Archived: Smith Crescent Care Home

Smith Crescent Care Home is a care home that provides short stay care and accommodation for younger adults with learning and physical disabilities. At the time of our inspection, there were two people using the service and 23 people regularly used the service for short stays.

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

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to reduce the risks. There were sufficient numbers of staff who had been safely recruited to meet people’s needs. Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People’s care needs were assessed before they received a care package. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care. People were supported to eat and drink enough. Staff supported people to live healthier lives and access healthcare services when required.

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.

People were treated to kind and compassionate care maintaining their dignity and confidentiality. Staff knew and, were sensitive to people’s individual needs. People were supported respectfully and individually and, a warm and welcoming atmosphere had been developed. People were able to personalise their rooms during their stay and were encouraged to be independent. People had opportunity to meet with the registered manager to discuss any concerns and visitors were welcomed to the service anytime.

The care provided was person centred and delivered the way people preferred to meet their individual needs. Staff understood people’s needs with regards to the protected characteristics of the Equality Act 2010. Information was available to people in accessible formats and staff knew people’s communication needs and understood how best to engage and support people. People were enabled to pursue hobbies and interests and be a part of the local community. Relatives knew how to make a complaint and felt confident doing so.

The service was managed well and there was an effective quality assurance processes in place. The service strived to improve the quality of the care for people. Action plans were developed following any shortfalls in the service.

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. 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 18 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Smith Crescent Care Home is a short break service and provides care and support for up to six people with learning disabilities or autism at any one time. The service currently supports 30 people when they require the service. At the time of our inspection one person was using the service.

There was a registered manager in place. It is a requirement that the service has a 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 and their relatives told us that the service was safe. Staff understood their responsibilities to protect people from avoidable harm and abuse. The provider had a system to manage accidents and incidents and staff were trained to respond to these. Risks to people’s health and well-being were assessed. For example, where people could show behaviours that could cause injury to themselves and others, staff knew about the guidance to follow to support people to remain safe.

The provider had a safe recruitment process in place for prospective staff including undertaking relevant checks. People and staff were satisfied with the number of staff recruited by the provider to offer them care and support. Some staff told us that more staff would help them to offer activities to people when the service was full. The provider said they would consider this feedback. We found that staffing numbers were suitable to support the person currently using the service.

People received their prescribed medicines safely. Staff received training and guidance and understood their responsibilities to handle people’s medicines safely. Medicines were stored appropriately and guidance was available to staff about how people preferred to take them.

People were supported by staff members who had the required skills and knowledge. New staff received an induction when they started to work for the provider. Staff received guidance and training about their role in topic areas such as epilepsy and health and safety.

People were supported in line with the Mental Capacity Act 2005 and were supported to make their own decisions. Where there were concerns about a person’s mental capacity to make decisions, the provider undertook assessments. Any decision made in a person’s best interest included involving significant others such as their family members. Staff understood their responsibilities under the Act. The registered manager had made applications to the appropriate body where they had sought to deprive a person of their liberties.

People and their relatives were satisfied with the food available. Staff knew people’s food preferences and support requirements. Staff followed specialist advice when they supported a person to eat.

Staff had guidance on people’s health conditions so they knew how to promote their well-being. Information about people’s health was available to share with health care professionals, should care and treatment be undertaken in other services that people accessed.

Staff supported people in a kind and compassionate way. Staff protected people’s dignity and privacy. For example, they stored people’s sensitive and private care records securely. People’s relatives could visit when they chose to.

Staff knew the people they supported including their preferences. Some staff told us that improvements could be made to people’s care records to include more information on people’s life histories. The provider told us they would consider this when reviewing people’s care records.

People were supported to be as independent as they wanted to be in order to retain their skills. People were, where they could be, involved in decisions about their care. The provider had displayed information on advocacy services where people may have required additional support to speak up.

People or their relatives had contributed to the planning of their care. People had support plans that were centred on them as individuals. Their support requirements were checked with them or their relatives every time they used the service to make sure staff had up to date information. Staff knew about the people they supported and offered their assistance in line with people’s preferences and routines that were important to them. People had opportunities to take part in activities and interests that they enjoyed.

People and their relatives knew how to make a complaint. The provider took action when they received one.

Staff were supported and knew their responsibilities as the provider had arrangements in place for them to receive support and guidance. Staff knew how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

People and others involved in their care had opportunities to give feedback to the provider. The registered manager was aware of their responsibilities. They had arranged for quality checks of the service to take place to make sure that it was of a high standard. The registered manager told us they would make improvements to the recording of some of the quality checks where this was required.

Smith Crescent Care Home offers short stay accommodation for six younger adults (under 65 years of age) who have a learning disability. The service offers people a break from their usual place of residence as well as providing support for full-time carers. There are six single bedrooms without en suite facilities. Accommodation is provided over two floors, access is via stairs or passenger lift. The home has a rear garden which is well maintained that is accessible to people living in the home. At the time of our inspection four people were using the service.

It is a requirement that the home has a 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. At the time of our inspection there was a new manager in place who was applying to be registered with CQC.

People told us they felt safe. There were systems in place to protect people from abuse and staff knew their responsibilities in relation to safeguarding adults. There were regular checks on the equipment being used and the provider had a plan of what to do if there was an emergency.

There were environmental risks to people who used the service that had not been fully risk assessed or considered. For example, the storage of chemicals was not safe.

People and their relatives felt that the staffing levels were adequate. On the day of our visit we found this to be the case. The staff records we viewed showed us that the manager had made the relevant checks before new staff started employment with the service.

Medicines were safely managed. We saw that there were safe systems in place to make sure that medicines were stored properly. Staff were checked regularly to make sure they were handling medicines safely.

Staff had received an induction and told us they felt supported by the manager. We found that staff were not having regular individual meetings with their manager. This meant that the manager may not have been fully aware of the development needs of staff in order to support people well.

Staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff told us how they offered choices to people and how they could not restrict people without the correct authority. We found that records did not show how or if people had consented to their care.

People told us that they were satisfied with the food and drink offered. We were told there was choice available and staff were aware of people’s likes and dislikes. This was important as some people could not express this for themselves.

People had access to see healthcare professionals when they needed to. The staff team updated people’s records on their health needs when this was required.

We found that staff were caring and offered support that was friendly and pleasant. Staff worked positively with people when they were anxious and used information from support plans to offer consistent support.

We saw that staff worked with people in a dignified and professional way.

Staff knew about what was important to people and we saw this in practice during our visit. However, records did not show how people had been involved in decisions about their care. There was not any information about advocacy available to people.

Staff worked with people in a person-centred way. People received care that was based on what they could and wanted to do. There was detailed information for staff to follow to provide the right support to people.

There were opportunities for people to take part in activities that were important to them. We saw that these were happening when we visited.

Reviews of people’s care and support were taking place but it was not clear from information in care plans when and if people had been included. Relatives told us they had been part of reviews.

People and relatives knew how to complain. The manager had received no complaints in the last year.

Staff told us they felt supported by the manager and enjoyed working at the service. There were opportunities for staff to make suggestions for improvement and we saw this happening when we visited.

The provider had sought feedback from relatives but the outcomes of this had not been shared. There was not a planned way for people who used the service to give feedback.

The manager was largely aware of their roles and responsibilities and knew about reporting specific incidents to the relevant authorities. However, we found that auditing of all of the activities the service undertook did not always happen.

We saw from written records how people were respected and involved in their care.

We found that although support plans were in place they did not always reflect people's current needs and risk assessments were not always in place where risk was identified.

We saw that people's nutritional needs were met during their respite stays with choice and a variety of nutritional meals available.

Medication was handled appropriately ensuring that people received the medication they needed and it was stored safely.

The building was well maintained and the kitchen had recently undergone a refurbishment ensuring that people using the service were able to access it and be involved in all aspects of their care.

Recruitment was carried out by the local authority human resource department and followed legal procedures to ensure that only people suitable to work with vulnerable adults were recruited.

We looked at records kept by the service to ensure they were up to date and fit for purpose, although the majority of the information was suitable, we saw that some support plans were not up to date and did not provide staff with the necessary information they needed to provide support to people using the service.

We saw that people were routinely offered choice in their daily lives. Care workers listened to people's views and took them into account when planning care. The provider told people how they could complain about the service. Care workers supported people to complain if necessary.

We asked people about staff at the service. Comments included, 'The staff's okay.' and 'They're alright.' There were sufficient staff on each shift to meet the needs of people using the service and the provider had systems in place to ensure people's stays were reviewed and any changes necessary were then made for the future short stay.