Croft House Rest Home was inspected on the 15 October 2018 and the inspection was unannounced.

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

This inspection was carried out on the 22, 28 November 2017. The first day was unannounced. We continued the inspection on the 08 December 2017. This was because the registered manager was not available on the first two days of our inspection and we needed to speak with them.

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

This inspection was carried out on the 17, 18 and 27 October 2016 and the first day was unannounced.

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

This inspection was carried out to follow up concerns we previously identified regarding the premises. We also reviewed some of the quality assurance systems at the home.

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.

People living at the home told us staff were friendly and kind. The relatives we spoke with confirmed they were kept informed of important changes and were generally pleased with the quality of care provided. Comments included; “My mother is happy here.” And “If I do mention something, they do act on it. They wouldn’t just leave it.”

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.

We visited the home because of information of concern that was shared with us and an opportunity to monitor areas of non compliance from July 2012. People living at the home told us they felt well cared for and staff were kind, polite and friendly. However we saw that some people spent a lot of time sitting in front of the television or were observed sleeping. People said staff did not appear to have time to sit and talk to them and there were not enough activities arranged. One person said, “Lovely staff that has hearts of gold. They are always busy and you have to ask them things in passing or they will sit with you when they have time”. Another person told us, “Too many old people here for me, I just want to be at home. I stay in the bedroom because there’s nothing for me to do, but they do come and check on me to see I’m alright”.

People living at the home told us they felt well cared for and staff were kind, polite and friendly. However, some people said that they spent a lot of time sitting in front of the television, that staff did not appear to have time to sit and talk with them and there was not enough going on, in terms of activities.

People said they were happy with their bedroom accommodation. One person who chose to spend long periods of time in her bedroom added; “I have got everything I need here.”

The relatives we spoke with were very happy with the care provided at the home. Comments included; “the staff are very kind” and “I can go away on holiday and know she is ok.” Relatives told us they had confidence in the staff team and that they were kept up to date of important matters, such as changes in health.

Although we received some positive feedback from the people we spoke with, we found areas of non compliance with some essential standards of quality and safety.