The Croft

People had access to a garden area, however on the days we visited we did not see anyone using this. However, people did tell us they had used this in the past.

The inspection was planned as a result of concerns we had received. This is the first assessment for this home since a change of provider who took legal responsibility for the running of the home in October 2025. Where a location is acquired by a new provider, they are considered to ‘inherit’ the previous location history (rating and report). Although the rating was not awarded to them, they will have full knowledge of the history and are responsible for maintaining and improving the service, including addressing any issues from the last inspection. The service was rated requires improvement with the old provider and we had identified breaches of the regulation in respect of legal regulations relating to safe care and treatment, informing the commission of certain events, duty of candour and good governance.

At this assessment, we found the provider was in breach of legal regulations relating to person centred care, ensuring people were supported in line with the Mental Capacity Act 2005, safe care and treatment and good governance.

People were not routinely protected from potential harm; risks were not always identified and mitigated in a timely manner. People were at increased risk of infection due to poor hand hygiene. Safe medicine practices were not always promoted. Records were not always accurate or well-maintained. Governance systems had not identified or addressed some of the areas for improvement. People were not routinely supported to engage in activities of their choice or had meaningful engagement with staff.

The environment was calm; however, concerns were identified relating to cleanliness, equipment maintenance and maintaining individuals' dignity. Examples included dirty chairs, a soiled wheelchair, and an unplugged call bell.

People were not always supported to have a meaningful and positive mealtime experience. We observed a lunchtime meal was disorganised and prolonged, with significant delays between serving people their food. Desserts were not provided until well over an hour after lunch began. Staff demonstrated a lack of familiarity with menu options, some people did not receive vegetables initially, and adaptive eating equipment was not available despite the need for it. Opportunities to support people who were struggling to eat independently were also missed. However, people generally reported being satisfied with the quality of food and appreciated being offered alternatives if they did not like the meal provided. Following our feedback to the provider on day one we noted some improvement in people’s mealtime experience on our second day at the home.

We found people were placed at greater risk of harm due to the long periods of time they were left without any staff oversight. For example, people were seen to be left in lounges with no staff presence.

Staff were described as, kind, caring, respectful, and well-intentioned. We observed some positive interactions between people and staff.

We have asked the provider for an action plan in response to the concerns found at this assessment.