Croft Care Services improved from its previous Requires Improvement rating to achieve an overall Good, with strong performance in caring, effective, responsive and well-led domains. The Safe domain remained Requires Improvement due to persistent issues with late and inconsistent call times, insufficient travel time between calls, and late rota changes, though medicines management, safeguarding and risk management were all found to be safe.
Concerns (4)
moderate
Missed or late visits
: “52% of people who responded said care staff were late. The survey was audited and an action plan was created which considered time management, communication and continuity.”
moderateStaffing levels: “Staff work 11 hours without breaks on occasion and nothing is done. Rotas were given in advance but sometimes only by a day and there was not always sufficient travel time between calls.”
minorPerson-centred care: “Some people had inconsistent call times and the registered manager agreed to look at these in more detail to see if there was any scope to promote greater consistency.”
minorCommunication with families: “Another relative said it was difficult not knowing what time care staff would arrive as they did not have a rota in advance.”
Strengths
· Risk management was person-centred with detailed risk assessments including diagrammatic guidance for transfers and equipment use.
· Medicines management was safe; staff competency assessed through observed practice and audits.
· Staff knew how to recognise and report safeguarding concerns and lessons learnt were integrated into practice meetings.
· People spoke positively of care staff, describing them as kind, caring and compassionate, with strong relationships evidenced.
· Complaints were fully investigated, acknowledged with apologies, and outcomes shared with complainants.
Quality-Statement breakdown (17)
safe: SafeguardingGood
safe: Call timing and rota managementRequires improvement
safe: Risk managementGood
safe: Medicines managementGood
safe: RecruitmentGood
effective: Mental Capacity Act complianceGood
effective: Staff training and supervisionGood
effective: Nutritional support and healthcare accessGood
caring: Kindness and compassionGood
caring: Dignity, privacy and independenceGood
caring: Involvement in care planningGood
responsive: Person-centred care recordsGood
responsive: Complaints handlingGood
responsive: Care reviews and responsiveness to changing needsGood
well-led: Governance and quality assuranceGood
well-led: Leadership and staff cultureGood
well-led: Call time monitoring and improvementRequires improvement
Croft Care Services was rated Inadequate overall and placed in Special Measures following a 24 August 2016 inspection, with continuing regulatory breaches in safe care and treatment (Regulation 12), supporting workers (Regulation 18), and governance (Regulation 17) that had remained unaddressed since the November 2015 inspection. Critical failures included unsafe medicines management, absent mental capacity assessments, an outdated care plan from 2005, and no action plan to address previously identified failings despite a Warning Notice and external audit.
Concerns (14)
criticalMedication management: “We looked at the medicine records for eleven people who used the service. We found the records did not provide a clear and accurate record of the medicines staff had administered to people.”
criticalMedication management: “On 19 June 2016 an entry read 'Unable to give night time medicines as none been delivered again'. We saw no evidence the person received their medicines until lunchtime, 21 June 2016.”
criticalStaff competency: “Only two of the staff we spoke with said their competency had been assessed by a more senior staff member.”
criticalSafeguarding: “A relative told us they had reported a safeguarding incident to the registered manager earlier in the year...the social worker was unable to find any record of the matter on their database.”
criticalCare planning: “We found a document entitled 'personal plan' dated 12 January 2005...the person received care each morning and required the use of a hoist for all transfers.”
criticalConsent / capacity: “Where people were living with dementia, there was no evidence of either mental capacity assessments or best interest's decision making.”
criticalGovernance: “The registered manager said 'There is a report and an action plan has been done, we are in the process of working through it.' When we asked to see the action plan the registered manager told us, 'No there isn't one.'”
criticalLeadership: “At the time of this inspection there was a lack of evidence to support either the registered provider or the registered manager having oversight of the service as a whole.”
criticalIncident learning: “During our inspection we found evidence regulatory breaches identified at our inspection on 12 November 2015 had not been addressed.”
moderateStaff training: “Of the 110 staff listed, 14 staff had not refreshed their [safeguarding] training within this timeframe, six of whom had gone over two and half years.”
moderateStaff training: “16 staff had not refreshed their moving and handling training within the annual timescale...five staff had gone over eighteen months since they last completed the training.”
moderateSupervision / appraisal: “I think I have only had one [supervision] this year. Some girls have said they have asked for one but they haven't had one.”
moderateRecord keeping: “Daily logs had only been returned for each month, between April and June for one person. None had been returned for another person.”
moderateComplaints handling: “We noted two incidents where people had said they were unhappy with the service but the matter had not been addressed as part of the complaints process.”
Strengths
· People told us staff did not miss their calls and the regular staff turned up on time.
· Pre-employment checks including DBS and references were completed on all potential candidates before they started work.
· Staff were able to identify signs of abuse and knew to report concerns to their manager.
· An electronic call monitoring system was in place to raise alerts if staff failed to arrive within the specified timeframe.
· People who used the service and relatives consistently praised staff as caring, kind and respectful of privacy and dignity.
Quality-Statement breakdown (17)
safe: SafeguardingRequires improvement
safe: Medicines managementInadequate
safe: Safe care and treatment / risk assessmentInadequate
safe: Staffing and recruitmentGood
effective: Staff trainingRequires improvement
effective: Supervision and performance managementRequires improvement
Croft Care Services improved sufficiently from an Inadequate rating to exit Special Measures, but continuing breaches of Regulations 12 and 17 were identified relating to unsafe medicines management, inconsistent moving and handling records, and failure to evidence Mental Capacity Act compliance. While staff were consistently described as caring and kind, governance systems, care plan oversight, staffing levels, and complaints resolution remained insufficiently robust.
Concerns (10)
criticalMedication management: “we saw a number of unexplained gaps on the MAR for one person and the MAR for another person did not record the maximum dose staff could administer.”
criticalRecord keeping: “two service user handling plans dated 14 September 2016...recorded conflicting information; one instructed staff to use a handling belt and the other instructed staff to use a hoist and sling.”
criticalConsent / capacity: “people's records did not evidence compliance with the Mental Capacity Act 2005.”
moderateStaffing levels: “only one member of staff had attended their call instead of two 'on several occasions'...due to staff shortages people were not consistently receiving their full package of care.”
moderateSupervision / appraisal: “four staff had not received a field based observation of their practice in the last seven months.”
moderateGovernance: “audits of people's daily records did not check that the content was reflective of the care plan.”
moderateCare planning: “the manager acknowledged the audit had not checked to ensure the content of care plans was an accurate description of people's needs.”
moderateComplaints handling: “a person who had raised a complaint in July 2016...at this inspection we saw from the complaints log the matter had still not been addressed.”
minorMissed or late visits: “Their timing leaves a lot to be desired, they quite often turn up late and [person] has struggled into their clothes by then.”
minorStaff training: “staff also completed a practical session in moving and handling people, however, we could not find documented evidence of this in the staff files we reviewed.”
Strengths
· People told us they felt safe and staff knew what action to take if they were concerned a person was at risk of harm or abuse.
· Recruitment processes were thorough, with completed application forms, two written references and DBS checks for all staff reviewed.
· People and relatives spoke positively about staff, describing them as caring, kind and respectful of dignity and privacy.
· Care plans were person centred, updated versions were detailed and reflective of individual needs.
· Medicines training had been completed by all 14 staff files checked, with competency assessments recently completed for 11 of 14.
Quality-Statement breakdown (16)
safe: Moving and handling recordsRequires improvement
safe: Medicines managementRequires improvement
safe: SafeguardingGood
safe: RecruitmentGood
safe: Staffing levels and rota managementRequires improvement
effective: Induction and trainingRequires improvement
effective: Supervision and performance assessmentRequires improvement
Croft Care Services received an overall rating of Requires Improvement following a November 2015 announced inspection, with Safe rated Inadequate due to breaches of Regulation 12 (unsafe medicines management and inadequate risk assessments) and Regulation 18 (insufficient staff training and supervision). Despite staff being described as kind and caring by people using the service, the provider had failed to address regulatory breaches identified at the previous August 2014 inspection, with governance, record keeping, care planning and complaints handling all remaining inadequate.
Concerns (10)
criticalMedication management: “The entries did not detail the strength of the medicine, the dose of medicine staff were to administer or how the medicine should be administered.”
criticalCare planning: “One care plan had been reviewed in September 2014 and another in June 2013 but there was no evidence they had been reviewed since.”
criticalStaff training: “22 of the 65 staff had not updated their moving and handling training for over fourteen months...eight staff had not completed any training in first aid.”
criticalGovernance: “The audits which had been completed had not picked up on the issues we found during our inspection.”
criticalRecord keeping: “One person had commenced using the service in March 2015 but there were no daily records available after July 2015.”
criticalStaff competency: “We were unable to evidence staff were competent to administer peoples medicines and the system for recording the administration of medicine was not robust.”
moderateSupervision / appraisal: “One said they thought their last supervision was eighteen months ago and another said their last supervision was at the beginning of 2015.”
moderateMissed or late visits: “From January to August 2015 the percentage of people who received their call within the time frame allocated by the local authority ranged between 75% and 78%.”
moderateComplaints handling: “One person told us they had raised two complaints but these were not logged in the complaints file.”
moderateConsent / capacity: “Only 19 of the 65 staff listed had completed training in the Mental Capacity Act 2005.”
Strengths
· People told us staff were kind, caring and treated them with dignity and respect.
· Staff recruitment processes were robust, including DBS checks, application forms, interviews and references.
· Care plans recorded gender preferences for care workers and how people wished to be addressed.
· Staff demonstrated awareness of promoting independence and people's right to make choices.
· Relatives told us staff informed them if their relative was unwell and sought additional support when required.
Quality-Statement breakdown (17)
safe: Risk assessmentsInadequate
safe: Medication managementInadequate
safe: Staffing and visit punctualityRequires improvement
safe: SafeguardingRequires improvement
safe: RecruitmentGood
effective: Staff trainingRequires improvement
effective: Supervision and inductionRequires improvement