The Crescent

The Crescent is a residential care home that was providing personal care to four people who had a learning disability and/or autism at the time of inspection.

People’s experience of using this service and what we found

The management of people’s medicines was not always carried out effectively. Systems had failed to ensure accurate medicines information was contained in people’s medicines records. There was no evidence people were harmed as a result of this oversight.

The locations fire risk assessments did not include the environmental recommendations, or any preventative changes completed as advised by the Fire and Rescue Service report.

Staff training was not always completed within timescales to ensure all staff have the necessary and up to date knowledge and skills to support people’s needs and safety.

The systems used by the provider to have oversight of the service were not always followed at the location to ensure accurate and robust quality monitoring was taking place or being completed consistently.

People felt safe and their freedoms were respected. Relatives shared positive views around people’s safety and staff understood people’s needs and how to raise concerns about people’s safety.

People’s needs and independence were promoted by staff and the management team. The provider understood their legal responsibilities in the safety and care of people. The provider was working in partnership with the local authority to make improvements to safety at the service and people’s experiences of care.

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The size and design of the service allows people’s privacy and dignity to be maintained and facilitates person centred care. The service did not feel impersonal and people could choose to use communal areas. The service is located within the local community, close to local amenities and health services. The service recognised people’s strengths, promoted people’s independence and used positive behaviour support to inform their practice.

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 Good (published 16 April 2019).

Why we inspected

We received concerns in relation to the safe care and treatment of people living at the service, the leadership at the service and the oversight of the service by the provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Crescent is a residential care home that was providing personal care to four people who had a learning disability and/or autism at the time of the inspection.

People’s experience of using this service:

Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. The managers worked with the local authority safeguarding adults team to protect people.

Staff were supported in their roles and received an effective level of training. They told us they were happy with the level of training and support they received and we observed them supporting people in a competent manner.

People continued to be supported by an established team of staff who provided kind and personalised care to people living in the home. Safe recruitment of staff ensured people were supported by staff of good character.

People were protected from harm by the provider having effective systems in place to monitor medicine management, staffing, infection control and upkeep of the premises.

Staff promoted people's dignity and privacy. Staff provided person-centred support by listening to people and engaging them at every opportunity. Staff were caring and understanding towards people. People using the service appeared comfortable in the presence of staff working in the service.

The premises provided suitable accommodation for people with communal areas and bedrooms which were personalised to people's individual interests.

Support plans were detailed and reviewed with the person and their relatives when possible. Staff worked with and took advice from health care professionals. People's health care needs were met.

People had a variety of internal activities and external activities, which they enjoyed on a regular basis. Relatives' views were sought, and opportunities taken to improve the service. Formal supervision meetings were carried out with staff. They told us they were supported and clear about what was expected of them.

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

This care service supported people in line with the values that underpin the Registering the Right Support and other best practice guidelines. 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.

Audits and checks were carried out, and any issues identified and rectified.

The home continued to meet the characteristics of a rating of good in all areas. More information about the inspection is in the full report.

Rating at last inspection:

The home was rated Good at the last inspection (report published in July 2016).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

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

The Crescent provides accommodation and personal care for up to 4 adults with a learning disability. At the time of our inspection 3 people were living there.

There was a registered manager in post at the time of our inspection: 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.

People felt safe living at the home. There were sufficient staff to respond to people’s needs and support people safely. People were supported by staff who had been recruited safely and had the skills and knowledge to meet people’s care and support needs. People were supported by staff who knew how to recognise and report potential abuse. Risks to the health, safety and well-being of people were identified and managed. Staff had a good understanding of how care and support should be provided in order to keep people safe. People’s medicines were stored and managed safely and people received their medicines as prescribed by their GP.

People had enough to eat and drink and were involved in the planning of meals. People were given choices of food and drink and were encouraged and supported to prepare meals for themselves. People had good access to a range of healthcare professionals when required. The principles of the Mental Capacity Act 2005 were understood and followed.

People and their relatives felt they were supported by staff who were friendly and caring. People’s individual needs were understood and met by staff. Staff supported people in a way that maintained their privacy and dignity and were aware of, and responded to, people’s anxieties. People’s independence was promoted.

Staff had a good understanding of people’s life histories, personal needs and preferences. People were encouraged and supported to follow their individual interests and had choice and control in how they lived their lives. People and their relatives felt involved in making decisions and choices about how their care was delivered and planned. People and their relatives knew how to complain and expressed confidence that concerns would be dealt with efficiently by the registered manager.

People, relatives and staff were involved in the development of the service.

The registered manager had effective systems in place to monitor the quality and consistency of the care provided and was committed to driving continuous improvement.

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-

Is the service safe?

People were treated with respect and dignity by the staff. Care plans were very personalised and identified people's needs. These were reviewed regularly. People were given choices and supported to make decisions themselves. Risk assessments were in place and control measures identified. This meant that people's needs were met and people were kept safe.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had received training in the Mental Capacity Act and Deprivation of Liberty safeguards. This meant that systems were in place to safeguard people as required.

The service was safe, clean and hygienic. We saw effective systems were in place to prevent and control the spread of infection. Regular audits were undertaken to identify areas for improvement. Cleaning schedules were in place and regular checks were made. Waste was segregated and disposed of appropriately. This meant that people were protected from the risk of cross infection.

Staff received appropriate professional development and were able to obtain further relevant qualifications. This ensured that people were kept safe and their needs met.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People's health and care needs were assessed. People were involved in the development of their care plans which were in an easy read format. This helped people to understand and participate in decisions about their health and care. People we spoke with confirmed they were happy at the home.

People were able to move around the home freely and safely. Systems were in place to protect people who were able to access the local community independently. For example people carried contact details of the home just in case they needed help.

Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people's needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's privacy and dignity were respected and people were encouraged to express what dignity meant to them. We asked people if staff were caring. One person told us they were caring and showed us some seeds they had been supported to plant.

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. People's birthdays were celebrated. We saw that people's diversity and individuality were promoted and respected

Is the service responsive?

We saw staff that responded quickly to meet people's needs and ensured people's safety was maintained. For example, we saw staff talked to people to help them reduce anxieties about their plans for the day. We saw that people were supported to express their views and these were acted on. People had the opportunity to engage in activities both in the home and within the community.

People were supported to understand their right to make a complaint. No complaints had recently been received. People told us they liked the staff. We saw the service had responded quickly to ensure identified maintenance and repairs were actioned.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened too.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. We saw feedback from professionals. One professional made positive comments on the fire and evacuation procedures. This meant the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Some staff felt the staff team supported each other. This helped to ensure that people received a good quality service at all times.

We found that people were supported to make decisions and that their choices were respected. We saw evidence that people's best interests were considered when decisions were taken on their behalf.

We saw that care plans were comprehensive and person centred. We saw that people's personal goals, choices, likes and dislikes were recorded in their care plans. The care plans also contained details of how each person expressed their dissatisfaction or disagreement. We saw staff treating people with respect and kindness throughout our visit.

We found that medicines were safely stored, handled and administered. Medicine records were accurate and doctors' instructions were properly acted upon.

We found that appropriate checks were properly carried out on staff before they were allowed to start work.

The provider had a suitable complaints procedure in place. It had been made available to people's relatives and representatives and was available in an easy to read format for those who needed it.