Crescent Nursing Home

Updated 19 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was conducted by 1 inspector, an inspector from the CQC medicines team and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Crescent is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Crescent is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The inspection was unannounced.

Inspection activity started on 25 October 2023 and ended on 13 November 2023. We visited The Crescent Nursing Home on 25 October 2023, and a member of CQC's medicine team visited the service on 09 November 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 16 people who used the service and 14 relatives about their experience of the care provided. We spoke with 16 members of staff including the registered manager, nominated individual, deputy manager, human resources manager, members of the quality and development team, registered nurses, senior care workers and care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 5 people’s care records and numerous medication records. We looked at 5 staff files and 1 agency staff file in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, training data and quality assurance records were reviewed.

Updated 19 January 2024

About the service

The Crescent is a residential care home providing accommodation for people who require nursing and personal care to up to 28 people. The service provides support to people living with a range of physical and psychological needs, including dementia, mental health and learning disabilities. At the time of our inspection there were 25 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Care

Medicines were not always administered safely. Information which was recorded within the medicine administration record (MAR) was not always clear or accurate. Guidance for staff was not consistent within records or person centred.

A recruitment process was in place. Staffing levels were appropriate to meet the needs of people safely.

Staff received training which equipped them with the skills for their role.

All staff were positive and motivated in their role. This supported a positive atmosphere and environment for people to live in.

Staff were passionate about the people they cared for and understood the importance of providing care, which was dignified, respectful and which enabled independence.

Right Support

Risk assessments and care plans had been completed. Not all of the records contained person centred information.

People were supported to maintain personal friendships and links within the community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Culture

The quality assurance processes and systems in place were not robust in identifying and addressing the shortfalls of the service.

People were supported by a familiar staff team.

People, their relatives and staff spoke positively of the registered manager who they found to be approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 04 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of Safe, Responsive, and Well-Led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Crescent on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the safe administration of medicine and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.