This was an unannounced inspection carried out on 9 February 2017. The Croft provides privately funded personal care and accommodation for up to ten people. At the time of our visit eight people lived at the home. The home is a single storey house set in its own grounds in Heswall, Wirral. People’s bedrooms are single occupancy and there is a communal lounge and dining room for people to use. Specialised bathing facilities and a walk in shower are available for people to use and a small car park is situated at the front of the home.

At the time of inspection there was a registered manager in post. They had been in post approximately six months on the day of our visit. 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 reported directly to the general manager. The general manager supervised the registered manager in the day to day management of the home. The general manager had also been in post for approximately six months prior to our visit.

We looked at the care files belonging to three people who lived at the home. We found however that risk management advice with regards to people’s identified risks was not always sufficient or specific to the individual. This meant there was a risk that staff would not know how to mitigate these risks in the delivery of care.

On the day of our visit, we found the laundry door had been left open posing a fire containment risk and a cupboard containing products potentially harmful to health left unlocked. This meant these areas were not secure. We saw that a manual sluice was in operation in the laundry and fabric hand towels for people to use in the communal toilets. Neither promoted good infection control practices but we saw that there were plans in place to improve these arrangements.

We saw that staff were recruited safely with appropriate checks made on their suitability to work with vulnerable people. There were sufficient staff on duty to meet people’s needs and we saw that they were regularly supervised by the registered manager. We found limited evidence that staff had received an annual appraisal prior to the registered manager coming into post. The registered manager told us that they had not yet had chance to conduct appraisals but that they had plans in place to do so.

We saw that people’s care plans were person centred with sufficient information about their likes and dislikes and how they wished to be cared for. Personal life histories were gained from people to help staff understand the person they were supporting and to assist them to provide person centred care.

People we spoke with during our visit told us the staff were kind, caring and looked after them well. Staff spoken with, were knowledgeable about the people they cared for and had received sufficient training to meet their needs. It was obvious from our observations that people felt relaxed and comfortable in the company of staff and it was clear that staff and the people who lived at the home knew each other well.

People had sufficient quantities of nutritious food and drink. They were given a choice of menu options or, offered an alternative, if the options weren’t suitable. People’s weight was monitored to ensure they maintained a healthy weight and people’s care was responsive to their needs.

There were a variety of activities on offer from quizzes, to baking to fitness exercises that promoted people’s physical health. People’s opinions and suggestions on the range of activities and the running of the home were regularly sought and where people had made suggestions we saw evidence that these had been acted upon where possible.

We saw the beginnings of good practice

This was an unannounced inspection carried out on 29 January 2015. The Croft provides privately funded personal care and accommodation for up to ten people. Nursing care is not provided. At the time of our visit eight people lived at the home.

The Croft is a single storey house set in its own grounds in Heswall, Wirral. Accommodation is single occupancy. There is a communal lounge and dining room for people to use and specialised bathing facilities are available. A small car park is available at the front of the property.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at the location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. A new registered manager was appointed to manage the home in January 2015.

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 time our inspection, the registered manager had only been in post as registered manager of this location for two weeks. The home manager had been in post for approximately six months. The home manager supervised the day to day running of the service and reported directly to the registered manager who managed the service. We last inspected The Croft on 22 November 2013 and the home was found to have met all of the regulations we inspected.

At this inspection we spoke with two people who lived at the home, two relatives and one care staff. We also spoke with the registered manager and the home manager who worked at the home. We reviewed a variety of records including care records, policies and procedures, staff records, medication charts and audits.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We found people’s care plans did not cover all of people’s needs and lacked clear information about people’s risks. Risk assessments were not always updated and changes to people’s care needs were not always reflected within their care plan. Where people’s risks had increased, these had not always been acted upon to ensure people received the support they required.

We reviewed accidents and incident information and found that several people had experienced numerous falls over a 12 month period. We found that no appropriate referrals to the Falls Prevention Team had been made to access specialist preventative advice so the risk of further falls could be managed and prevented.

Some people who lived at the home had short term memory loss or dementia type conditions. The home manager told us that no-one lacked the capacity to make decisions or required the protection of a Deprivation of Liberty Safeguard (DoLS). The Deprivation of Liberty Safeguards (DoLS) came into force on 1 April 2009 and ensures people are looked after in a way that does not inappropriately restrict their freedom.

The home in accordance with the Mental Capacity Act 2005 (MCA) had assessed and regularly reviewed each person’s mental capacity and routinely sought their consent. We found however that where people’s behaviour was affected by a decline in their mental health, any unwanted behaviours were not appropriately risk assessed and care planned.

Staff were not always recruited in line with the provider’s own recruitment policy. Employer based references were not always sought to check staff had the necessary skills and abilities for their job prior to employment. Staff had also not consistently received the supervision and training required to do their jobs effectively.

The home was clean and well maintained with ten individual bedrooms. Some bedrooms had an ensuite bathroom. There was a communal bathroom with specialised bathing equipment and a communal shower room. On the day of our visit, the shower room was being used as a storage facility which meant it was not available for people to use. This was rectified by the registered manager the next day. There was also a laundry on site.

We saw that the provider had an infection control policy and risk assessment in place to minimise the spread of infection. We found some of the infection control procedures relating to the laundering of people’s clothes and personal items were not followed. There was also a lack of available hand hygiene facilities. This meant there was a risk of cross infection. Staff knowledge about how to prevent the spread of infection in respect of laundry was also poor.

The providers had a range of audits in place to check the quality and safety of the service. None of the systems however identified the issues we noted during our inspection. This meant that the systems were ineffective. Where issues were identified for example the provider’s infection control audits, no appropriate action had been taken. This demonstrated that the management of the service required improvement.

On a positive note, people who lived at the home were happy and said they were well looked after. Our review of people’s care records and from our observations it was clear that people were able to choose how they lived their lives at the home. We saw that the culture of the home was to support people to do things for themselves by encouraging and reminding them of everyday personal tasks. This promoted people’s independence.

Staff were caring and respectful and the home provided a range of activities to occupy and interest people. This promoted their well-being. Interactions between people and staff were positive and the home had a relaxed, comfortable atmosphere.

People had access to sufficient quantities of nutritious food and drink. They were given a choice of menu options or, offered an alternative, if the options weren’t suitable. People’s meals were served promptly and people were offered additional portions. We observed a medication round and saw that it was administered safely. Medication administration records were completely accurately and properly signed for.

The number of staff on duty was sufficient to meet people’s needs. People told us they felt safe and comfortable with staff. Staff we spoke with were knowledgeable about types of potential abuse and what to do if they suspected abuse had occurred.

We saw people had prompt access to their GP when they were ill and were supported to access any hospital or other medical appointments to meet their ongoing healthcare needs.

The people and relatives we spoke with had no complaints. They were really positive about the staff. Everyone we spoke with said the home manager and staff were approachable and they would have no worries about approaching them if they had any concerns. People views were sought through the use of satisfaction questionnaires and resident meetings. We saw that people were given relevant information about the home and their care and that their suggestions and opinions on the service were sought.

We spoke to four people who lived at the home. People said they were well looked after and they were treated with dignity and respect. People’s comments included staff “Are brilliant”; “Lovely, you couldn’t ask for nicer people”; “Very helpful, very obliging” and “I know them all, they are very good”.

We saw people's needs were assessed and regularly reviewed. Care records contained information about a person's individual needs and preferences and promoted the person's independence where possible. We observed people were well cared for and treated kindly by staff and the manager.

Staff we spoke with were knowledegable about types of abuse and knew what action to taken in the event of an allegation of abuse being made. Staff received training in safeguarding and had access to both an internal safeguarding policy and the local authority’s no secrets guidance.

Recruitment and selection practices were in place to ensure appropriate checks on the suitability and competency of staff were undertaken prior to employment. This included employment based references and a disclosure and barring check.

The provider monitored the quality of the service through weekly service updates and a quarterly health and safety audit. Care plan and medication audits had recently been introduced and were in progress. The views of people living at the home were sought through residents' meetings and an annual satisfaction questionnaire. We saw the feedback received was positive.

We spoke with a range of people about the home. They included the manager, staff, a district nurse and people who lived at the home. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced living at The Croft.

People told us they were treated well by staff and felt safe, comments included, “The staff are brilliant”. Also, “They are so polite and always around to spend time with you.”

Other comments from people living at the home were all positive and included,

“The place is always clean and it feels so homely”.

“The staff and manager put themselves out all the time, nothing is too much trouble.”

“Never have to wait long if I need someone to help me.”

We contacted Wirral contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

The people using the service said the staff respect their privacy and dignity and they are very happy with the care and support they receive. They said they enjoy the food and always have plenty to eat. The people using the service said they always get to see their GP when needed. And they have never been treated badly in any way. The people using the service said the staff manage their medication and they are happy with this arrangement. They said there are always enough staff available, and they are never have to wait long after using the call bell. The people using the service said they know what to do if they want to make a complaint.

Comments from the people living at the home include:

'The staff are very kind and respectful'.

‘I’m happy with the care and I know its ok to disagree with what the staff say’.

‘The staff are all very good, nothing is ever any trouble‘.

‘The staff discussed my likes and dislikes when I first moved into the home and I have never been given food I don't like’.

‘When I wasn’t well last month, the staff called my doctor straight away’.

‘I have never been treated badly, the staff are all lovely’.

‘The staff look after my medicines and they never run out’.

‘I am very happy with the way I get looked after, they staff are very good’.

‘I don’t have any complaints to make but I know how to make a complaint’.

A number of relatives were spoken to as part of the inspection process. They were very happy with the service their relative received. They said the staff are very professional and courteous. A relative of one person living at the home commented on the low turnover of staff and how positive this was as it meant staff could get to know the people living at the home better.

Comments made by relatives include:

‘The staff are always very professional and friendly’.

‘I’m very impressed with the home. I wouldn’t put my Dad anywhere else’.

‘The staff kept me informed about when my relative wasn’t well and called her doctor immediately’.

‘The staff are all lovely, they are all excellent’.

‘The home is brilliant, I couldn’t wish for anything better’.

One relative said ‘I know how to make a complaint but I have no complaints to made, the service is excellent’.

The Wirral Contract Department had no concerns to raise about The Croft.