Archived: The Crescent

Updated 21 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 20 September 2018. We gave the service 36 hours’ notice of the inspection visit because it is a small home supporting people with learning disabilities and autism, who can display behaviour which can be described as challenging. We wanted to ensure people were in and to give the home time to inform and support people before our visit. One inspector completed the inspection.

Before our inspection the provider completed a provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the service. We looked at the statutory notifications the home had sent us. A statutory notification is information about important events, which the provider is required to send to us by law.

We contacted the local authority safeguarding and commissioning teams. Details of their feedback is included within the main body of this report. We also contacted Stockport Healthwatch who did not have any information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spoke with one person who used the service and observed people and staff interactions as three people living at the service could not verbally communicate with us. We also spoke with four members of care staff, the director and assistant director of health and social care. We viewed feedback from relatives through surveys they had completed.

The registered manager was not available on the day of our inspection. Following the inspection, we spoke with them by telephone.

We looked at records relating to the management of the service such as the staffing rotas, policies, incident and accident records, four staff recruitment files and training records, two care files, meeting minutes and auditing systems.

Updated 21 November 2018

This inspection took place on the 20 September 2018. We gave the service 36 hours’ notice that we were coming as it is a small home supporting people with a learning disability and autism.

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.