We carried out this inspection at The Croft Nursing Home (The Croft) on 8 January 2019. The inspection was unannounced which meant the provider was not expecting us.

We last inspected The Croft in July 2016. At that inspection the service was rated good in all five domains. At this inspection we found the service remained good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The Croft is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The Croft provides accommodation and long-term nursing care for up to 46 people with a physical or learning disability. This is for 23 people with nursing needs and 23 people needing residential care and support. People living at The Croft had a range of complex care needs and some required a high level of support with daily living inside and outside of the home.

The service had not originally been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We saw that people at The Croft were given choices in their everyday lives and their independence and personal development was well supported and participation within the local community was very actively encouraged. The service had gone to great lengths to find out what people wanted out of life and to take steps to achieve that.

The home is in its own grounds with easily accessible outdoor patio and garden areas. Accommodation is provided on the ground and first floor of the main building and there is a passenger lift to assist people to access the accommodation on the first floor of the home.

Within the grounds of the home there are four bungalows in the area called ‘The Village’. Each of the four separate bungalow can accommodate up to five people. The adults living in the bungalows can live more independently. They are supported by care staff to go out into the local community, to attend work or day services and to undertake their chosen interests and hobbies. The home has a range of specialist equipment and facilities in both the main nursing home and the separate bungalows to promote mobility and independence for all the people living there.

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 person's'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At this inspection we found the service had continued to maintain its high standards and had also improved the services and support offered. There was no evidence or information from our inspection and ongoing monitoring that demonstrated any serious risks or concerns. We found that staff and management at The Croft were constantly working to improve and develop their service to meet the needs and aspirations of the people who used it and their families. For example, the service was particularly skilled at enabling people to carry out person centred activities focusing on people’s choice, independence, community inclusion and on healthy nutrition.

People who lived at The Croft told us they were happy and felt safe and secure living at the home. People and their relatives expressed great confidence in the staff skills and knowledge and about the effectiveness of the management team. Records showed the staff team completed a wide range of mandatory training and this was confirmed by

We considered our inspection findings to answer the questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. The summary is based upon our observations, discussions with people who used the service, their relatives and the staff who supported them and from looking at the records held in the home. We also observed the interactions between people living there and the staff supporting and caring for them. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw that risk assessments had been carried out to help make sure that people who lived there received safe and appropriate care and treatment. This included the important areas of nutrition, personal care, skin care and wound management, mobility and moving and handling and the risk of falls.

Staff had received training on safeguarding vulnerable adults. Staff we spoke with were clear about the procedures to use in reporting any concerns. We found that staff had received a range of training to maintain and develop their skills and that was suited to their roles and responsibilities.

We saw that the premises and grounds were being maintained and were accessible to the people living there. Appropriate measures were in place to ensure the security of the premises to keep people safe. The service had systems in place to manage and monitor the prevention and control of infection and the home was clean and hygienic.

The home had a range of equipment to support the people who lived there. We saw that all the equipment in use was being serviced and checked regularly to ensure it was safe for people to use.

Is the service effective?

We found that people’s health and care needs had been assessed with them and they were involved in deciding the care, treatment and life styles they wanted. We saw records that showed staff had undertaken appropriate and accredited training to give them the skills and knowledge to look after people properly.

Where people had been identified as at higher risk due to complex needs we saw that appropriate specialist services had been contacted for advice and support. People’s needs and abilities had been taken into account in the way the home was laid out and furnished. People’s bedrooms and bathrooms had been adapted to meet their individual physical needs.

Is the service caring?

The information we looked at about the people using the service was written in a holistic and positive way. People’s aspirations, interests and different needs were clearly recorded. People living at the home who spoke with us were happy living there and liked the staff caring for them. People were supported to take part in a wide range of interests and activities they enjoyed both inside and outside the home.

We saw that the care was monitored through regular reviews and changes were made where necessary. Relatives we spoke with felt they were “included” in care and “Kept up to date”.

We saw that people living there were comfortable with the staff caring for them and appeared relaxed in their company. The staff took the time to talk with people as they went about their duties. We saw many positive interactions between the staff on duty and people who used this service. These positive interactions supported individuals' wellbeing.

Is the service responsive?

People were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time. We were told about trips out, holidays, attending the theatre, discos and using the local church and leisure centre. The home had its own mini buses to take people out into the community.

We could see that the clinical manager and nursing staff monitored people’s conditions and made timely referrals to other services to access the care people needed. The clinical manager took responsibility for making sure care had been well coordinated between different services involved in people’s care and support.

There were clear policies and procedures in place regarding making a complaint if people wanted to. This information was available in different formats including pictorial if people found that easier to use.

Is the service well led?

Relatives we spoke with praised the dedication of the management and staff. Staff we spoke with felt they were well supported and trained to do their work well and that senior management were “Very approachable”. Staff were clear about what their roles and responsibilities were and told us the management had an “Open door policy” if they needed to talk about any matter.

When found there was an effective and verifiable system being used to assess and monitor the quality of the services and records about the care and support people living at the home received. Formal systems were in place to audit the quality of the service provided. We saw that the management team and staff took a proactive approach and identified areas that could be improved and acted promptly to do so. This meant that the provision was continuously improving.

There were records of the regular meetings that were held with people who lived there, their families and the staff employed, to gather their views about the service. We saw that action had been taken in response to the feedback given at these meetings.

We spent a lot of time observing daily life in the home and at the lunch time meal and saw that there were staff available to help people with their meals and prompt them to eat and drink. Some people in the home had limited verbal communication therefore we spent time observing people's behaviour and their interactions with staff. We did not observe any negative interactions between staff and people in the home.

As we went around the home we saw that people had been able to personalise their rooms with their own pictures and personal items. We saw that peoples' rooms had been furnished and decorated as they wanted and appropriate equipment and facilities were provided. In several cases equipment and facilities had been upgraded or replaced to meet peoples' individual or changed needs. We found that the premises and grounds were well maintained and accessible to promote people's personal independence and welfare.

Staff working there had received appropriate training to support people's individual needs and understand their different conditions. We found that the provider had effective recruitment procedures in place and had carried out relevant checks on the staff they employed. This helped to make sure that staff were suitable for working with the people living there.

People told us they liked living at The Croft Nursing Home (Barrow) and said the staff in the home were “very nice.”

A number of the people living at the home were not able to easily express their views about the service but we could see people were treated with respect and received a good standard of care which met their needs.

Visitors to the home told us they felt their relatives were safe living at this service and said the staff in the home provided a very high quality of care. People we spoke to said they had, “No concerns” about the services provided at the home.

This inspection took place over two days 15 and 17 December 2015. The inspection was unannounced. The Croft Nursing Home (Barrow), (The Croft) provides personal and nursing care for up to 46 people with a physical or learning disability some of whom have complex  and challenging physical, medical and mental health needs.

The home is in its own grounds with easily accessible outdoor patio and garden areas. The front and rear gardens are well maintained and there are flowerbeds and patio areas for people to enjoy and use for recreation such as barbeques. All rooms are single occupancy and have ensuite facilities that are adapted to meet the individual needs of the people using them. The accommodation is on the ground and first floor of the main building and there is a passenger lift to assist people to access the first floor of the home. There are also four bungalows in the ‘village’ area of the home where people are able to live more independently. The home has a range of specialist equipment to promote mobility and independence for the people living there. At the time of our inspection the home was fully occupied.

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.

We found that there was a relaxed and inclusive atmosphere in the home and people had a good quality of life with high levels of engagement and activity. We saw staff spending time with and interacting with people in a very calm, positive and respectful manner and displaying empathy and compassion in these interactions. People using the service told it was a “good place to live”. Surveys completed by people living in the home and relatives indicated people were very happy with the care, safety and support in the home. A relative told us, “We feel it’s a very safe place” and professionals coming into contact with the service and the people living there commented that it was a “caring” home.

People living in the home were at the centre of the service and were treated very much as individuals. People and their relatives told us that staff understood their specific needs. People told us that staff “Are all my friends”. We could see that staff had built up supportive relationships with people and were familiar with their life stories, goals and preferences.

We saw activities and leisure choices were personalised for each person and their plans were clear on how they wanted to live their lives and make their own choices. Staff were familiar with people’s life stories and people’s likes, dislikes, preferences and care needs and understood their different communication needs. We could see that staff knew how to respond and talk to each person to give them the support and care that they needed and wanted.

People’s care and health plans were detailed, person centred and clearly described the individual care, treatment and support people needed and preferred. Care plans had been written together with people to minimise risk but also to promote choice for the person and keep their independence. The care and health plans were regularly reviewed, the care evaluated and updated as required. The care plan format was pictorial to help people who used the service to understand them more easily. Individual plans of care included assessments and support for psychological, emotional and mental health needs and these were monitored closely so that appropriate support could be provided quickly if needed.

People were given time and the appropriate support they needed to take their medicines. People’s care plans detailed any assistance or support that people might need to take their medicines safely and to best effect. Medicines were stored, administered, recorded and disposed of safely and in line with current National Institute for Health and Care Excellence (NICE) guidelines. Staff were trained in the safe administration of medicines and kept records that were up to date and accurate.

Staff levels were organised to make sure there were enough staff on hand to support people to follow their interests and go out or take part in chosen activities as they wished. Some people who used the service required one to one support and we saw this was provided. All the staff we spoke with told us they enjoyed their work and felt valued by the organisation. The staff we spoke with demonstrated a good understanding of the values and the philosophy of the service.

Staff received appropriate training to carry out their roles and they also had specific training to support people’s different care and personal needs. This included training on diabetes, autism, epilepsy, swallowing difficulties, interactive communication and nutrition. Staff confirmed that their managers provided good support and supervision and encouraged their continual professional development. Some staff acted as ‘champions.’ They provided a resource to staff and people living there and gave additional support, advice and guidance. There were champions in privacy and dignity, health and safety, mental capacity and deprivation of liberty safeguards, medication and infection control.

A complaints procedure was displayed in standard and pictorial formats around the home. The registered provider had a pictorial complaints procedure which people told us they felt they were able to use. We looked at the procedures and records of complaints received and their investigation and resolution. All complaints received in the last 12 months had been resolved to the complainant’s satisfaction and within the timescales stated in the home’s procedures.

Staff had received training to recognise the signs of potential abuse and knew what action to take. They gave examples of what they needed to be aware of and what would give rise for concern. They said any concerns they raised were “always” listened to and looked into by the management team.

Staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they demonstrated a good understanding of these. Where people did not have the capacity to make decisions about their care, we saw that ‘best interests’ meetings were held. These included the people concerned, their relatives and health and social care professionals involved in their care. This helped to ensure that their individual rights were protected and that any decisions were made in their best interests.

The management team demonstrated strong values and a desire to learn about and implement best practice throughout the service. There was a strong organisational structure and all the people we spoke with were clear about their roles and responsibilities to the people living there. Surveys done showed that satisfaction with the care and support people received was high. One comment was "You offer an excellent service and [relative] always seems very happy in the Croft environment”. Another comment was “[Relative] could not be in a better place, this is an outstanding care home”.