Crescent House

Crescent House is a residential care home for up to 33 older people and people living with dementia. At the time of inspection there were 33 people living at the home.

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

There was a registered manager who had been the manager of the service since it registered with CQC in December 2010.

Staff received training in safeguarding vulnerable adults. They demonstrated they understood their responsibilities to protect people from the risks of harm and abuse.

People’s risks were assessed at regular intervals or as their needs changed. Electronic care plans were readily available to staff who used these to provide care to meet people’s current care needs.

People were involved in planning their care; their care plans clearly showed how people preferred to receive their care. Staff supported people to maintain their dignity and their independence was promoted.

People received care from a consistent group of staff who knew people well. Staff were recruited using safe recruitment practices.

People were protected from the risks of infection by staff who followed the provider’s policies. The management team carried out spot checks on staff and there were extra washing facilities in areas where people petted the animals.

People received their medicines as prescribed. Staff received training in the safe management of medicines and their competencies had been checked.

Staff received an induction which provided staff with a good foundation of knowledge and understanding of the organisation and their roles. Staff received regular updates to their training and supervision to support them in their roles.

People received meals that met their dietary needs and helped maintain their health and well-being.

Staff supported people to attend health appointments and referred people promptly to their GP or other medical services when they showed signs of illness.

People lived in a well maintained, nicely decorated home. People could access communal areas easily. Additional social areas had been developed including a covered patio area where people accessed ponies and an activities room that had facilities designed for people living with dementia.

People were involved in creating activities where they wanted to. People who received all their care in their bedrooms received one to one time with activities staff. The provider ensured people with a disability or sensory loss had access and understood information they were given.

People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

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 registered manager and the management team promoted person centred care in all aspects of the service.

The management team were pro-active in using information from audits, complaints, incidents and safeguarding alerts to improve the service. The managers worked with staff to identify ‘near misses’ to understand how things went wrong and involved them in finding solutions.

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 April 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.

Crescent House is registered to provide residential care for up to 33 older people. At the time of this inspection there were 33 people living in the home.

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 2008 and associated Regulations about how the service is run.

People felt safe in the home and relatives said they had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. There were sufficient staff to meet the care needs of the people and recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Staff had good relationships with the people that lived in the home. Staff responded to complaints promptly and in line with the provider’s policy. People and staff were confident that issues would be addressed and that any concerns they had would be listened to and acted upon. There was a stable and accessible management team in place.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

Care plans were written in a person centred approach and detailed how people wished to be supported. Where possible people were involved in making decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People were not always able to access suitable levels of social interaction and activity. In response to feedback from people, relatives and staff the provider has reviewed and increased staffing levels to support this.

There were systems in place to monitor the quality and safety of the service. Where these had required strengthening in some areas the provider had acted promptly to ensure that people’s care and support needs were being met appropriately.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The staff on duty had a good understanding of how to meet the needs of people who used the service. We saw that people were relaxed and comfortable in the presence of the staff. All the people we spoke with told us that they felt safe living at the service and they were happy with their care

Staff received regular training and support which helped them to provide safe care. Staff knew who they should contact, should they have any concerns about the treatment of people who used the service. Health and safety checks were carried out to make sure the premises and equipment used were safe for people using the service.

People received an assessment of their needs so their needs could be met by staff. However, we found that some people did not have care plans and risk assessments put in place for care needs that had been identified. People's care plans were also not always updated with changes in their care needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were involved in making decisions in how they wanted their needs to be met. They told us they were asked by staff how their care and treatment needs were to be met by them. They told us that they were happy with the care they received from staff. We saw staff had received the training and support they needed to meet people's needs effectively.

Is the service caring?

We saw that staff approached people who used the service in a caring and respectful manner. People we spoke with told us that the staff were available when they required their support. They told us that the staff were kind and supported them. One person told us that they had 'no complaints' and got on well with all the staff. The staff told us that they enjoyed working with the people and they worked well as a team.

Is the service responsive?

We saw that staff were available to support people who used the service. One person told us when they felt un-well; the staff rang the GP to visit them. Another person told us that they had review meetings with their family and the staff from the home. This was to discuss how their needs were being met at the service. They told us they felt listened to and supported by everyone at the meeting. They also told us when they rang the call bell; the staff came and helped them with their personal care needs.

Is the service well-led?

The provider had monitoring systems in place to ensure that medication administration records were fully completed. We saw that health and safety checks were also undertaken regularly to ensure all systems were kept up to date to keep people safe. However we found people's care plans and risk assessments were not being monitored and updated to meet their current needs.

The service had a quality assurance system to obtain annual feedback from people who used services and their representatives to monitor the quality of service provided. However, we found that some identified improvements were not always acted upon. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve

We spoke with four staff members who told us they felt well supported by the manager and that people who used the service received a good standard of care.

We found that people's needs had been assessed and care plans were put in place to ensure their needs were met. We found they included information about people's preferences and usual routines. We saw that where risks relating to people's care had been identified control measures had been put in place. We saw that people were protected from the risks of inadequate nutrition and dehydration.

However, we identified some concerns with pre-employment checks that had been undertaken and the way in which training records were being maintained. We also found that there no records kept of when cleaning had been carried out.