Archived: The Crescent

The Crescent is a care home for up to six people with a learning disability and autism. People had complex needs and may display behaviours that challenged the service. The home is in a residential area of Stockport and has been adapted to meet the needs of the people living there. People have their own rooms and some share lounge areas, whilst others have their own lounge area. At the time of our inspection there were four people living at The Crescent. Due to the needs of the people living at the service we were told that there would not be any more admissions to the home.

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.

At our last inspection in March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

A registered manager was in place at The Crescent. 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. The registered manager had moved to The Crescent from another of the provider’s services in April 2018.

The ethos of the service was to promote people’s skills and independence. People were trained and encouraged to do tasks for themselves, for example making their own drinks and buying their own snacks. People were supported to take positive risks. For example one person with complex behavioural needs was now travelling independently by bus and completing some of their own shopping.

Thorough holistic assessments were completed for people moving to the service. We saw a very positive example of the service assessing and planning a move to the service for a person with complex behavioural needs. A small team was identified and trained in the person's specific needs. A specialist ‘pod’ identical to one used as a safe space when the person was at school had been bought to provide familiarity and they used it to help them manage their anxieties. After three months it had been possible to reduce the person's medication as their anxiety had reduced and they had settled into their new home.

Care plans gave detailed step by step guidance for the support people needed, for example with personal care and going out on activities.

The service was very responsive to people’s needs. For example, the service identified that one person did not like to share their space with other people and so was arranging for them to move rooms within the home and were in the process of adapting the room with underfloor heating and window coverings to meet the person’s needs.

Each person had a communication passport which comprehensively detailed how they communicated what they wanted and how they were feeling. This included verbal and non-verbal communication, with communication aids being used where required, for example Picture Exchange Communication System (PECS) cards. This enabled people to be involved in their care and support and reduced their frustration as they were able to communicate their needs to the staff team.

Social stories were written with easy read symbols and simple words to inform people about their care, support and activities. Information was available in an easy read format, for example the guide to services and complaints procedure.

A tenant's voice easy read document was used to enable people to say what they thought about their support, activities and home. This was used in the staff meetings to drive changes and improvements at the service.

Risks people may face were assessed and clear guidance was provided for staff to reduce and manage these risks. A daily risk assessment was used to assess people’s moods and the activities were tailored to the person’s current mood and level of anxiety.

Detailed positive behaviour support plans were used to identify people’s complex behaviours and the strategies and distraction techniques required to reduce their anxieties. Any physical intervention techniques that could be used were specified in the positive behavioural support plans. These were reviewed each month or following an incident.

Comprehensive annual reviews were held, with family involvement, which identified what was working well, areas for development and strategies and plans for the future.

All incidents were recorded in detail and de-brief meetings were held to discuss any changes that could be made to people’s support plans to reduce the chance of further incidents.

Staff knew people’s needs well and we observed positive interactions between people and the members of staff.

There were sufficient suitably qualified staff on duty to meet people’s assessed needs. Staff were safely recruited. The staff were organised into small teams around each person so both the person and staff could get to know each other really well and build confidence and trust in each other. Each team was led by a senior support worker who ensured all care plans and risk assessments were up to date.

Staff said they enjoyed working at the service and felt well supported by the senior care staff and registered manager.

Following our last inspection action had been taken to ensure all windows had restrictors in place and radiator covers were fitted where required to help keep people safe.

People received their medicines as prescribed.

Each person had a health action plan and was supported to maintain their health and their nutritional needs were being met.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People's rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

A robust quality assurance system was in place. The registered manager had introduced new checks and increased the focus on infection control at the home.

Further information is in the detailed findings below.

The Crescent is located with Davenport Conservation Park in Stockport. It is a large semi- detached property that has been adapted and converted to accommodate up to six young adults who have a diagnosis of autism or learning disability. There are gardens to the front and back of the home with parking to the front of the home for approximately four cars. People are accommodated in single bedrooms on two floors and access to the first and second floor is via the stairs. There were four people using the service at the time of the inspection.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We found the premises were not as safe as they should have been because two of the upstairs windows were without restrictors; heavy furniture was not secure and radiators were not covered where there was an identified risk. This placed the health and safety of people at risk of harm.

You can see what action we have told the provider to take at the back of the full version of the report.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People’s care records contained detailed information to guide staff on the care and support to be provided. They also showed that risks to people's health and well-being had been identified. These involved risks such as travelling in the car, specific risk areas in the home, poor nutrition and hydration and outside activities. We saw that detailed plans were in place to help reduce or eliminate the identified risks.

The staff we spoke with had an in- depth knowledge and understanding of the needs of the people they were looking after. We saw that staff provided respectful, kindly and caring attention to people who used the service.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. All staff had access to the whistleblowing procedures (the reporting of unsafe and/or poor practice).

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

In addition to regular trips out for meals to pubs and cafes, people were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met.

The system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure that people received timely, appropriate care and treatment.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. A fire risk assessment for the premises was in place and systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems in place for receiving, handling and responding appropriately to complaints.

We found that the care records clearly identified the needs of the person in relation to managing their mental and physical health and the support they required to develop their independence.

We found there were policies and procedures in place to ensure people who used the service were protected from the risk of abuse.

We looked around the home and saw that the layout of the premises was suitable for carrying out the regulated activity. However risk assessments relating to some windows in the home would complement the building safety standards already in place.

We found that staff had been recruited appropriately to carry out their role and to meet the needs of people who used the service. Staff spoken with told us they ensured that care and support was delivered privately, was person led and reflected the care instructions detailed in peoples individual support plans.

We found there were adequate systems in place to regularly assess and monitor the quality of the service people received at The Crescent.