15 Manor Crescent

15 Manor Crescent provides accommodation and personal care for up to four people with learning disabilities and who may also have a physical disability. The accommodation is on one level and consists of four bedrooms with ensuite bathrooms. There were four people living in the home at the time of our inspection.

There is a care home for people with learning disabilities next door which is owned by the same provider. The registered manager of 15 Manor Crescent was responsible for both locations and all members of staff work between both houses.

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

Family members told us their relative was safe. Staff understood their roles in safeguarding people from harm. Risks to people were assessed and identified. There was guidance for staff on how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns. There were enough staff to meet people’s needs and safe recruitment practices were in place. Medicines were safely managed.

The provider and staff were following government guidance in relation to infection prevention and control. Staff had received training on COVID-19 and the use of personal protective equipment (PPE). The service had business continuity and COVID-19 contingency plans in place that made provision for safe care in the event of an emergency, or an outbreak of COVID-19.

Quality assurance processes were robust to give oversight of the service. The registered manager and team leader had ideas of how to continuously improve people's lives and valued working in partnership with others to achieve this.

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. Staff were seen to continuously encourage people to share their views and make choices and it was clear they treated people as individuals.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the safe and well-led key questions, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• 15 Manor Crescent is a small care home which can accommodate four people. The building is similar to other houses in the area and has no external identifying features. Staff were observed to enable people to make day to day choices, including around food and activities. The care home is located within walking distance of local shops and amenities. Whilst people are not able to travel independently, staff supported them to access the community and there were sufficient car drivers to enable longer trips. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• People received support which kept them safe and encouraged their independence. Risk assessments were in place which identified people's individual health care needs and support. Staff understood how to keep people safe and told us they reported and reviewed significant incidents at the end of each shift in order to consider learning from it.

Right culture:

• Leadership and staff showed commitment to those whom they supported. They told us that central to their role was to empower those whom they supported to be as independent as possible. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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

Rating at last inspection

The last rating for this service was good (published 20 November 2020).

Why we inspected

This report only covers our findings in relation to the key questions Safe and Well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains 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 New Generation Care Limited - 15 Manor Crescent on our website at www.cqc.org.uk.

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.

15 Manor Crescent provides accommodation for up to four people with learning disabilities and who may also have a physical disability. The accommodation is on one level and consists of four bedrooms with ensuite bathrooms. There were three people living in the home at the time of our inspection.

There is a care home for people with learning disabilities next door owned by the same provider. The manager was responsible for both locations and all members of staff work between both houses.

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

It is a condition of registration that the registered provider must ensure that the regulated activity is managed by an individual who is registered as a manager in respect of that activity. The manager in post at the time of this inspection was not registered with CQC, which has an effect on the rating of the service.

The provider had made improvements since our last inspection. Infection prevention and control practices were improved, as were auditing and quality monitoring processes. There was also an increased staff presence at night.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The building is a house in a residential community, with no external identifying features. Staff were observed to enable people to make day to day choices, including around food and activities. The care home is located within walking distance of local shops and amenities. Whilst people are not able to travel independently, staff supported them to access the community. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• Care records were person centred and staff could tell us about an individual’s specific care needs and preferences. Risk assessments were in place which identified people's health care needs and support. People who used the service told us staff were always there to help them. Staff understood how to keep people safe and told us they reviewed significant incidents at the end of each shift in order to consider learning from it.

Right culture:

• Leadership and staff showed commitment to those whom they supported. They spoke with passion about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us they viewed themselves as visitors and as such, the needs and views of those whom they supported were paramount and must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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 20 June 2019). We found the provider was in breach of Regulation 17 HSCA RA Regulations 2014.

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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 June 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 good governance.

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 and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 New Generation Care Limited - 15 Manor Crescent on our website at www.cqc.org.uk.

15 Manor Crescent is a residential care home providing personal and nursing care to four people with learning and physical disabilities.

People live in one adapted bungalow and each have their own bedroom and bathroom. The service is fully accessible and has been adapted to meet the specific needs of people with physical disabilities, including overhead tracking for hoists and en-suite wet rooms.

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 a domestic style bungalow. It was registered for the support of up to four people. The building design fitting into the residential area and the other properties in the street. There were deliberately no identifying signs outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. Records held about people did not always reflect up to date information.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with kindness by a caring and dedicated care staff. Care staff demonstrated a compassionate approach towards people and worked well together as a team. People told us that they felt that the staff cared about them.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people’s dietary needs and people told us they enjoyed the food available to them. People told us they could choose alternative meals if they did not like what was on the menu.

People and relatives told us they were happy with the service, and that staff had a good understanding of their needs and preferences. Staff understood how to recognise signs of abuse and actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. People an professionals and relatives spoke highly about the management and staff had a clear understanding of this roles and responsibilities.

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.

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

Rating at last inspection

The last rating for this service was Good. (published 22 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New generation Care Limited – 15 Manor Crescent on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Good governance. There was not an adequate process for assessing and monitoring the quality of services provided and that all records were accurate and complete.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will discuss with the provider following this report being published how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

New Generation Care Limited - 15 Manor Crescent provides accommodation and personal care for up to four people. There were four people living at the service at the time of our inspection. New Generation Care Limited specialises in providing residential support for adults with learning disability, autism and communication difficulties, who may also have physical disability and/or challenging behaviour.

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 and associated Regulations about how the service is run.

People were safe because there were enough staff available to meet their needs. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

Risks to people had been assessed and action had been taken to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly. The provider had considered how the service could be made as safe as possible for people and developed an action plan where potential improvements had been identified.

Although there were recording errors on the day of our inspection, people’s medicines were managed safely overall. Medicines were stored securely and there were appropriate arrangements for the ordering and disposal of medicines. Each person had an individual medicines profile that contained information about the medicines they took. Medicines audits were carried out regularly as part of the provider’s quality monitoring process.

People were supported by staff that had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. They had access to regular supervision, which provided opportunities to discuss their performance and training needs.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

People were receiving their care in line with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had attended training in the MCA and DoLS and understood the importance of consent. People and their families were involved in decisions about their care and treatment and these decisions were respected.

People were supported to have a balanced diet and to eat according to their preferences. People told us they enjoyed the food provided and that they were involved in choosing what they ate. They said they enjoyed eating out in pubs and restaurants and did this regularly.

People were supported by kind and caring staff. People had positive relationships with the staff who supported them. Relatives said staff were kind and friendly and knew their family members well. People told us that staff treated them with respect. Staff recognised the importance of encouraging people to develop their independence and supported people in a way that promoted this. People were encouraged to be involved in planning their own care and support.

People’s needs had been assessed before they moved in to ensure that staff could provide the care they needed. A care plan had been developed for each person, with their involvement. Plans were person-centred and provided clear information for staff about how to provide care and support in the way the person preferred. People’s plans were reviewed regularly to ensure that they continued to reflect their needs.

Staff supported people to spend their time as they chose. People had opportunities to attend colleges and resource centres during the week and regular social events in their leisure time. People were supported to pursue individual hobbies and interests.

People and their relatives had opportunities to give their views about the service. They told us their views were encouraged and listened to. We found that complaints and concerns were taken seriously and used as an opportunity to improve the service.

People benefitted from a well-managed service. Relatives told us the service was well run and that communication with families was good. They said the registered manager was always available to speak with them when necessary and knew all the people who lived at the service well. Staff told us they were well supported by the registered manager. They said the registered manager welcomed feedback from staff about how the service could be improved.

The provider had an effective quality assurance system to ensure that key areas of the service were monitored effectively. There were systems in place to ensure staff communicated important information about people’s care. Team meetings were held regularly and used to ensure staff were providing care consistently. Records relating to people’s care were accurate, up to date and stored appropriately.

People who used the service told us that staff asked them for their permission before they helped them with their care needs. For example, one person told us, 'Staff always asked me if they could help to me get ready for bed.'

Two people who used the service went through their care plans with us. They told us, 'We always attend our annual reviews but we do not look at them after that.' They knew what was in their care plan.

People told us they were happy and safe living the service. They told us they knew who to talk to if they felt threatened or had been mistreated.

People told us that there were usually enough staff on duty at the service, but there had been some weekends when there had just been two members of staff on duty. They told us that they did lots of activities during the week with help from staff.

People who used the service told us that they made choices every day that included choosing their bedtimes, the food they wanted to eat and the clothes they wanted to wear. They told us that they could do the activities they choose to. One person told us, 'We do activities every day, and I like drawing.' Another person told us, 'I like line dancing and we have done that this morning.' People we spoke to were complimentary about the staff and the care, treatment and support they received from staff at the service. They told us that staff looked after them well and that they were happy living at the home. They particularly enjoyed the activities they do. One person told us, 'I like cooking on Thursdays and going to the cinema.' All the people we spoke to told us that they felt safe living at the service.