This inspection took place on 18 and 20 September 2018. The first day of our visit was unannounced.

Butts Croft House provides care and accommodation for up to 35 people. Whilst the majority of people who live at the home are older people living with dementia, the service also offers care and support to young people living with dementia. The home provides eight temporary beds for people who have come from hospital for further care or assessment before going back to their own home. At the time of our visit there were 26 people living in the home.

People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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 our previous inspection in November 2017, we found a breach in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. We found breaches of the regulations related to managing risks to people's safe care and treatment, the need for consent, safeguarding service users from abuse and improper treatment, requirement to have a registered manager and display performance ratings and notification of incidents. We gave the home a rating of inadequate in well-led and served the provider with a Warning Notice. The overall rating of the home was ‘Requires Improvement’.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found that sufficient improvements had been made to meet the terms of the Warning Notice and the service was no longer in breach of the regulations, we found improvements were still required in how managers assured themselves they were providing a safe service, that ensured people's health and welfare needs were fully met.

Since our last inspection visit the manager had become registered with CQC and the provider had provided them with more support to improve the quality of the service. A management consultant had been appointed who had introduced systems and processes to monitor the quality of the service, but these needed to become embedded in every day practice to be consistently effective.

People felt safe living at Butts Croft House because there were enough staff to meet their care and support needs. Staff were recruited safely because the provider had checked they were of good character. However, improvements were needed to ensure any gaps in employment history were explored within the interview process. Staff received training and support to provide them with the skills and qualities to provide effective care. Some refresher training was overdue, but the provider had plans to address this.

Staff understood their responsibility to record and report any concerns they had about people's health or wellbeing. Safeguarding concerns had been referred to the local authority as required. Processes had been introduced for managing accidents and incidents that occurred within the home. Accidents and incidents were analysed as part of the provider’s monthly quality checks to identify any trends or patterns and as further scrutiny to ensure appropriate actions had been taken.

People were supported to eat a balanced diet and encouraged to eat and drink enough to maintain their wellbeing. People were able to access support from external healthcare professionals to maintain and promote their health. Overall, people received their medicines as prescribed, but staff did not always fo

This inspection took place on 28 November 2017 and 7 December 2017. The first day of our visit was unannounced.

Butts Croft House provides care and accommodation for up to 35 people. Whilst the majority of people who live at the home are older people living with dementia, the service also offers care and support to young people living with dementia. The home provides eight temporary beds for people who have come from hospital for further care or assessment before going back to their own home. At the time of our visit there were 24 people living in the home.

We last inspected this home in November 2016 when we rated the service as requiring improvement in safe, effective and well-led. The service had an overall rating of Requires Improvement. At this inspection we found improvements had not been made and the provider was not reaching the requirements of some of the Regulations in the Health and Social Care Act 2008. This is the third time the service has been rated as Requires Improvement.

There had been no registered manager at the service for over 12 months. 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. When there is no registered manager in post, the legal obligations imposed by the Health and Social Care Act 2004 remain with the provider.

The provider had not ensured there was a person with the skills and experience to manage the service at the time of our inspection visit. The manager was on annual leave and the home was being managed by the deputy manager who had been appointed three days prior to our inspection visit. Whilst very supportive of our inspection, the deputy manager had limited knowledge of the systems and processes for managing the home.

There was a lack of proactive management and leadership by the provider, which impacted on the quality of service. Quality assurance systems were either not in place or ineffective and failed to identify areas of concern we found during our inspection visit. At our last inspection, the provider gave us assurance improvements would be made. We found these improvements had not been made, and the poor governance of the home had resulted in new breaches of the regulations because the provider continued to place people at risk.

We could not be assured the provider understood the responsibilities of their registration with us. The provider had failed to notify us of important events at the service or displayed the ratings from their last inspection as required under our registration Regulations.

During our inspection visit we identified physical risks related to the premises, that compromised people’s safety, that the provider had either not identified or taken action to minimise. Although people felt very safe living at the home, some potential safeguarding incidents had not been referred to the local authority as required. Safety incidents were not effectively monitored and analysed to prevent further incidents from occurring.

There were enough trained staff to keep people safe, but the provider did not have oversight to ensure staff continued to receive training that was appropriate to their role and responsibilities. The provider had not ensured managers and staff always followed the MCA code of practice to make sure the rights of people who may lack capacity to make particular decisions were protected. However in their everyday interactions, staff gave people choices and respected the decisions they made.

People had enough to eat and drink, were supported to maintain good health and received appropriate and timely healthcare support. People received their medicines as prescribed.

Care plans did not always contain sufficient detail to ensure people's care needs were met in

The inspection took place on 29 November 2016. The visit was unannounced.

Butts Croft House provides care and accommodation for up to 35 people. The majority of people who live at the home are older people living with dementia. The service also offers care and support to seven younger people living with dementia. Younger people have a separate area for their accommodation, however, both older and younger people are able to access all parts of the home. At the time of our visit, there were 24 people living at the home.

The home is required to have a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager at the time of our previous inspection in January 2016 had left the service. There was a new manager who was not yet registered with us.

When we inspected the home in January 2016 we identified breaches in the regulations relating to safe care and treatment, consent, and good governance of the home. We rated the home as ‘required improvement’. At this inspection visit, we looked to see if the provider had taken action. We found improvements had been made and the provider was no longer in breach of the regulations. However, some further improvements were still required.

People told us they felt safe and happy living at the home. Staff knew how to protect people from the risk of abuse because they had been trained to safeguard people and knew what to do if they had a concern. There were enough skilled and experienced staff to meet people’s needs and the provider's recruitment process ensured, as far as possible, staff were safe to work with people.

Risks associated with each person’s care and support had been assessed, recorded and plans developed to manage these. Staff received induction, training and supervision to support their practice in meeting people's assessed needs safely and effectively.

Improvements were needed in the management of medicines within the home. The manager was working with commissioners and the local pharmacy to ensure people received their medicines safely and as prescribed.

People's rights under the Mental Capacity Act were protected by the provider and staff team who sought their consent to care. However, there was some inconsistency in the recording of when people’s capacity, in respect of specific decisions, had been assessed.

People were satisfied with the food provided and were able to have as much food and drink as they wanted. People had access to, and used the services of other healthcare professionals to maintain their health.

People spoke positively about the friendly, warm attitude of staff and the homely environment within Butts Croft. People felt able to approach staff and staff took time to sit and talk with people. Staff were attentive to people and displayed interest and affection when speaking with them. People told us staff were respectful and promoted their privacy and dignity when providing care. People said they felt comfortable to approach staff if they had any concerns or problems.

Where possible, people and their relatives were involved in making decisions about their care needs and how they would prefer them to be met. Care plans provided information for staff on how to meet people’s care needs and were reviewed regularly. Staff had a good knowledge of people's needs, preferences, likes and dislikes.

Since our last visit the provider had taken action to ensure the accommodation people lived in was safe and risks to people were minimised. However, further improvements were required to ensure checks carried out by the manager and provider to assure themselves people received safe, effective care were consistently recorded.

This inspection took place on 20 January 2016 and was unannounced.

Butts Croft House provides care and accommodation for up to 35 people. The majority of people who live at the home are older people with dementia. The service also offers care and support to seven younger people with dementia. Younger people have a separate area for their accommodation however both older and younger people are able to access all parts of the home. Some bedrooms are double rooms. At the time of our visit, there were 25 people who lived at the home.

The home has 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.

The registered manager had worked at the home for six months. They were new to managing a care home, as well as new to working at Butts Croft House. The provider had not provided sufficient formal support to the manager to make clear what their roles and responsibilities were, and how to achieve these.

There was insufficient monitoring by the provider to ensure the accommodation people lived in was safe, and the staff delivered safe care. The provider had not sent us all of the required notifications.

We had concerns about the provider’s fire safety checks and requested that Warwickshire Fire Authority undertake a fire safety check of the home. They visited the home on 27 January 2016 and identified a number of areas which required action.

People benefitted from a satisfactory living environment, although some areas of the home and some equipment was not clean. We considered some areas of the home a risk to people. We have asked the provider to act on our concerns.

Prior to our visit, concerns had been raised about the management of medicines in the home. The registered manager had acted on advice given by pharmacy professionals and most of the necessary improvements had been made.

Risks associated with people’s care and support had been assessed, but more detailed guidance was needed to ensure people remained healthy and safe. There was no analysis or learning from accidents and incidents leaving a risk of further occurrences.

The registered manager and staff had limited knowledge about the Mental Capacity Act and when to take decisions in people’s best interest. Deprivation of Liberty safeguards had been applied for.

People were cared for by staff who were kind and caring. There was a consistent staff group who knew people well. People did not have many opportunities to engage with staff, as staff mostly only had time to meet people’s essential care needs such as personal care and support, and meals. People who lived with dementia did not routinely receive specific care tailored to meet the needs.

People were satisfied with the food provided and could have as much food and drink as they wanted.

People’s care plans were not personalised to enable staff to provide individualised care to meet people’s needs and in line with their wishes and preferences. Plans did not always detail people’s skills in relation to tasks and what support they required from staff, in order that their independence was maintained. Staff had received dementia care training, but there were limited opportunities available to support people with their dementia care needs.

People were mostly supported to have access to health professionals when required.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

During our visit we looked at records, spoke with people, their relatives and staff. This helped us to answer five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were observed being treated with dignity and respect. People told us they were happy living at Butts Croft and they felt safe.

We looked at accident and incident records. We saw these had been fully completed and the appropriate action taken. We saw risk assessments were updated to ensure further accidents or incidents were minimised.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). We noted the service had worked with other professionals to undertake best interest decisions for a person under the Mental Capacity Act, although no applications under DoLs needed to be submitted. This meant people were safeguarded as required.

We looked at recruitment practice. We saw the service had effective systems in place to ensure people working at Butts Croft were safe to work with people living in the home.

Is the service effective?

The service used Age Concern as an advocacy service if people needed it. This meant that when required people could access additional support.

People’s health and care needs were assessed and reviewed with them or their families. Specialist mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “They (the staff) look after us very well, everyone has different needs and they accommodate everybody”. “Staff are very nice…if you have problems they will try to sort it out.” Relatives we spoke with told us, “The staff are brilliant, patient, caring, it’s more like a family atmosphere.” “The care is really good, it’s like x is part of a new family.”

Is the service responsive?

People using the service, their relatives, friends and other professionals involved with the service were provided with opportunities to provide feed-back on the service. This was through resident meetings, review meetings, and through quality assurance surveys. The manager’s office was in the central part of the home. This meant they were accessible to people. The manager told us they had an ‘open-door’ policy which meant they could address any concerns raised quickly and effectively.

We saw there had been no formal complaints recorded.

People’s preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The manager had a good knowledge of dementia and worked well with their staff team to provide a safe and effective place for people to live. Staff told us they worked well as a team and were provided with training each month to support them in their roles.

When we visited Butts Croft we did so unannounced which meant that no one who lived at or worked at the service knew we were coming. During our visit we a met some of the people that lived in the home and visiting relatives. We also met and spoke with the manager and the deputy and four members of staff.

People living in the home had complex needs which meant that they were not always able to tell us their experience. We spent time during our visit observing staff interaction and observing the care being provided. People in the home were able to move around the variety of communal areas confidently and appeared relaxed.

Staff were interacting with the service users in a respectful way and treating them with dignity and respect. Service users appeared relaxed and comfortable with the care and support being provided.

People told us that they were happy with the care and support that was being provided and making comments such as 'The care is very good, some carers are better than others but they are all good. The staff are very great here anything I need they help me to get it.' Relatives spoken to said they were happy with the care and support provided. 'I feel that the home is well staffed with the same staff here which is really nice to have that consistency. I feel so lucky everyone is so obliging.'

Clear well organized care plans and relevant training were in place to ensure that staff were able to meet the needs of each individual.

When we visited Butts Croft House we did so unannounced which meant that no one who lived at or worked at the service knew we were coming. During our visit we met some of the people that lived in the home and visiting relatives. We also met and spoke with the manager, deputy manager and three members of care staff.

People living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences.

Staff were respectful to people, calling them by their name and showing kindness and concern for people. People appeared at ease and relaxed around staff and were able to approach them freely.

People told us they were happy with the care and support provided, making comments such as, "They made me a lovely cake for my birthday and I feel the staff do try to make you feel happy. The home is always beautifully clean, one of the staff does my washing for me, they are really kind lovely people." Relatives told us they were satisfied with the care provided by the home. "They explain mum's care plans to me to make sure I'm happy with the care being provided" was one comment made.

People had care plans in place that contained information to assist staff with meeting their care and support needs.

Confidential records belonging to both the people living in the home and the staff were maintained in good order and were stored securely.

During our visit on 22 August we talked to three people who use the service and met several more. Some of the people we met were unable to talk to us about the quality of the service they receive because of their dementia care needs.

We met with four people who were visiting people living at the home. They all gave positive feedback about the care that their loved one receives at Butts Croft House. They also commented on the kindness of the staff and the quality of the meals.

We observed a lunchtime meal being served and noted that staff were attentive to people's needs but also encouraged people to do things for themselves to try and maintain their independence. Staff were quick to assist people who were aggitated or distressed and spent time with them chatting and offering them choices of things to do.