to identify shortfalls in the service provided. These included accident and incident audits, weight management audits, care planning audits, medication audits and training audits. However, we noted the audits had not identified some of the concerns we had identified on inspection. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Good Governance.)

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we spoke with six people who lived at the home. The people we spoke with described staff as ‘busy’ and ‘rushed.’ One person told us they had to wait for personal care and said, “They need more staff here.” A further person told us they saw staff, “rushing.” We spoke with staff who told us people sometimes had to wait for help as they were busy supporting other people. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Staffing.)

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we saw alert sensors were used to minimise the risk of people falling. We also saw one person had a bed with bedrails in place to ensure their safety. We asked the deputy manager if an application to the supervisory body had been made to ensure people were being lawfully deprived of their liberty. The deputy manager told us they had not and they would complete the applications as required. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2010 (Safeguarding service users from abuse and improper treatment.) We discussed this with the deputy manager and prior to the inspection concluding we saw action had been taken to ensure people were lawfully deprived of their liberty.

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we saw people’s personal details were displayed in a communal area, bathroom locks were not working and a communication book, containing personal details of people who lived at the home was left on a table in a communal area. We discussed this with the deputy manager and prior to the inspection concluding we saw action had been taken to address this. We have made a recommendation regarding this.

There were systems in place to manage medicines safely. People told us and records we viewed; indicated people received their medicines as prescribed. We found best practice guidance was not always followed. We noted two bottles of prescribed medicines had not been dated on opening. We have made a recommendation regarding this.

People told us they were happy living at Croft House Rest Home and the care met their individual needs. We were told, “I think my care is excellent. And, “I’m well looked after.” People described staff as, “thoughtful” and “wonderful” and told us they were involved in their care planning.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner. We found medicines were stored securely.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff told us they received regular supervisions and appraisals to ensure training needs were identified. Two staff told us they felt they would benefit from a one to one meeting with the registered manager at the point of their appraisal. We passed this to the registered manager for their consideration. Staff told us, and we saw documentation which evidenced that staff received training and development opportunities to maintain their skills.

We viewed the kitchen and saw it was well stocked with a variety of tinned, frozen and fresh produce. All the people we spoke with told us they were happy with the meals provided and they were given an alternative if they did not like the meals offered to them.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate. Documentation reflected the advice of health professionals.

Our observations during the inspection showed staff treated people with respect and kindness. People told us they considered staff were caring and we saw a positive rapport between staff and people who lived at the home.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. People spoke positively of the activities provided at the home and we saw people laughing and smiling as they joined in a quiz.

There was a complaints policy which was understood by staff. Information on the complaints procedure was available in the reception of the home. It is a legal requirement that the home conspicuously displays its last CQC rating. We noted this was available in the reception area of the home and was also displayed on the registered provider’s public website.

The registered provider had taken steps to improve the environment at the home. We saw a wet room had been installed and decoration had taken place in some areas of the home.

People who lived at the home were offered the opportunity to complete surveys and meetings were available for people to participate in. People and relatives also told us they found the registered manager approachable if they wished to discuss any matters with them.

Croft House Rest Home is a registered care home situated in Freckleton close to shops and public transport. It is registered to provide accommodation for up to 22 older people. Bedroom accommodation is situated over two floors and there is a stair lift to the first floor. There are three lounges plus a conservatory which is used for dining. There is a patio area for people to enjoy and car parking is available at the home.

Croft House Rest Home has a manager who is 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.

Croft House Rest Home was registered with the Care Quality Commission in April 2012. We last inspected the home in October 2013 and found no breaches in the regulations we looked at.

At this inspection visit carried out in October 2016, there were 18 people who lived at the home. People we spoke with said they were happy with the care and support they received. People told us staff were caring and were knowledgeable of their individual needs. People described staff as, “Very good, very kind.” And, “lovely and thoughtful.”

We found risks to people who lived at the home were not always identified and control measures implemented to mitigate the risk. This was a breach of Regulation 12 (Safe care and treatment.) You can see what action we told the provider to take at the back of the full version of the report.

Quality assurance checks were carried out to ensure areas of improvement were identified, however did not always identify if improvements were required. This was a breach of Regulation 17 (Good Governance.) You can see what action we told the provider to take at the back of the full version of the report.

Overall we found the environment was clean. However we noted some equipment required cleaning and infection control measures required improvement to ensure the risk of cross infection was minimised. We have made a recommendation regarding this.

People told us they could take part in activities which interested them. We were told, “People come in and sing to us.” And, “I like the quizzes”.

People who received care and support told us they felt safe. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found medicines were administered safely. Staff were knowledgeable of arrangements for the ordering, storage and receipt of medicines and we saw medicines were dispensed in a safe way. However we found policies regarding medicines were not always in place to provide instruction for staff. We have made a recommendation regarding this.

We saw recruitment checks were carried out to ensure suitable people were employed to work at the home, however this did not record any gaps in employment. Prior to the inspection concluding we were provided with documentation that allowed for this information to be recorded.

There were sufficient staff to meet people's needs. People were supported in a prompt manner and told us they had no concerns with the availability of staff.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet peoples' needs. Staff told us further training was available if they requested this.

Processes were in place to ensure people's freedom was not inappropriately restricted. Staff told us they would report any concerns to the registered manager.

We saw people were offered a variety of foods at Croft House Rest Home and people were supported to eat and drink sufficient to meet their needs. People told us they liked the food provided.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate and documentation we viewed reflected this.

Staff treated people with respect and kindness. People told us they were involved in their care planning.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People who lived at Croft House Rest Home and their relatives were offered the opportunity to participate in an annual survey.

During the inspection we noted improvements were required to ensure the safety of the environment. We discussed this with the registered manager who took action to remedy this. Prior to the inspection concluding we saw windows were appropriately secured.

We found the provider had taken steps to ensure the premises were adequately maintained. Some bedrooms, the ceiling in one of the lounge areas and the ground floor toilets had been decorated. Bedroom carpets had been cleaned.

The quality of the service was being monitored, with action taken to address any shortfalls.

The new paperwork for the plans of care made information easy to find. Regular reviews meant any changes were responded to. Staff kept good daily records, giving an overview of how each person had been each day. Health issues and treatment could be tracked and followed up where necessary. These systems promoted the health and well being of people living at the home.

People were generally satisfied with the meals provided. There were systems in place to reduce any risks of poor or inappropriate nutrition.

The staff we spoke with knew the residents very well and showed a good understanding of their needs and preferences.

Some improvements had been made to the premises. However parts of the home were still in need of attention. A smart and well decorated environment would enhance the general well being of those living at the home.

There were both internal and external quality monitoring systems in place. These helped to identify shortfalls and led to service improvement.