The inspection took place on 26 March and 18 April 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

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 receiv

This inspection took place on 1 and 2 February 2017 and was unannounced. A previous inspection, undertaken in December 2015 found three breaches of legal requirements. These related to staffing, safe care and treatment and good governance. The provider subsequently wrote to us to tell us the action they would take to address the issues we found. This inspection was to check that improvements had been made and consider the overall rating of the home.

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

We saw people were treated with respect and their privacy and dignity was maintained. The manager encouraged people to be involved in how the service was run. Comments included, "I enjoy the food, you always have a choice" and "I choose to spend a lot of time in my bedroom, I like to watch TV in private."

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.

At this visit, we did not speak to people who used the service.

Forty one people were using the service at the time of our visit. As we walked around the premises we met with many of them, and spoke with five of them in detail. Everyone we spoke with was positive about the care and support they received from the service. Comments included, “I love it here, the girls are so nice, they do a lot to help you” and “I do get looked after because I’ve got what I need”.

We spoke with four relatives of people. Their comments included, “They look after my dad perfectly” and “It’s fantastic, they are lovely with her (my relative)”.

During our visit we spoke with two visiting professionals who told us, “I’d be happy to put my own parents here” and “It’s excellent, and I’m not just saying that”.

The inspection took place on 26 November and 2 December 2015 and was unannounced. The previous routine inspection was carried out on October 2013 when all standards were met.

Crofton Court is located in the centre of Blyth it provides accommodation and personal care for up to 50 older people some of whom have dementia. People living with dementia at the home were accommodated upstairs in the Edward and Renwick units. At the time of the inspection there were 48 people using the service.

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 and associated Regulations about how the service is run.

We found shortfall in how medicines were managed and the storage of medicines. In addition, we found shortfalls in the recording of some medicines which meant it was not always possible to ascertain whether people had received their medicines as prescribed.

On the second day of the inspection the registered manager told us that they had brought forward planned medicines refresher training as a result of our findings.

People told us they felt safe. There were safeguarding policies and procedures in place. Staff knew what action to take if abuse was suspected and we saw posters displaying information about safeguarding champions and whistle blowing. We had not been informed however, of certain safeguarding incidents. These involved altercations between people.

The building was clean and well maintained, there were no malodours. The overall standard of décor and furnishings was good and attention had been paid to dementia friendly design upstairs in the Edward and Renwick units.

Staff told us that there was only one moving and handling hoist for people who were unable to weight bear. We observed staff moving one person inappropriately when they became unwell because the hoist was stored downstairs.

Records of regular safety checks and inspections of the premises and equipment were available.

Visiting professionals spoke highly of the service. People had access to a range of health professionals including GP’s, specialist nurses, dietitians and physiotherapists. People and their visitors told us they were very happy with the care provided but some people, staff, and visitors told us that staffing numbers appeared low at times.

There was a training programme in place. Staff told us they received regular training and we checked records of training that had been completed. Systems for supervision and appraisal were in place but some staff told us they did not receive regular supervision, and we found inconsistencies and irregularities in some of the dates of supervision records we looked at. We also found that regular supervision had not been carried out for all staff.

Safe recruitment procedures were followed. Pre-employment checks were carried out to ensure the safety of people living in the home was maintained. New staff members told us that they had completed an induction process when they came into post and said that they felt they had been given the necessary training to carry out their role.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS)

The registered manager had submitted DoLS applications to the local authority for authorisation. Mental capacity assessments had been carried out for all people living in the home but these were generic and did not always relate to specific decisions. We have made a recommendation that records evidence that care and treatment is always provided in line with the Mental Capacity Act 2005.

People told us that they were happy with the meals provided. Mealtimes were relaxed and a social occasion with appropriate support being provided to people if required. Kitchen staff were aware of special diets and people were able to share their views about the meals and menu choices at a residents food forum.

Care records contained key information including medical and social histories and included the person’s likes, dislikes and preferences. Records available however, did not always assure us that people were supported to meet their nutritional and healthcare needs. This was due to gaps and omissions in record keeping. People and their relatives told us that staff were caring. Throughout the inspection staff were observed acting in a professional and friendly manner, treating people with dignity and respect.

People were supported to maintain their hobbies and interests and we received positive feedback about the activities coordinator. There had been a delay in responding to the one complaint received which the manager stated was due to a change in the area management structure. There were a number of feedback mechanisms to obtain the views from people, relatives and staff. These included meetings and surveys.

We had concerns with the management of the service. Some staff said they did not feel well led by the manager. Other people and visitors told us the manager was friendly and approachable.

We identified shortfalls in the maintenance of records relating to people, staff and the management of the service. The provider’s own auditing system had not highlighted this issue.

We had not been notified of some incidents of abuse between people using the service, for example, as a result of behavioural disturbance or distress. This is being followed up and we will report on any action once it is complete.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staffing, safe care and treatment and good governance. You can see what action we told the provider to take at the back of the report.