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St Anne's Community Services - The Crescent Requires improvement


Inspection carried out on 3 December 2019

During a routine inspection

About the service

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.

Inspection carried out on 10 May 2017

During a routine inspection

St Anne's Community Services - The Crescent is a residential care home located in the village of Green Hammerton, a short drive from York. The service is registered to provide accommodation for persons who require nursing or personal care for up to 5 adults. The service specialises in supporting people who may be living with a learning disability or autistic spectrum disorder.

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.

Inspection carried out on 22 January 2015

During a routine inspection

This inspection took place on 22 January 2015. Because it is a small service we contacted the registered manager the day before the inspection to check that people would be in.

St Anne's Community Services - The Crescent is a care home registered for up to 5 people with a learning disability. The service is a detached two-storey property converted from two former semi-detached houses and is located in the village of Green Hammerton. The home is close to a range of community amenities and facilities. At the time of our inspection there were 5 people living there. The service includes an outside space which is accessible for wheelchair users.

There was a registered manager in post at the time of our inspection. 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.

St Anne's Community Services - The Crescent provided good care and support for the people that lived there. People were encouraged to lead fulfilling lives in line with their own preferences and choices. The emphasis was on supporting people to be as independent as possible. People were involved in making decisions about their care and how the service was run. Care and support plans contained clear and up to date information about how people wanted their needs met. There were good opportunities for people to discuss any concerns or ideas that they had.

People were supported in having their day to day health needs met. Health services such as dentists, GPs and opticians were used as required and there were close links with other services such as the local North Yorkshire County Council Learning Disability Team.

People told us they had good relationships with the staff team. Staff were knowledgeable about the needs of each person and how they preferred to live their lives. Staff got the training they needed and were supported through regular supervision meetings with the registered manager. There were safe recruitment practices in place for new staff and people got involved in the recruitment process.

There were good systems in place to keep people safe. Staff were confident about their responsibilities in relation to safeguarding and also knew how to whistle-blow if needed. There was a positive approach to risk taking so that people could be as independent as possible. Risks in peoples’ day to day lives had been identified and measures put in place to keep people safe. The focus was on how each person benefited from the activity undertaken.

The staff team were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are safeguards put in place to protect people where their freedom of movement is restricted. One person had been referred for DoLS authorisation due to their dependence on staff for help with mobilising. Staff had been trained in the MCA and had a good awareness of issues relating to capacity and consent.

The service was well led. The registered manager was responsible for managing two services and spent part of her time at St Anne's Community Services - The Crescent. Staff told us that the service was well managed and that there was good support. The registered manager promoted a culture of respect, involvement and independence. There were good systems in place to make sure that the quality of care was maintained and areas that required improvement were identified and necessary action taken.

Inspection carried out on 11 February 2014

During an inspection looking at part of the service

In November 2013 we carried out an inspection of this service. We judged, at that time, that improvements were needed to the infection control arrangements at the home. At this inspection, we found improvements had been made and the issues we identified had been addressed.

Inspection carried out on 12 November 2013

During a routine inspection

During our visit we spent time observing how people were being cared for. We also spoke with people who were able to share their views and talked with the staff on duty. We saw that people were at ease with staff and that the staff knew the people they were supporting well. People appeared relaxed and comfortable in their surroundings.

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.

Inspection carried out on 4 October 2012

During a routine inspection

People were supported to make decisions and choices regarding their care and treatment. They told us that they were supported to attend health appointments and had read and agreed to their care records.

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.

Inspection carried out on 20 June 2011

During a routine inspection

People who use the service told us that they are able to make their own decisions and staff support them with this. They also said ' I like living here and I can do what I want to' another person said 'staff help me to be independent'. During the visit staff were observed working with peopleand seen to ask and encourage people about what they were doing.

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