St Anne's Community Services - The Crescent

St Anne’s Community Services – The Crescent is a residential care home providing accommodation and personal care to up to 5 people, in one adapted building. The service provides support to people with learning disabilities and people who may be living with autism spectrum disorder. At the time of our inspection there were 5 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Support was provided to ensure people received their medication as prescribed however records in place did not always reflect best practice. We made a recommendation about this. The service gave people care and support in a well-furnished environment that met their sensory and physical needs. People had choice about their living environment and were able to personalise their rooms. Improvement is needed to ensure the cleanliness of the service meets a good standard; we made a recommendation about this and the registered manager took action to review their practice and improve. Staff supported people to take part in activities and pursue their interests however staff told us an increase in staffing would provide people with greater opportunities to access the community. People were supported by staff who knew them well and staff supported people to make decisions following best practice in decision-making. 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.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

The service had enough staff to provide safe care however refresher training was needed to ensure staff practices were in line with best practice. People could communicate with staff and staff understood their individual communication needs however more work is needed to ensure all information within the service is accessible. We fed this back to the registered manager who planned improvements. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff promoted equality and diversity in their support for people. Relatives we spoke to were happy with the care provided; One relative said, “They just do a good job and [person] is happy.”

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

People’s care, treatment and support plans did not always reflect their range of needs and support required. However, staff turnover was low, which supported people to receive consistent care from staff who knew them well. The service did not have clear guidance on what people’s goals and aspirations were so these were not monitored however, staff worked with people to meet their aspirations. The service enabled people and those important to them to work with staff to develop the service. Staff placed people’s wishes, needs and rights at the heart of everything they did. One staff member said, “We want to ensure the people have the best quality of life.”

We received positive feedback from people and their family members about the service. One relative when speaking about the staff, told us, “They’re all good, and lovely to talk to.” Another relative said, “It’s just good, and I have no concerns at all because [person] is well cared for.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 January 2020) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 3 December 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and 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 remains as requires improvement. 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 St Anne’s Community Services – The Crescent on our website at www.cqc.org.uk.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety and governance of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Anne's Community Services - The Crescent provides residential care for up to five people with a learning disability or autistic spectrum disorder. Five people were using the service when we inspected.

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.

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

People had been put at increased risk of harm because aspects of the service were not always safe. Recording issues meant we could not be sure people’s prescribed medicines were managed, stored and administered safely. Health and safety risks had not been identified and addressed in a timely way. For example, adequate window opening restrictors were not always in place. Records were not available to show equipment was checked, serviced and safe to use. Improvements were needed to reduce the risks associated with a fire occurring.

People did not benefit from an inviting and homely environment. Areas of the service were unclean. There were a number of maintenance issues throughout the service including damaged paintwork, fixtures and fittings. Cluttered communal areas made it harder to support people who used mobility aids.

Management and provider audits had been ineffective in identifying and addressing the concerns we found about the quality and safety of the service. The acting manager split their time between two of the provider’s locations and needed more support to address the concerns identified. Records were not always well maintained and statutory notifications had not been submitted as legally required.

The provider immediately responded to our concerns, arranging for the service to be deep cleaned, maintenance issues to be addressed and putting additional management support in place. Whilst this showed a positive commitment to improve the service, further sustained improvements were needed to make sure robust systems were in place to identify and address problems in future.

Although sufficient staff were deployed to meet people’s needs, there was a high level of agency staff used. New staff including agency workers had not always received a thorough induction to the service. There were some gaps in staff’s training. Staff received supervisions and an annual appraisal of their performance.

Staff were trained to identify and respond to safeguarding concerns. People’s needs were assessed and person-centred care plans and risk assessments were in place to support staff to safely meet people’s needs. Some risk assessments had not been reviewed in line with the provider’s own policies and procedures. Accidents and incidents were recorded and monitored to make sure appropriate action was taken to keep people safe.

People gave positive feedback about the food available. Staff supported people to make sure they ate and drank enough. We spoke with the acting manager about evaluating changes in people’s weight to help identify any issues or concerns.

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. Appropriate applications had been made when necessary to deprive people of their liberty.

People praised the kind and caring staff. The provider was working hard to recruit permanent staff and tried to use the same agency workers, so people were supported by staff who they were familiar with and who knew their needs. Staff treated people with dignity and respect.

Staff understood people’s communication needs and accessible information was available to help people understand information about choices and to support them to make decisions. Systems were in place to respond to complaints about the service.

The outcomes for people using the service in part reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People had some opportunities to take part in activities. The provider was working with the local authority to improve access to transport and help people more regularly access their wider community. We made a recommendation about continuing to develop the support with activities. Staff supported and encouraged people to maintain their independence.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (report published 30 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety and the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We inspected this service on 10 and 22 May 2017. The inspection was announced. We gave the registered provider 48 hours’ notice of our inspection, because it is a small service and we needed to make sure people would be in when we visited. At the time of our inspection, there were five people using the service. At the last inspection in January 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

People who used the service felt safe with the care and support staff provided. People were protected from the risk of abuse by staff trained to identify and respond to safeguarding concerns.

Recruitment checks were completed to ensure suitable staff were employed. Sufficient staff were deployed to meet people’s needs and agency staff were used where necessary to ensure safe staffing levels.

Medicines were managed safely, although we spoke with the manager about ensuring staff countersigned handwritten prescribing instructions and they agreed to address this.

Care plans and risk assessments contained detailed information about people’s needs and guidance to staff on how to provide safe care and support. Care plans and risk assessments included person-centred information. Staff knew and understood people’s needs and supported people to pursue their hobbies and interests. Systems were in place to gather feedback and to manage and respond to any complaints about the service provided.

Staff received training and on-going supervisions; spot checks and appraisals were completed to support continued professional development. Staff supported people to ensure they ate and drank enough.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. Where people had capacity, we spoke with the registered manager about ensuring people signed their care plan to record that they consented to the care and support provided.

People who used the service provided positive feedback and said staff were caring. Staff supported people to maintain their privacy and dignity.

There was a positive atmosphere within the service. People told us the registered manager was approachable and responded to any issues or concerns. Systems were in place to monitor the quality of the care and support provided.

Further information is in the detailed findings below.

We found that people were involved in making decisions about their care wherever possible. Where people did not have capacity or needed additional support to make decisions appropriate arrangements had been put in place. This was important to make sure people's rights were protected.

We found that the systems for helping people to manage their medication were overall safe and well organised.

We found that staff were trained and well supported to do their jobs. This included consistent up to date training, regular supervision and staff meetings.

However we did have concerns that some practices in the home were not sufficient to ensure a clean, hygienic environment. These were important to help make sure that people lived in a comfortable home and were protected from the risk of infection, or other illnesses.

People told us 'I can choose when I get up and I get support if I need to see my GP' and 'I attend my review meetings with my social worker, I can discuss my care.'

People said they were well cared for and liked living at the home. One person said 'I get well looked after and I am able to go out on my own.' Another person said 'I go to visit my family and I can go to the shops.'

The home had systems in place to help safeguard people and people told us they felt safe. One person said 'I feel safe and well cared for.'

People told us that they liked the staff that supported them. Comments included 'I like all of the staff who work here' and 'I like to go out shopping with staff.' Staff were recruited safely with relevant checks being completed before they started work. Staff received regular training to help keep their knowledge and skills up to date.

All of the people we spoke with said that they would feel confident in raising any concerns. People told us that they could attend meetings and were asked for their views and opinions. They said that staff were friendly and approachable.