This unannounced inspection took place on 11 October 2018. Croft Meadow is a 'care home'. People in care homes receive accommodation and nursing or 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.

Croft Meadow is situated in Steyning in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Croft Meadow is registered to accommodate 60 people. At the time of the inspection there were 58 people accommodated in one adapted building, over three floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs.

The management of the home had been through a period of transition. The home had a registered manager who had been on long-term leave from work. A registered manager is a ‘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 home is run. The management team consisted of team leaders, a deputy manager, a clinical lead registered nurse and the registered manager. An operations manager also regularly visited and supported the management team.

The provider's and staffs' practices were not always responsive to people's specific needs. Not all people received their medicines in a timely way. Some people had specific healthcare conditions that required their medicines to be given at specific times. Records showed that people had not always had their medicines according to the prescribing guidelines. One person, had consistently been given their medicines outside of these times. People did not always have timely access to medicines to manage their symptoms or healthcare condition.

Not all risks to people’s safety had been identified, considered or mitigated. Some people smoked and had documented risk assessments to guide staff’s practice to ensure people’s safety. One person who smoked used an emollient cream to maintain the condition of their skin. Staff had not learnt from a safety alert that had been issued in relation to this. Risks to the person had not been considered and measures had not been taken to mitigate the potential risks. The provider had not done all that was reasonably practicable to assess and mitigate risk. This was an area of concern.

Staff had not demonstrated a caring approach when caring for one person who had not been protected from the risk of harm. The person had been assessed as being at high-risk of malnutrition. They had not had their weight monitored frequently, as outlined within the provider's policy and within the person's care plan. It was not evident if they had access to fortified food in increase their calorie intake. There were concerns that risks for the same person were not always identified or managed appropriately. There had been two separate incidents where the person had come to harm. The provider had not considered these in accordance with their safeguarding policies and procedures. This was an area of concern. Following the inspection, CQC made a safeguarding referral to the local authority.

There were concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Areas that were identified as part of this inspection had not always been picked-up and acted-upon by the provider’s own quality assurance audits. When the provider had identified issues that needed improvement, it was not evident what action had been taken to ensure those improvements were made. This was an area of concern.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least re

We carried out an unannounced comprehensive inspection at Croft Meadow on 10th February 2016. Croft Meadow is part of the Shaw Healthcare group and is a purpose-built home situated in the middle of a West Sussex village. The home is registered for a maximum of 60 people. On the day of our inspection there were 59 people living at the home. The home has three floors. The ground floor provides residential care support without nursing care for people, the first floor of the home provides care for people with nursing care needs and the second floor provides support for people living with dementia. Therefore people living at Croft Meadow have a variety of physical and mental health needs that the home provides care and support to meet.

The service 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.

There were group activities in place and two activity co-ordinators in post. Although we saw an activity co-coordinator providing a stimulating storytelling group with enthusiasm people told us that there were not enough staff to support them with one on activities and we observed on the day of our inspection that there were not enough staff to provided activities across the three floors of the home or to provide regular input to people who stayed in their rooms. This was discussed with the registered manager who agreed that this was an area that needs improvement.

People and their relatives told us people were safe living at Croft Meadow. One relative said “We wanted to know [the person] was safe and we absolutely know [the person] is here”. People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the manager.

We observed lunch, people had enough to eat and drink. They were given choices of food from a menu. Drinks were available throughout the day. One person told us “I think the food is very good here”. The service monitored people’s weights and recorded how much they ate and drank to keep them healthy.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Staff had received all essential training and some were working toward an award in health and social Care. They received supervisions from their line managers.

People told us that staff were kind, caring and approachable. One person told us, “They are all really lovely and as helpful as they can be”. We observed staff treating people with dignity and respect and involving them in their care. Another person said of staff, “They are very nice, we get on very well”.

People’s care plans were up to date and contained information about their individual preferences and needs. The complaints policy was available and complaints were responded to in a detailed and timely way. There were relatives meetings and we were told that information was shared with people and staff by the registered manager. Relatives told us “As relatives we feel we can go and talk to the manager anytime and there have been a few minor things and they got sorted out straight away”.

The registered manager and deputy manager promoted a positive culture where person centred practice was promoted. They ensured people, staff and relatives were valued. There was a range of audit tools and processes in place to monitor the care that was delivered. This ensured the man

Croft Meadow is a 60 bedded nursing home, registered to provide nursing or personal care for up to 60 people. At the time of our visit, there were 57 people living at this location. The accommodation is divided into three areas – the top floor provides care for people with dementia, the middle floor provides nursing care to people with a range of care needs and the ground floor provides care and support to older, frail people.

Our inspection team comprised an inspector and a nurse specialist. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People’s diversity, values and human rights were respected. We observed care being offered to people. Staff were seen to be supportive in a manner that was individual to the person’s needs, respectful and maintained people’s dignity, privacy and independence. We saw that staff were knowledgeable about people’s needs and preferences.

We saw that potential risks to people were appropriately assessed and planned for. The service routinely screened for risks associated with mobility, falls, medication and environment. These risk assessments were reviewed regularly to determine if any changes had occurred. There were instructions for staff on how to reduce risks to people in these care areas.

Staff told us that they used personal protective equipment (PPE) to protect against infection. We saw that staff wore blue aprons for kitchen duties and assisting people to eat their meals and white aprons and disposable gloves to deliver personal care. We talked with people who used the service and asked for their views. One person told us that they did not see the cleaning staff as their room was cleaned when they were out. However, they confirmed that they thought their room was clean and described it as, “very good”.

Medicines were stored safely. We saw that all medicines were either kept in a locked cupboard or trolley within a dedicated, temperature controlled storage room. We looked at the records relating to the recording of the administration of medicines (MAR) charts. We saw that the MAR charts were completed correctly and entries were signed off by the team leader or registered nurse as medicines were administered.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

Where they were able, people expressed their views and were involved in making decisions about their care and treatment. One person told us that they could get up independently, usually at 7.00 am and that they liked to have breakfast before getting washed and dressed. They told us that the staff always treated them with respect and, “Yes, they always knock” on the door before entering. We spoke with two other people who used the service. They told us that they were fully involved in all aspects of their care and that staff treated them with respect and dignity.

In the care records we saw, people’s capability had been assessed. For example, in what ways they were fully independent and what level of support might be needed, from a verbal prompt and light assistance to full assistance.

Is the service caring?

We sat near a table where two people were being supported to eat their lunch and we observed that they were offered food in a relaxed manner and could eat at their own pace. We saw that one person was offered another plate so that they could separate the food they did not like from food that they wanted to eat. We observed one person being encouraged to eat by staff who said, “Is it nice?” At one point, the same member of staff had to break off helping this person as another person was in distress at the next table. We saw the staff member reassuring the person in distress, then returning to the table. On their return, they apologised for leaving them in the middle of the meal.

We spoke with a relative who was visiting and they confirmed that their family member was always treated with respect and dignity. They told us that their relative enjoyed helping out and would push the laundry trolley around the corridor, supported by staff. They told us that it was, “Always nice and relaxed here”.

Is the service responsive?

It was apparent that a lot of thought had been given to caring for people who had a wide range of care and support needs and that provision had been planned accordingly. The environment at Court Meadow was homely and had a relaxed feel.

Thought had also been given as to how to create an interesting environment for people receiving care in bed. For example, articles relating to one person's particular interests were suspended from the ceiling above their bed. This meant that an interesting environment had been created so that people could interact with their surroundings.

Is the service well-led?

The manager told us that they undertook monthly internal audits at Croft Meadow and we were shown the records that evidenced this. We saw that these audits covered a range of areas, for example, that people’s care plans had been reviewed and updated on a monthly basis. The audit then recorded which member of staff was responsible for which action.

At the time of our visit, we ‘sat in’ on a residents and relatives’ meeting. We were told these were organised on a monthly basis and saw the minutes that evidenced this. Items under discussion included outings in the summer and staffing. One person was concerned about the staffing levels as they thought the staff were always busy. The manager said that staff could move flexibly between floors and that additional staff could be brought in, as required. Another person said, “Staff are wonderful”. A relative said, “I’ve found here that nothing needs to be a problem.

The quality of the service being provided was not being assessed and monitored effectively to ensure people were being cared for safely and effectively and this impacted on the care people were receiving.

People were not always given choices about their care and treatment. People’s dignity was not always respected. People we spoke with were happy with the care they were receiving. One person said, "I have been here for two and a half years and seen changes."

We used a number of different methods to help us understand the experiences of people using the service. People who lived in the home all told us "staff are nice but always busy" and "there’s not enough equipment".

We viewed records relating to staff recruitment and found that the provider was operating effective recruitment procedures. We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

The people we spoke to told us they liked living at the home and liked the staff.

A visitor told us that the care their friend received was excellent “The staff are very caring, I can not fault them, I have no concerns “

We saw that people's privacy and independence were respected, people experienced safe and effective care based on detailed care plans and risk assessments that documented people’s preferences and met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

We saw evidence that staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.