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Inspection carried out on 16 January 2020

During a routine inspection

About the service

58 Crantock Drive is a ‘care home’ providing support for up to eight people who have learning disabilities, autistic spectrum conditions or additional needs. Eight people were living there at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was had been extended and was larger than most domestic style properties in the area. However, the building design fitted into the residential area and the service was an accepted part of the community. There were deliberately no identifying signs, intercom anything else outside to indicate the building was a care home.

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

People and their relatives told us they were happy with the care and service received. Staff were kind and caring towards people, and people appeared relaxed and comfortable in their presence.

People were supported by enough staff and vacancies were being recruited to. Any gaps in shifts were covered by regular bank staff or agency workers who knew the people they were supporting.

People were protected from the risk of harm or abuse. Staff knew how to keep people safe, and guidance was available if staff needed to report concerns. Risk assessments reflected people’s needs and ensured staff provided safe care for people. Risks relating to the environment and equipment were regularly assessed to ensure these were managed.

People received their medicines safely and as prescribed. Staff received training to ensure they were competent in administering and managing medicines. Some checks required more consistent completion, although any risk to people was low.

Staff supported people to eat and drink enough to maintain a balanced diet which met their needs and preferences. People had access to routine and specialist healthcare services. Staff worked with other professionals to ensure people received effective care which met their needs.

Care records were person-centred and gave information about what was important and how people wished to be supported. People’s capacity was considered and documented on each care plan and assessed for particular decisions. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff knew people well and information about their preferences and interests was recorded. People were able to access a wide range of opportunities and activities which were meaningful to them. Staff supported people to maintain relationships with friends and family.

A clear leadership structure was in place, and the service was well led by knowledgeable and respected managers. Staff felt supported by the management team and there was a commitment to the service from the staff we met. System

Inspection carried out on 30 March 2017

During a routine inspection

This inspection took place on 30 March 2017 and was unannounced. The service provides accommodation for up to 8 adults with a learning disability. At the time of our visit there were six people living at the service.

There was a registered manager in post. 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.

At the last inspection of October 2015, we identified a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we could not be satisfied that one person’s food and fluid intake and pressure areas were being monitored adequately. Records evidencing what staff were doing to support this person required improvement. During our visit of 30 March 2017 we followed this up and saw that improvements had been made and the requirement met.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, action plans were in place about how to manage, monitor and review these. Medicines were managed safely and staff followed the provider’s policy and procedures.

The provider’s recruitment policy and practices helped ensure people were supported by suitable staff. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

People were confident in their surroundings and with each other. The atmosphere in the afternoon on the day of our inspection was very pleasant and people were doing their own things to relax and pass the time of day.

People moved into the service only when a full assessment had been completed and the registered

manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People were helped to exercise choice and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.

The service had a family atmosphere and homely feel. Staff were knowledgeable about everyone they supported and it was evident they had built up relationships based on trust and respect for each other.

People experienced a lifestyle that met their individual expectations, capacity and preferences. There was an ethos of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated.

The provider and registered manager had a clear vision about how they would continue to improve the service for people and staff. The service was important to them and they wanted the best for people. There was an emphasis on teamwork and unison amongst all staff at all levels.

Inspection carried out on 7 and 8 October 2015

During a routine inspection

58 Crantock Drive is a care home registered to accommodate up to eight people with learning disabilities. The building is a large bungalow that has been adapted to meet the mobility needs of people with physical disabilities. At the time of our inspection eight people were using the service.

This inspection was unannounced, which meant the staff and provider did not know we would be visiting. We visited the service on 7 and 8 October 2015.

The manager registered with the Care Quality Commission (CQC) for the service was no longer working at the location. CQC had not received an application to cancel the registration for the previous manager. The provider had appointed a new manager who was in the process of submitting an application to register with CQC as 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.

People were safe because the manager and staff team understood their role and responsibilities to keep people safe from harm. Staff knew how to raise any concerns regarding people’s safety. People were supported to take appropriate risks and promote their independence. Risks were assessed and individual plans put in plans to protect people from harm. People were protected from the risks associated with medicines because the provider had clear systems in place and staff had received the appropriate training.

There was sufficient staff to provide care and support to people. Pre-employment checks were carried out on staff before they started work to assess their suitability. Staff had received the appropriate training to meet people’s needs.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were able to make choices and decisions regarding what they had to eat and drink.

People received a service that was caring. People were involved in making decisions about how they wanted to be looked after and how they spent their time. People had positive relationships with staff. Staff treated people with dignity and respect. Staff supported people to maintain relationships with family and friends. People’s independence was promoted.

The service did not always provide person centred care and support consistent with people’s care plans. People were offered a range of activities both at the service and in the local community. People using the service, families and professionals were encouraged to make their views known and the service made changes as a result.

The service was well led. The manager provided good leadership and management. The vision and culture of the service was clearly communicated. The quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the service not always providing care and support as identified in people’s care plans.

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

Inspection carried out on 15 June 2013

During a routine inspection

We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

When we asked people about their care and if they were happy living in the home no concerns were raised to us. People said �It�s alright here�, �I am ok�. One person had recently been discharged from hospital following an operation when we asked them if they were glad to be back home they told us they were.

People living at 58 Crantock Drive can be assured that the administration, recording and handling of medication was done in a safe manner.

The home was found to be well maintained, clean and provided a �homely� environment for people to live.

People�s wishes, likes and dislikes had been obtained. Information on how people wanted to be supported was known to staff because accurate and appropriate records were being maintained.

Inspection carried out on 23 September 2012

During a routine inspection

58 Crantock Drive provides accommodation and personal care support for people living with a learning disability. Some people were able to talk with us about their life in the home; however, one person people who had a diagnosis of early onset dementia had limited communication and understanding.

We spent time in various parts of the home, including all communal areas so that we could observe the direct care, attention and support that people who live at this home receive. People who were able to give us an opinion told us they were happy with the care and support provided.

We spoke to some of the people living at the home to see if they had any concerns about where they live and the staff that supported them. People told us they were happy, that staff were kind and two people we spoke to knew who to speak to if they had a complaint. One person said �I would speak with X. my key worker, they would help me and make sure that I was alright�.

People said they felt safe and well cared for at 58 Crantock Drive. People said staff were very kind to them Two people told us about their key worker. A key worker is a named member of staff, who is linked to a person living at the home, that is allocated to provider support. People told us they knew who their key worker was, that they enjoyed spending one to one time with their named member of staff. One person told us I really like X they take me shopping for my clothes and toiletries, they are very kind to me.

Inspection carried out on 25 March 2012

During a routine inspection

People who spoke with us were able to discuss their life at the home and what they enjoyed about living there.

People said that they appreciate having their own rooms, and being able to choose how they are decorated. One person told us "I like my room. I keep it spotless�.

People told us that they liked living at the home. All the people we spoke with told us that they were happy with their decision to live at the home. One person told us "I like living here. We are all friends here".

Two people who use the service told us that they felt safe at the home and that staff are "lovely".

Another staff member told us "we are all like a community here. Some staff have worked here many years".

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