Crofton Court

Crofton Court is a care home providing accommodation and personal care without nursing for up to 50 people. At the time of the inspection, 38 people were living at the home.

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

People and their relatives told us they felt the service was safe. Accidents and incidents were recorded and reported correctly, and lessons were learnt to minimise reoccurrence.

Monitoring of the building and safety checks were completed, including fire safety measures. We have made a recommendation about timings of fire drills.

Staff were described by people and their relatives as kind, very caring and friendly. One relative said, “All of these carers have a great sense of humour mixed with an incredible sense of caring for everyone. I really don’t know how they do their job, day after day.”

Medicines were managed safely.

Enough staff were employed to meet people’s needs and a safe recruitment system was in place.

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 home supported this practice.

Robust monitoring processes were in place to help ensure a good standard of service. Quality assurance systems identified areas for further development and actions were implemented.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that staff deployment be kept under review. At this inspection we found recommendations had been addressed.

Why we inspected

We carried out an unannounced focused inspection of this service on 20 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve medicines management.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. 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 changed to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crofton Court 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.

Crofton Court is a residential care home providing accommodation and personal care to up to 50 older people, some of whom are living with a dementia related condition. At the time of our inspection there were 40 people living at the home.

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

The service was going through a period of change. There had been a number of management changes at the home over recent years. Staff told us these changes had affected morale and the running of the service. There had also been a history of non-compliance with the regulations. We have made a recommendation that the provider keeps the management and support of the home under review to help ensure stability, consistency and compliance with the regulations.

There was a new manager in post. Staff, people and relatives spoke positively about her. One person told us, “[Name of manager] is absolutely fantastic. She is a people person she always says hello.”

Medicines were not always managed safely. Records did not always demonstrate that medicines had been administered as prescribed. The manager told us that additional checks and training were being carried out.

Records were not fully available to demonstrate how the provider was meeting their responsibilities under the duty of candour. We have made a recommendation about this.

A safeguarding system was in place. People told us they felt safe. This was confirmed by relatives. One relative told us, “The best thing is this is the first time I feel she is safe and I don’t have to worry.” Accidents and incidents were analysed and monitored. There had been a delay in notifying the local authority and CQC of several incidents. This had been highlighted by the provider’s system and notifications were immediately submitted.

A system was in place to assess, monitor and manage risks. Due to the impact of COVID-19 and changes in management, staff explained that some people’s electronic care plans and risk assessments had not been updated as planned, however, this had now been actioned. There had also been a delay in certain kitchen and bathing equipment being fixed due to COVID-19. Management staff told us this was being addressed. Additional shower facilities and bathing equipment were available.

We received mixed feedback about staffing levels. Some people and staff said more staff would be appreciated. Some staff also raised concerns about the skill mix, supervision and staff allocation. The manager was already aware of these issues and had commenced systems to help ensure staff were correctly deployed and supervised. We have made a recommendation about this.

Safe infection control procedures were followed. Visiting was carried out in line with government guidance.

People and relatives also spoke positively about the staff and the care they provided. Comments included, “There’s nothing I would improve, everyone is so kind” and “The best thing is the friendliness of the staff.” We also spoke with a social care professional who stated, "Nothing but positives" [about home 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 and update

The last rating for this service was good (published 16 September 2021).

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.

The provider was taking action to address the issues identified. Their quality governance system had already identified many of the shortfalls identified and an action plan was in place.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 Crofton Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified one breach of Regulation 12 (Safe care and treatment) in relation to medicines management.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Crofton Court is a residential care home providing accommodation and personal care to up to 50 older people some of whom are living with a dementia related condition. At the time of our inspection there were 40 people living at the home; some of whom were living with dementia.

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

Action had been taken following our previous inspection. Lessons had been learnt and improvements had been made.

Most people and relatives spoke positively about the home and the care and support provided. One relative told us, “Staff make them feel wanted and they are always treated with dignity and respect. Their room is basic but clean and tidy - nothing posh here, but they are shown compassion and patience which is what they need - they feel it is their home.”

An effective system was now in place to protect people from the risk of infection. One relative said, “Staff always wear appropriate PPE, we have to do a lateral flow test (LFT) before we visit at home now, I think they have handled COVID-19 very well under the circumstances.”

There were sufficient staff deployed at the time of the inspection to meet people’s needs. We observed lovely interactions between staff and people. Staff worked as a team to meet people’s needs.

Medicines were managed safely. We identified several issues relating to the recording of medicines. We have made a recommendation that best practice is followed in relation to the recording of medicines.

People were supported to eat and drink enough to meet their needs. Work was ongoing to ensure records relating to people’s fluid intake were accurate and personalised.

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. Action was being taken to ensure records demonstrated how the MCA was followed.

Audits and checks were carried out. A new computerised care planning system was in place. We identified several shortfalls regarding the maintenance of records. These related to medicines, MCA and the recording of people’s fluid intake. We did not identify any impact upon people because of these shortfalls. We have made a recommendation about ensuring that records accurately reflect people’s needs.

Systems were in place to involve people, relatives and staff in the running of the home. We passed feedback about certain issues relatives had raised to the management team so these could be investigated and addressed.

There was a new manager in post who was going through the application process to become a registered manager with CQC. One relative told us, “There have been a lot of staff changes, but the new manager is like a breath of fresh air, she is brilliant, amazing - can’t praise her enough. 100% changed the place and better staffing.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 February 2021). There were three breaches of the regulations relating to safe care and treatment, staffing and good governance. We issued a warning notice and told the provider they needed to improve. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to confirm that they had followed their action plan and met legal requirements . The inspection was also prompted in part due to concerns received about people’s care and support, staffing levels, accidents and incidents, eating and drinking, medicines and the management of the home. We found no evidence during this inspection that people were at risk of harm from these concerns.

This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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

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.

Crofton Court is a residential care home providing accommodation and personal care to up to 50 older people some of whom are living with a dementia related condition. At the time of our inspection 39 people were living at the home. Accommodation is available across two floors.

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

The service was not always well led. There had been numerous changes within the management structure at the home which had impacted upon the quality of the service. Effective systems were not in place to monitor quality and audits had not always been completed regularly.

People were not always protected from the risk of harm. Staff did not always follow government guidance in relation to safe infection prevention and control procedures. People did not always receive their medicine as prescribed and a high number of medicine errors had been reported. There were not always enough staff deployed to meet people’s needs and there was a dependency on the use of agency staff within the home. During the inspection the provider authorised the use of additional agency staff to support the home until more staff could be recruited. Systems were in place to safeguard people from the risk of abuse. Staff spoken with understood their responsibilities in how to protect people.

Risk assessments did not always contain enough information to guide staff in how to provide support and had not always been reviewed at the frequency identified by the provider. Systems were not in place to monitor people who were assessed as being at risk of dehydration. A member of the management team had started to review accidents and incidents to share any lessons learnt with the whole staff team.

An effective system to ensure staff were supported and appropriately trained was not in place. There were gaps in the training deemed as mandatory by the provider. Feedback from staff detailed they did not always feel supported or valued by the provider, which impacted upon the morale of the home.

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 and update

The last rating for this service was requires improvement (published 16 March 2020) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to follow up on specific concerns we had received about the service. The inspection was prompted, in part, due to concerns received about medicine errors, management of the home, staffing, a lack of activities for people and the infection prevention and control practices of staff. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Crofton Court is a residential care home providing accommodation for persons who require nursing or personal care. The service can support up to 50 people. At the time of the inspection 45 people were using the service, some of whom were living with a dementia.

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

Policies and procedures had not been effectively implemented to ensure the proper and safe management of medicines. We found no evidence people had come to any harm, however there was an increased risk that people may be harmed due to the identified concerns.

Due to ongoing recruitment people were supported and cared for by agency staff and staff from other Akari homes as well as permanent staff. This had impacted on people’s care and support as staff did not always know people. Assurances were offered during the inspection that longer-term secondments had been offered to staff to ensure consistency. We have made a recommendation about staffing and recruitment.

We have made a recommendation about nutrition and hydration to ensure people’s needs are met in line with guidance from external professionals. People told us the food was lovely and they were offered plenty of choice.

Overall, 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. Risk assessments were in place to assess the need for restrictions, however specific capacity assessments and best interest decisions were not always completed. We have made a recommendation about capacity and consent.

Care records varied in quality, completeness and detail. This had been identified by the provider and steps were being taken to improve the accuracy and quality of record keeping. We have made a recommendation about this.

Overall, people told us they felt safe living at the home and the permanent staff who knew them well were kind, caring and treated them with dignity and respect. People were not happy about the high use of agency staff and staff who did not know them well.

Staff had confidence in the support and leadership offered by the team leader and the regional manager however morale was low due to the number of changes in management and leadership in recent months.

The regional manager and head of quality were responsive to our feedback, acknowledged our findings and where they could took immediate action to address concerns. A detailed home improvement plan was already in place which identified actions that needed to be taken, and by when to ensure continuous learning and improvement.

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. (Report published 25 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines, falls and lack of leadership. A decision was made for us to inspect and examine those risks.

We found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We identified a breach in relation to the safe management of medicines.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Crofton Court 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. Crofton Court provides care and support for up to 50 people who require support with personal care, some of whom are living with dementia. At the time of the inspection there were 43 people living there.

The service had 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.

At the last inspection in February 2017 we found that there was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to systems not being place to ensure that care and treatment were only provided with the consent of the relevant person or action had been taken in line with the Mental Capacity Act (2005). During this inspection we found the service had made improvements.

We previously inspected Crofton Court in February 2017, at which time the service was not meeting all regulatory standards and was rated ‘Requires Improvement’. At this inspection we found the service had improved to Good.

People and their relatives told us people were safe living at the service. Staff had completed training in safeguarding people and the registered manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

People’s medicines were administered in accordance with best practice and managed in a safe way. People continued to receive their medicines in a timely way and in line with prescribed instructions. There were some ongoing issues with topical medicines administration records and work to improve these was ongoing.

People and relatives told us there were enough staff to meet people’s needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

Staff received regular training, supervisions and annual appraisals to support them in their roles.

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 were supported to meet their nutritional needs and to access a range of health professionals. Information of healthcare intervention was included in care records.

People and relatives spoke highly of staff and felt the service was caring. Staff treated people with dignity and respect when supporting them with daily tasks.

People had access to advocacy services if they wished to receive support. Independent Mental Capacity Advocates (IMCAs) services had previously been involved with people in the home.

People’s physical, mental and social needs were assessed prior to them moving into the home. Care plans were personalised, detailed and reviewed regularly and included people’s personal preferences.

There was a range of activities available for people to enjoy in the home. People were also supported, where necessary, to access activities in the local community including going for walks and shopping.

There were audit systems in place to monitor the quality and safety of the service. The views of people, relatives, staff and professionals were sought by the registered manager via annual questionnaires. There were no negative comments received during the latest questionnaires sent out in January 2018.

Crofton Court is located in the centre of Blyth. It provides accommodation and personal care for up to 50 older people, some of whom are living with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 42 people living at the home.

The home had a registered manager in place and our records showed he had been formally registered with the Care Quality Commission (CQC) since December 2014. A registered manager is a person who has registered with the 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.

People told us they were safe living at the home and staff had a good understanding of safeguarding issues and how to recognise and report them. There was regular maintenance of the premises and fire risk and other safety checks were carried out on a frequent basis. People had emergency evacuation plans in place to identify the support they required in the event of a fire. Accidents and incidents were monitored and reviewed to identify any issues or concerns. At the previous inspection staff had told us there was not always enough equipment available to help transfer people during care. At this inspection we found additional equipment was available at the home.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). At the previous inspection we had noted concerns about the safe management of medicines. At this inspection we saw this area had improved and a new electronic recording system was in place, although topical medicine records (creams and lotions) were sometimes not well kept.

Previously people and staff had raised concerns about staffing levels at the home. At this inspection some people still had concerns about staffing at certain times of the day, although most people and staff felt there were sufficient for day to day care.

Staff told us they had access to a range of training and updating and records confirmed this. At the previous inspection there were inconsistencies in the recording of staff supervisions and appraisals at the home. At this inspection staff confirmed they received supervision and records regarding the practice were available to view.

People told us, and our observations confirmed the home was maintained in a clean and tidy manner. People’s health and wellbeing was monitored and there was regular access to general practitioners, district nurses and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw evidence DoLS had been granted in some cases or that applications were still pending with the local authority. At the previous inspection we had made a recommendation about ensuring care was delivered in line with the MCA. At this inspection we found there continued to be issues around valid consent or the provision of best interests decisions, as laid down by the MCA.

People were happy with the quality and range of meals and drinks provided at the home and we witnessed that food was served hot and was well presented. Mealtimes could sometimes be a busy period for staff. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements, likes and dislikes.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity.

At the previous inspection we had found care plans were not always comprehensive or appropriately reviewed. At this inspection we found plans had improved, were thorough, contained good personal detail and highlighted the individual needs of the person. Care plans were reviewed monthly. There was still the occasional use of phrases such as, “Remains appropriate.” A range of activities were offered for people to participate in. Some people and staff told us they would like more activity time to support people to go out into the community. People and relatives told us they had not made any recent formal complaints and would speak to the registered manager if they had any concerns. The registered manager had dealt appropriately with any complaints received.

The registered manager told us he carried out regular checks on people’s care and the environment of the. However, these checks had failed to identify the issues related to effective and legal consent being obtained, or the minor issues with topical medicines recording. Staff felt well supported by the manager, who they said was approachable and responsive. There was evidence of meetings at which people could express their views. The provider had sought people’s views through the use of questionnaires, which were overwhelmingly positive. Daily records were well maintained and up to date.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the Need for consent. You can see what action we told the provider to take at the back of the full version of the report.

People's care needs were assessed and their care and treatment was planned and delivered in line with their individual care plans. People told us they were well looked after and they were provided with a good service that met their needs. Comments

included, "I am receiving excellent care, the food is great and I've put on weight," "I am very comfortable I have no problems" and "It couldn't be better."

The people who used the service were provided with a clean and comfortable place to live. There were adequate systems in place to ensure the premises were well maintained and adequately furnished to meet people's needs.

There were systems in place to ensure people were cared for by staff who were well trained and supervised to meet individual needs.

People were asked their views about the service provided and these were taken into account. The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service.