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Inspection carried out on 15 September 2017

During a routine inspection

Crescent Nursing Home provides nursing care for up to 28 people with a range of physical and psychological needs, including dementia, mental health and learning disabilities. There were 27 people living at the service when we visited.

At the last inspection on 25 March 2015 we rated the service overall Good, however they Required Improvement under safe. On 29 July 2015 we carried out a focused inspection to check if the necessary improvements were made. We found that the service improved, however we did not change the rating to ensure that the improvements were sustained over a longer period of time. At this inspection we found that the improvements were sustained and further improved. At this inspection we rated the service Outstanding.

The home has a registered manager. 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.

Without exception people told us that staff were extremely responsive to their needs and preferences and that their care was personalised about them as an individual person. Relatives were highly complementary about the exceptional care and support their family member received.

People were able to maintain hobbies and interests that they enjoyed prior to moving to the home and develop others. Staff enabled people to live the life they wanted and organised social activities, group activities and individual activities. People were able to decide what they wanted to do every day or participate in planned activities, which took place in the day service. This gave people a sense of being in control of their life and empowered them to do what they wanted.

The service was exceptionally well led. There was visible and effective leadership within the service. The service was effectively organised and well run with an open and transparent culture. The registered manager was supported by a dynamic management team that demonstrated a holistic approach and had clear oversight of how the service was meeting people’s physical, emotional and social needs.

People received care and support from competent and dedicated staff because the management team encouraged them to learn and develop new skills and ideas. Staff when asked about the culture and values of the service told us that they felt an integral part of a team and enjoyed their work. They were extremely passionate and committed to providing quality care and were clear on their roles and responsibilities.

The service promoted a culture that was open and transparent. The registered manager operated an open door policy and people, relatives and staff felt able to make suggestions on the quality of the care provided. Quality assurance systems were in place and these were used to obtain feedback about the service, monitor performance and manage risks.

The provider was actively involved in pilot projects and different local groups to constantly improve and broaden the services and opportunities they offered to people living at the home.

People were actively encouraged to voice their opinions regarding all aspects of their care and support. They told us they felt valued and included in making decisions that affected them and were actively involved in their on-going care arrangements. People and their relatives could voice their views and opinions which the management team listened and acted on.

People told us they felt safe and protected from harm in Crescent Nursing home. Staff were knowledgeable about people`s vulnerability and demonstrated good understanding about safeguarding procedures and signs of possible abuse. They told us they always reported their concerns to managers and they were knowledgeable about whistleblowing procedures to report their concerns externally to local safeguarding authorities.

People told us there were sufficient staff employed to meet their needs at all times. Recruitment procedures were robust and ensured that staff working at the home had the right to do so.

People were supported to take their medicines safely by appropriately trained staff who had their competencies regularly assessed.

Risks to people`s well-being were assessed and measures were in place to mitigate these, however staff had a positive approach towards taking risks and enabled people to live the life they wanted.

People`s consent to the care and support they received was sought and staff worked following the principles of the Mental Capacity Act 2005 for people who lacked capacity to take certain decisions to ensure that the care and support they received was in their best interest.

People told us they were provided with sufficient food and drinks and the quality of the meals were good and satisfied their needs.

Staff told us they received regular training and updates to keep them skilled and knowledgeable about the roles they performed. Staff had regular supervisions and they felt supported by the management team at the home.

Inspection carried out on 29 July 2015

During an inspection to make sure that the improvements required had been made

During our inspection in March 2015, we found that people were not protected from the risk of infection. There were ineffective cleaning processes in place. Communal areas within the service, including toilets, armchairs and people’s bedrooms had not been cleaned effectively.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make.

This report only covers our findings in relation to the outstanding breach of regulation. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘The Crescent Nursing Home’ on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 29 July 2015.

During this inspection, we found improvements had been made to the service’s cleaning processes to ensure appropriate standards of cleanliness and hygiene were maintained. Toilet cleaning schedules had been revised and they were now being checked and cleaned on a two hourly basis if required. Staff had reviewed their cleaning practice to ensure it was now more thorough.

We reviewed the audit systems in place, which at the past inspection had failed to identify the issues we found in respect of poor hygiene. We found that these had been strengthened and had more managerial oversight which meant that any issues could be identified and addressed in a timely manner.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

Inspection carried out on 26 March 2015

During a routine inspection

The inspection was unannounced and took place on 26 March 2015.

Crescent Nursing Home provides nursing care for up to 28 people with a range of physical and psychological needs, including dementia, mental health and learning disabilities. There were 25 people living at the service when we visited.

The home has a registered manager. 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 found the home’s infection control procedure was not appropriately followed. Appropriate standards of cleanliness and hygiene of the environment were not maintained within the home. You can see what action we told the provider to take at the back of the full version of the report.

Staff demonstrated a good understanding of what abuse meant and how to report any suspected abuse.

There were risk assessments in place to support people to maintain their independence and to minimise any potential risks of harm.

Sufficient numbers of suitable staff were employed to keep people safe and to meet their assessed needs. Safe recruitment practices were being followed.

People were supported to take their medicines safely; however, the practice to ensure that handwritten entries on the medication administration record [MAR] sheets were countersigned was not consistent.

Staff were provided with induction and on-going training. There was a supervision and appraisal framework in place.

People’s consent to care and treatment was sought. Where there were concerns around people’s capacity to make decisions, best interest meetings were held.

People were provided with adequate amounts of food and drinks and menu choices were discussed with them.

People had access to healthcare facilities if needed and were supported by other healthcare professionals.

Staff spent time interacting and communicating with people to ensure they understood what was happening around them.

People’s privacy and dignity were promoted. The home did not have any restrictions on visiting.

People’s needs were assessed prior to them coming to live at the home. The information obtained from the needs assessment was used to develop the care plan.

People were encouraged to raise concerns. The complaints procedure was accessible to people in an appropriate format.

The registered manager operated an open door policy. People and their relatives were able to make suggestions on the quality of the care provided.

There was a quality assurance system in place which was used to obtain feedback, monitor performance and manage risks.

Inspection carried out on 14 May 2014

During a routine inspection

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they felt safe. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The service had sufficient staff, who were appropriately trained and knowledgeable about people's care and support needs.

Is the service effective?

People were provided with appropriate care and treatment, and their needs had been met. Staff received training to support people with various care needs. Some of the people had complex needs which meant they were not able to understand their care plans. However, we saw multi-disciplinary involvement in assessing people's needs.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. They were able to communicate effectively with people with limited verbal communication. The staff obtained people's consent before any care or treatment was provided. One person said, "Staff are friendly and caring. They always help you if you need anything."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals were made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to access a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

Inspection carried out on 29 April 2013

During a routine inspection

Before our inspection at The Crescent Nursing Home, we had received some information via our website which raised concerns about how staff were recruited to the service and the accessibility of information given to visiting professionals.

We spoke with three people about their experience of living at the home and the care and support they were offered. People told us they liked living at the home and were happy. They told us they felt safe in the environment and with the care they were given by staff. One person said, "Staff do everything for me. They are really kind and I like them all." Another said, "It's ok here."

Some of the people were unable to express their views directly because of complex communication problems so we observed engagement between them and staff. It was evident that staff interacted positively with people and respected their individual needs and abilities. We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support.

We observed evidence of effective record keeping and robust recruitment processes. We were given free access to all information we required as part of this inspection.

Inspection carried out on 8 March 2013

During an inspection in response to concerns

We visited the Crescent Nursing Home on 8 March 2013, to follow up on some information of concern we had received in respect of the safeguarding and care and welfare of people living at the home.

We used different methods, such as observations, to help us understand peoples' experiences and to ensure that they were being treated with dignity and respect. Some people had complex needs which meant that they were not fully able to tell us about their experiences, so we communicated in a way that was appropriate for them.

We observed a relaxed atmosphere in the home with positive interactions between staff and people who were engaged in activities of their choice, either within the day centre or on a more individual basis. Although we noted there was a planned activity schedule in place, we saw that people had the choice to participate as they pleased with staff offering choices as to how they spent their time.

Staff were friendly and polite in their approach and interacted effectively with people. This showed that staff understood the needs of the people they were supporting. One person said, "Staff do what I want them to and know me well."

During our visit, we spoke with four members of staff who told us they were happy working at the home and felt supported to carry out their roles, receiving a robust programme of training and supervision, including Safeguarding of Vulnerable Adults and Mental Capacity Act 2005.

Inspection carried out on 14 November 2012

During a routine inspection

We visited Crescent Nursing Home on 14 November 2012 and found people living there in a relaxed manner. We spoke with seven of the 24 people living at the home although some people had limited communication abilities. We used a number of different methods to help us understand the experiences of people using the service, as some people living in the home had complex needs which meant they were not always able to tell us their experiences. All those we spoke with were able to tell us they enjoyed living there and felt cared for by staff.

We spoke with one person’s relative who told us they “couldn’t fault” the care and support given to their family member. They said they were made to feel "part of the family" and staff were very supportive and understanding of both their needs and those of their relative.

We observed a friendly atmosphere with good interactions between staff and people living in the home. Some people displayed behaviour which at times impacted on other people living in the home. However, we observed that staff managed this appropriately and respectfully, and were able to engage with people to meet their needs.

We saw people were involved in decisions about their care and that people were treated with respect and dignity. Staff we spoke with told us they enjoyed working in the home.

Inspection carried out on 12 July 2011

During an inspection in response to concerns

During our visit to the service on 12 July 2011, the people we spoke with told us they felt safe and secure living at The Crescent. One person told us the staff are very helpful and are quick to respond to my needs. One person told us they are well looked after. Another person told us ‘they can’t do enough for us’. People we spoke with told us they felt confident that any concerns they raised would be listened to and any action would be taken.

As part of this review we also looked at a number of other outcomes. The findings of these can be found throughout this report.

Reports under our old system of regulation (including those from before CQC was created)