Croft House Care Home Limited

We found the following examples of good practice.

¿ There have been no positive cases of COVID 19 in the service during the pandemic.

¿ Good controls were in place which ensured anyone entering the service did so safely. Detailed COVID 19 information was posted outside advising visitors of procedures. On entry each person’s health and temperature was checked and. if safe to proceed, full hand washing/sanitising and donning of PPE took place.

¿ People had been included in staff infection control training to help them understand and become less anxious of staff wearing PPE.

¿ The service is in local lockdown and currently closed to visitors. However, prior to lockdown outside visiting had taken place in a marquee with separate entrances; one for people and staff, the other for relatives. Perspex screening was in place which allowed people to sit opposite one another yet remain shielded. A microphone enhanced communication for people with a hearing loss.

¿ Staff supported people to stay in contact with relatives and friends via video calling.

¿ There was an increased focus on providing meaningful activities to engage people which had reduced levels of anxiety. Additional staffing hours were provided to ensure people had regular contact, especially when isolating in their rooms.

¿ Enhanced cleaning schedules include the use of a specialist sanitiser machine which is certified COVID effective and used to deep clean and sanitise rooms.

Further information is in the detailed findings below.

Croft House is a residential care home located in Eastburn near Keighley. It provides personal care for up to 29 people aged 65 and over. At the time of the inspection there were 23 people living in the home.

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

People received exceptional outcomes using the service. People had experienced a better quality of life after moving to the home, made possible due to the dedication and skill of the staff team. People received care from a highly knowledgeable staff team who had access to a wide variety of training and support. The service had developed extremely strong working relationships with local health professionals which ensured people’s healthcare needs were fully met. The service was creative in the ways it promoted good nutrition and hydration, in a way that worked for each individual.

Staff were exceptionally kind and caring to people and were dedicated to ensuring each person had as comfortable a life as possible. All staff and the management team demonstrated extremely caring and person-centred values. People were treated with a high level of dignity and respect. People were truly listened to by staff and their views and opinions used to ensure an individualised framework of care and support. Staff promoted equality and diversity in creative ways, ensuring people’s rights were continuously upheld.

People’s needs were fully assessed by the service and used to develop a comprehensive range of care plans which were well understood by staff. The service fully met the requirements of the accessible information standard, ensuring creative aids were available to support people’s communication and understanding. An excellent range of activities and social opportunities were available to people and there were exceptional links with the local community.

Everyone involved in the service provided exceptional feedback about the overall quality of the service. There was a truly person-centred culture with the management and staff team and all were highly involved in peoples’ care and support. The service sought and developed its own best practice to be at the forefront of high-quality care. A range of audits and checks were undertaken to ensure continuous improvement of the service.

The service was safe. Risks to people’s health and safety were assessed and mitigated. Medicines were managed in a safe and proper way. There were a high number of staff available each day to provide people with stimulation, interaction and ensure they were safe. Incidents and accidents were logged and investigated and learnt from where appropriate.

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 23 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Croft House provides personal care and accommodation to a maximum of 29 people, mainly older people and people living with dementia. It is an adapted property which provides accommodation in single rooms some of which have en-suite facilities. The communal rooms are on the ground floor. There is level access to the lower floor and a passenger lift to the first floor. There is an enclosed garden which people can easily access from the ground floor.

The last inspection was in June 2016. At that time we found the service was in breach of five regulations, regulation 11 (Consent), regulation 12 (medicines), regulation 13 (safeguarding), regulation 18 (staff training) and regulation 17 (good governance). We told the provider they must make improvements. The providers, who had always prided themselves on delivering the best possible care to people, acknowledged the shortfalls and acted promptly to address them.

During this inspection we found the provider had taken action to address the concerns identified at our previous inspection. We were assured they were actively engaged in implementing systems to ensure the continuous improvement of the service.

There was a registered manager in place. 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 service was exceptionally caring. Everybody we spoke with told us the staff were very caring, kind and compassionate and always treated people with respect. During the inspection we observed staff had developed positive relationships with people. We saw all the staff including those employed as housekeepers and laundry assistants took the time to talk with people as they carried out their work. All the relatives we spoke with were full of praise for the home and the standards of care provided. Everybody we spoke with told us they could recommend the home

Staff we spoke with demonstrated a commitment to making people’s lives as good as possible. We found examples of staff going out of their way to make sure people’s individual needs and wishes were met. We found staff knew people well and were attentive to their needs; they focussed on people’s strengths and supported them to maintain their independence. The providers were actively involved in the day to day running of the home. Throughout the day we observed they provided excellent role models for staff.

We found staff were proactive in making sure risks were addressed and managed so that people were supported to maintain their independence.

People who lived at the home and their relatives told us they felt Croft House was a safe place. Staff knew how to recognise and report any concerns about people’s safety. Any concerns about people’s safety and welfare were identified, dealt with and reported to the relevant agencies. The required checks were done before new staff started work and this helped to protect people from the risk of abuse.

There were enough staff available to meet people’s needs. Throughout the inspection we observed staff were attentive to people’s needs and took care to make sure there was always a member of staff in the communal areas. Improvements had been made to the way staff were trained and supported to deliver safe and effective care. People told us they were confident staff knew how to look after them properly.

We found improvements had been made to the way people’s medicines were managed. People received their prescribed medicines safely.

We found risks to people’s health, safety and welfare were identified and action was taken to minimise and manage risks.

The home was clean and well maintained.

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.

People enjoyed a variety of food and drinks, including alcoholic drinks, and their individual likes/dislikes and dietary needs were catered for. People’s weights were checked and action was taken to make sure people who were at risk of poor nutrition received the right support.

People were supported to meet their health care needs and they had access to the full range of NHS services.

Care was delivered in a person centred way and the service was in the process of implementing new care records to support this.

People told us they did not have any complaints or concerns and they knew who to talk to if they had any concerns. The management team had a very ‘hands on’ approach and dealt with any concerns as they arose.

Everybody we spoke with was unanimous in their praise of the provider and registered manager. People were confident the service was well managed and everything possible was done to enhance the quality of life experienced by people living in the home.

Croft House provides accommodation and personal care for a maximum of 29 older people and people living with dementia. It is an adapted property and accommodation is provided in single rooms some of which have en-suite facilities. The building has access for people with disabilities and there is a passenger lift to the first floor. At the time of the inspection there were 27 people living in the home.

The last inspection was in January 2014 and at that time the provider was compliant with all the regulations inspected.

There was 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.

People described the staff as caring, kind and compassionate and throughout the day we observed staff were attentive, kind and patient. People were treated with respect and staff knew about people’s individual likes and dislikes. We saw staff took time to offer people choices and encourage them to make decisions about their day to day lives.

People living in the home told us they felt safe and people’s relatives told us they had no concerns about people’s safety. The staff we spoke with told us they would recommend the service to family and/or friends and they knew how to recognise and report abuse. However, we found that although safeguarding concerns were dealt with they not always reported to the relevant agencies and the actions taken were not always recorded.

We found that people’s medicines were not always managed properly and safely. In addition, when people were having their medicines covertly, disguised in food or drink, the correct processes were not always followed to show when and by whom it had been decided this was in the person’s best interests.

There were enough staff and people told us staff were available when they needed assistance. New staff did not start work until all the necessary checks had been done. This helped to reduce the risk of people being cared for by staff unsuitable to work in a care setting. Staff had induction training when they started work and we saw there had been training on topics related the needs of people living in the home. However, there was no system in place to show what training staff were required to complete or how often they should attend refreshers to make sure they were kept up to date with safe working practices.

The building was clean and well maintained. Improvements to the environment took account of the needs of people living in the home, for example an enclosed courtyard garden had been created to enable people to go outside easily and safely. We found risks to people’s safety and welfare were identified and dealt with in practice. However, the actions taken were not always reflected in people’s care records.

People enjoyed a variety of food and drink and their individual needs and preferences were catered for. People who needed help to eat and drink were supported by staff in a sensitive and discreet way. However, we found there was a risk of people’s nutritional needs being overlooked because of shortfalls in the record keeping.

People had access to the full range of NHS services to make sure their health care needs were met.

We found people’s needs were assessed. People had individual care plans, however, although the approach to the delivery of care was person centred this was not reflected in the care plans which were lacking in detail. This created a risk people could receive care which was inconsistent or not in accordance with their wishes.

People and their relatives told us they were involved in care planning but this was not reflected in the care records.

People were offered the opportunity to take part in variety of activities which reflected their interests both inside and outside the home. An activities organiser was employed specifically for the purpose of spending time with people during the morning when other staff were busy. During the morning we saw some people benefitted from this. Throughout the day we saw staff engaged with people while supporting them to meet their needs.

People were given information about the complaints procedure. The provider operated an ‘open door’ policy and our review of the records and conversations with people confirmed concerns raised dealt with as they arose.

All the feedback we received about the management of the home was positive. People living in the home, relatives and staff were united in their praise of the leadership and management.

However, we found improvements were needed to the way the quality and safety of the service was monitored and to record keeping. This was to make sure people continued to experience consistently safe and effective care.

We found five breaches of regulations in relation to safeguarding, staff training, record keeping and monitoring and assessing the quality and safety of the service. You can see what action we told the provider to take at the back of the full version of the report.

We also looked at information on the website carehome.co.uk which showed 18 people had made comments about Croft House, all of which were positive giving the home on overall recommendation rating of 9.8. One person said Croft House provided care which was 'Person centred and respectful' and another said 'Love and compassion are the main ingredients here'.

We found people's wishes were respected, their needs were assessed and care and treatment was planned and delivered to take account of people's individual needs.

We found people were cared for in an environment which was clean and well maintained and there was an ongoing programme of refurbishment and redecoration.

We found people were protected because the correct checks were done before new staff started work.

People were protected from the risks of receiving care and/or treatment that was inappropriate or unsafe because their records were kept up to date and were stored correctly.