The Crescent Residential Care Home

The Crescent Residential Care Home (The Crescent) is a residential care home providing personal care to up to 15 people with mental health needs. At the time of our inspection there were 15 people living at The Crescent. The service was based in an older building close to nearby shops and local facilities. The premises were not suitable for people with reduced mobility.

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

Regular checks were made of the environment to help ensure it was safe for people to live in and any risks were mitigated. On the day of the inspection fire doors had been wedged open by a resident to improve ventilation. We have made a recommendation about this in the report.

There were normally enough staff to support people and respond to their needs. At certain times of the week staffing levels were lower and we have made a recommendation about this in the report.

Staff had received training to keep people safe and knew what action to take in response to any allegations of abuse. There were no restrictions on family and friends visiting.

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.

People were encouraged to be independent and grow their confidence in social interactions and developing independent living skills.

Medicines were stored and administered safely. When people had medicines for use as required there were protocols in place to help ensure staff were consistent in how these were administered.

The service was led by a registered manager who was described as approachable, supportive and caring. The culture at the home was open and inclusive. Staff understood their roles and responsibilities. The provider acted upon suggestions or ideas that were made to drive improvement in the service.

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 requires improvement (published 31 December 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we made recommendations about the management of specific medical risks, storage and recording of drugs which require stricter controls and checks to minimise risk when entries on medicine records were handwritten. At this inspection we found improvements had been made.

Why we inspected

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

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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 10 December 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

For those key questions 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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Crescent Residential Care Home 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.

We found the following examples of good practice.

Throughout the inspection we observed all staff were wearing the correct level of Personal Protective Equipment (PPE). We had been alerted to staff not adhering to social distancing guidelines. The registered manager acknowledged this had occurred on one occasion and took immediate action to address the issue.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. Cleaning and infection control procedures had been updated in line with Public Health England (PHE) Covid-19 guidance to help protect people, visitors and staff from the risk of infection.

Signage and information posters were in evidence at the entrance to the home to inform visitors of the procedures to follow. The service had supplies of personal protective equipment (PPE). People visiting the service were screened by a staff member before entry. This included temperature checks with consent before accessing the service.

People had the choice to remain in their own rooms and use communal areas as they wished. Where people wanted to go out, they were supported by a staff member and wore masks in the community settings.

There was a contingency plan in place including supporting people needing to isolate in order to keep people safe. There were appropriate audit and quality assurance systems in place to effectively manage infection control measures.

The Crescent provides accommodation with personal care for up 15 people who are living with mental health needs. There were 12 people using the service at the time of our inspection.

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

People told us they felt safe being supported by staff. Staff understood risks to people and how to help reduce them whilst promoting their independence. However, some medical risks and non-compliance with health advice were not always well managed or reported to external healthcare professionals.

People received their medicines on time from staff who had received training in medicines administration. However, medicines were not always recorded and stored in line with current guidance.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. Staffing levels were flexible in order to meet people’s fluctuating needs. However, previous employment start and finish dates were not recorded and verified by the referees. This meant the accuracy of the application form information could not be assured.

We have made recommendations in the safe section of this report regarding these concerns.

People were supported by staff who had the skills and knowledge to meet their needs. Staff meetings were used to remind staff of best practice and to discuss any concerns about people’s needs. Staff told us they felt well-supported by the registered manager.

Staff had received appropriate training and support to enable them to carry out their role safely.

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. There were no restrictive practices in place at the time of this inspection.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. People were able to make choices about their life and how their care and support were provided. This information was reflected in people’s care plans. Staff understood the importance of respecting people’s wishes and choices.

People told us, “I love it here and love the staff,” “We cook our own food when we want it and do our own laundry” and “It is like a sanctuary here.”

Care plans were held on an electronic system. Care plans were regularly reviewed and updated. They provided staff with guidance and direction to enable them to meet people’s needs, their wishes and preferences. One person who had moved to the service a few weeks before this inspection did not have a full care plan or risk assessments. This is detailed in the safe section of this report.

There were activities provided for people within the service. People were involved in choosing what activities they did. People were encouraged to go out regularly either independently if able, or with support from staff.

People felt supported by staff. Staff spoke about people with affection and empathy. Staff respected people’s diverse characteristics and were clear that each person’s individual needs were their priority. People told us they felt listened to and their privacy and dignity were respected.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service. However, the concerns identified at this inspection were not identified by audits.

People were supported to access healthcare services, staff recognised changes in people's physical and mental health, and encouraged people to seek professional advice appropriately.

The registered manager also had responsibility for another service, owned by the provider, where they spent two days a week. People and staff told us the service was well led. People, relatives and visiting healthcare professionals were given various opportunities to provide feedback about the service. Any concerns or complaints were recorded along with the response. The manager told us there were no on-going complaints at the time of this inspection.

The management and staff had developed positive relationships with local organisations, which helped ensure people were supported when necessary.

Staff told us they enjoyed working at the service and that the team worked well together.

Visiting healthcare professionals told us, “The support The Crescent provides is very good. They really try to manage risk against people’s independence” and “Their approach is adaptable and they liaise regularly with us appropriately.”

Rating at last inspection

This service was registered with us on 3 December 2018 and this is the first inspection under the new provider. The last rating for this service, under the previous provider, was rated good (Published 11 October 2017)

Why we inspected: This was a scheduled inspection.

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.

We have found evidence that the provider needs to make improvements. 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.

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