The Crescent Care Home Limited

The Crescent is a residential service providing personal care for up to 6 people with a learning disability. The service operates from an adapted building with an enclosed garden in a residential area of Hartlepool. At the time of inspection there were 4 people living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it

Right Support

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. All staff ensured people living in the service were happy with the environment and found ways to promote their independence; their passions and interests were supported by the wide range of activities they took part in, not only inside the home but out in the community. People and relatives were involved in every stage of care planning. Systems and records were in place to ensure people received person-centred, safe care. People were supported safely with medicines. Infection prevention and control practices reflected current guidance.

Right Care

People received kind and compassionate care in a safe, homely environment. People and their relatives were very positive about the care provided. People told us they felt safe and staff had the skills to support them. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. The registered manager had an effective quality assurance system in place. Regular audits and checks were completed. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home. Staff were safely recruited and received an induction followed by training from the provider.

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

Rating at last inspection and update

The last rating for this service was good (published 1 March 2018)

Why we inspected

This inspection was undertaken due to the age of the previous rating. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Crescent Care Home Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The Crescent Care Home is registered to provide care for up to nine people in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. 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. On the day of our inspection there were six people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in February 2016 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The provider and registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at The Crescent Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Activities and work placements were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had a complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

The Crescent Care Home is a large grade II listed building situated in Hartlepool. The accommodation is provided over three floors for up to nine people living with a learning disability and autism. At the time of the visit seven people were using the service.

There was a registered manager at the service at the time of the 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.

We last inspected the service on 12 and 18 November 2014 and breaches of legal requirements were found. We told the provider there were no robust systems in place to identify risks and how they would be managed and reviewed. The provider did not have an effective system for monitoring the service. Staff had not received all the training they needed or professional development, supervision and appraisal.

We asked the provider to take action to make improvements. The provider submitted an action plan detailing how they would achieve improvements. The service was expected to be compliant by 31 October 2015.

During the inspection on 9 and 26 February 2016 we found improvements had been made.

We found that the service had reviewed their care planning process and had made improvements to care planning and risk assessments. The service gained confirmation from Employment Link, (the service that supports people into work) that risk assessments were carried out as part of the process undertaken when they support people in to work in the community. The registered manager told us and records confirmed they had contacted the local authority for evidence of risk assessments for those who are accessing day services.

We saw that the provider had sought the views of people who used the service as well as relatives and other stake holders. Views were analysed and finding were used in the plan to develop the service. The registered manager had completed an infection control audit, medication audit and a full review of care plans. However, the quality assurance process still required development to ensure the provider could demonstrate an auditing process in all areas of service delivery.

Staff had received training, regular supervision and appraisal. One staff member told us, “Supervisions are more in-depth now.”

The people who lived at The Cresent Care Home were able to give us their views on the service. One person told us, “They look after me, and help me to meet my brother.” Another said, “I am really settled here, I have lots of things to do.”

We spoke to relatives to get their views on the service. Relatives gave positive comments about the service and said people enjoyed being at the home. One relative told us, “There is a professional side and a caring side, they always let [family member] be his own person.”

Staff had an understanding of safeguarding and whistleblowing and were confident that any concerns they had would be listened to by the registered manager. One staff member told us, “I would report it to [registered manager] and if needed I would go to the safeguarding team.” Staff gave examples of abuse such as physical, financial and emotional, and how behaviours may change if someone had been or was subject to abuse.

Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were aware of who had a DoLS in place and why. The registered manager had a good insight into the principles of the MCA and explained the processes used by the service in meeting their responsibilities. We found support plans were linked to DoLS.

Recruitment practices were robust and safe. This meant that only people who were suitable to the role were employed. Staff received an induction in the home on commencement of employment. Staff had completed a range of in house training, such as safeguarding, first aid, and behaviours that challenge. Staff had received regular supervision and appraisals to discuss personal development.

Relatives told us that their family members had the correct level of well trained staff supporting them in the home and in the community. People had access to other health care professionals to ensure their health and wellbeing was monitored. We reviewed the most recent and historical rotas. There were sufficient support workers employed to meet the needs of the people who used the service.

People’s choices were acknowledged. People told us they had a range of different activities which they were involved in planning. We saw that the service acknowledged peoples’ nutritional needs and had developed a varied menu. One person told us, “The food is okay, I am given a choice.”

Relatives felt involved in decisions about their family members care and support and were kept up to date with any changes. Relatives only had positive comments about the service. One relative told us, “I don’t know where I would be without the care and support, they have helped me so much with [family member]. I trust them.”

We saw genuine relationships between staff and people. Staff were encouraging and supportive promoting peoples’ independence. There was lots of laughter in the home, people appeared to be comfortable with each other and staff.

The service had systems in place for recording safeguarding, accidents, incidents and complaints. People knew how to make a complaint. One relative told us, “I know how to complain but I have never needed to.” Another person said, “If I had a problem about anything I would speak to [registered manager] and they would sort it for me.”

Relatives told us they felt the service was well managed, and that the registered manager was open, supportive and approachable. They felt that any concerns and complaints would be acted on.

Policies and procedures were in place to ensure medicines were managed in a safe way. Records were up to date with no omissions. Staff who administer medicines had been trained in the safe handling of medicines.

The home was clean and comfortably furnished with a homely feel. There were communal areas for people to meet. People’s rooms were pleasantly decorated with ornaments and personal items on display.

We found that where people did not have capacity to consent, formal assessments were not undertaken to ensure that the provider acted in accordance with legal requirements.

People who used the service, staff and visitors were protected against the risks of usafe or unsuitable premises.

People were protected from unsafe or unsuitable equipment.

We spoke with five people who used the service and one relative. People who used the service told us, "It's wonderful here", and "I love it here, I would not want to live anywhere else". The relative we spoke with told us, "I cannot speak more highly of them here, it really is wonderful. They have put their whole lives into it and I know I couldn't ask for anything more."

The care and welfare needs of people were met. People had access to dentists, opticians and other health professionals. There was evidence that when people were unwell, appropriate action was taken. One person told us, 'When I wasn't feeling very well they called the doctor for me'.

Staff were aware of their responsibilities relating to safeguarding vulnerable adults and the people who lived at The Crescent Care Home felt safe and happy to live there.

The service had systems in place to monitor the quality of the service it provided and made sure that people were able to make their wishes and opinions known. They were given choice and involved in decisions about the way their support was delivered.

The records held by the service relating to people who lived there were in need of improvement because some were out of date and some had not been reviewed regularly to make sure they were still relevant.