About the service: Croxley House is a residential care home that provides personal and nursing care for up to 33 people most of whom may be living with dementia, or who are elderly and frail. At the time of our inspection, 30 people were living in the home.

People’s experience of using this service:

People told us that staff were kind and caring, however we observed occasions when staff did not always show people the respect that they deserved. People received the medicines they needed, however we observed a medicines error which was not reported.

People were cared for by staff who had undergone good pre-employment checks and had access to training, although there were insufficient staffing to help ensure people received the attention they required and that staff had to spend with people. When people had accidents and incidents these were recorded.

Risks to people had been identified, although we found many people had had unwitnessed falls and we observed people walking around without staff, when they were at high risk. The environment in which people lived required improvement to ensure its appropriateness and cleanliness. This included its suitability for people living with dementia.

People’s consent was not sought in line with the Mental Capacity Act 2005 (MCA) as decision-specific mental capacity assessments had not been completed. Although regular audits of the service were carried out, shortfalls identified, such as the failure to follow the principles of the MCA had not been identified.

People received sufficient nutrition and hydration and where staff were concerned about people’s eating or health, they involved appropriate healthcare professionals. Some people were seen to retain a sense of independence and make their own choices about how they wished to spend their time. However, there were mixed views on the activities offered to people.

People’s care needs were clearly recorded in their care plans. These included their likes, dislikes and background information on people. People could express their views and opinions about the service through regular residents’ meetings and surveys.

During our inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: We last inspected Croxley House on 26 April 2016 when we rated the service as Good. The report was published on 17 June 2016.

Why we inspected: This was a routine, scheduled comprehensive inspection which we carried out in line with our inspection methodology.

Follow up: We will ask the registered provider to draw up an action plan telling us how they propose to rectify the shortfalls we have identified. We will review this action plan when we carry out our next inspection to check that actions have been addressed as stated. We will next inspect the service in line with our inspection timescales methodology.

We carried out an unannounced inspection on 26 April 2016.

Croxley House provides care and support for a maximum of 33 older people. Some of whom may be living with a form of dementia. At the time of our inspection there were 27 people living in the home.

The service had 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff also said that they knew the people they supported well.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits, such as GP appointments, optician appointments, chiropodists and hospital visits.

There was a formal process for handling complaints and concerns. The registered manager encouraged feedback from people and acted on the comments received to continually improve the quality of the service. There were effective quality monitoring processes in place to ensure that the home was meeting the required standards of care.

We observed that staff were attentive to people`s needs and treated them with respect and dignity calling them by their name. We saw that staff sought people`s agreement before providing any support and assistance. One person told us that “If I am unwell they always ask me if I want to see a doctor.”

We saw that the provider gave due consideration to people's capacity to consent, and that the provider had taken the relevant action to ensure that they complied with the Mental Capacity Act 2005.

We saw that staff were knowledgeable about people’s needs and promoted their independence. When we talked with people they told us that the staff had a good understanding and awareness of their care needs and preferences. We saw that care plans and risk assessments were regularly reviewed and updated.

We saw that medicines were stored, administered and disposed of correctly.

We saw that staff had been provided with training and support to enable them to care for people living at Croxley House.

People who used the service told us they were aware of how to make a complaint and who to make it to. One person told us "I have a good relationship with the staff we have a laugh and a joke together, if I was unhappy I would tell them so."

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. We have advised the provider that an application to cancel the x registered manager's registration was required.

There was good regard for people’s privacy and dignity at the home. Care plans reflected people’s wishes and preferences. Staff portrayed respect for people when speaking with us and in the language they used in records.

People commented positively about the food choices, activities and staff. Care plans were in place for each person which outlined their needs and how those were to be met. Risk assessments had been written to reduce the likelihood of people being injured or harmed. All documentation we looked at had been kept up to date and regularly reviewed.

There was a system in place to ensure people were protected against the risk of abuse. We found there were sufficient staff on duty to meet people’s needs. Staff had access to training courses. This meant their skills and knowledge were kept up to date. Staff communicated well with each other to make sure people’s needs were met. The home had a system in place to regularly assess and monitor the quality of the care people received.