Crossbrook Court

About the service

Crossbrook Court is a care home without nursing providing accommodation and personal care to 10 people at the time of the inspection. The service can support up to 14 people.

There were 2 separate buildings sharing the same grounds. One building had 1 self-contained apartment and 7 en-suite bedrooms. The second building had 3 self-contained apartments and 3 en-suite bedrooms.

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

Right Support

Staff supported people to have the maximum possible choice and control over their lives and be independent. Since the last inspection all restrictions imposed to people’s freedom were reviewed and lowered as much as possible. Where restrictions had to be in place these were regularly reviewed, and staff involved health and social care professionals in these reviews. The provider’s behaviour specialists were working with people to manage their anxieties better so that restrictions were minimised. People had specialist psychological support as well as on-going support from staff.

People were supported by staff to identify and pursue their interests or aspirations. People were supported where possible to participate in setting goals for themselves as well as participate in ‘Quality of Life’ reviews. The provider started using the quality-of-life tool in care reviews. This tool helped them focus on people’s experience, allowed feedback from relatives and other professionals involved in people’s care and highlighted areas where further improvements were needed to achieve good outcomes for people.

People had a choice about their living environment and were able to personalise their rooms. People told us they were supported to choose their décor and furnishings. The environment was undergoing refurbishment at the time of the inspection to ensure it better suited people living there. People’s medicines were managed safely.

Right Care

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. Incidents were recorded electronically for senior managers to access and review remotely to identify trends and patterns if needed and take further action to support staff in how to keep people safe.

The provider employed enough staff to meet people’s needs and keep them safe. The use of temporary agency staff had dropped significantly since the last inspection, and this had a positive impact on people.

The provider started a training programme for staff to learn how to communicate with people who had individual ways of communicating, such as using body language, sounds, Makaton (a form of sign language), pictures and symbols. Daily support from a supporting manager was available for staff working in the home to help ensure effective communication with people.

People started to receive care and supported to fulfil their needs and aspirations and focus on their quality of life following best practice. Staff were working with people to create new opportunities for them to try and enhance their lives. However, more work needed to be done to ensure people’s care was centred around their likes, dislikes and their wishes respected.

Risk assessments were in place to ensure staff knew how to support people safely. Work was still being done to encourage and enable people to take positive risks.

Right culture

The provider’s management team recognised the need to promote a positive culture in the home. Their ethos and values to ensure people were enabled to lead inclusive and empowered lives were promoted within the new staff team. Staff were valued and supported to develop their strengths and skills and to understand best practice in relation to supporting people with a learning disability and/or autistic people. However, further work was needed for personalised care and support to be embedded in staff culture.

The quality of support provided to people was reviewed regularly. This involved people, their families, and other professionals as appropriate. Health and social care professionals as well as relatives gave positive feedback about the way the service had improved since the last inspection. Family members felt more involved in people’s care, and they felt listened to.

At the previous inspection we found staff did not ensure the risks of a closed culture were minimised. Whilst there was still a reliance on internal resources, the service had involved and listened to external health and social care professionals in implementing current best practice and guidelines when supporting people. The service worked in an open and transparent way, sharing information, and regularly meeting with external professionals to discuss people’s support.

The provider had changed and further developed their governance systems. This was to ensure they effectively monitored and improved the quality and safety of the care people received. The improvements identified as needed by our previous inspection had commenced with a delay. This was because the provider had to employ and train a permanent staffing group as well as employ a new manager. Some positive outcomes could be already identified for people following the improvements made, however the improved practices needed to be embedded and sustained.

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 inadequate (published 06 September 2022).

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.

This service has been in Special Measures since 06 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Crossbrook Court is a care home without nursing providing accommodation and personal care to 12 people at the time of the inspection. The service can support up to 15 people.

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

Right Support

The staff did not support people to have the maximum possible choice and control over their lives and be independent. Not all restrictions were considered when looking at the least restrictive options for individual people. Some internal doors were kept locked to all people without considering how the risks for each individual person could be safely supported. The service did not work with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

People were not consistently supported by staff to identify and pursue their interests or aspirations. People were not supported to agree plans with clear steps that would support them to develop skills and interests, get jobs or support their sensory needs to enable people to cope with their environment.

Most people had a choice about their living environment and were able to personalise their rooms but not all people were supported to choose their décor and furnishings. The environment was not designed in a way that comfortably supported people to have a choice over when they used communal spaces due to the small size of the rooms.

Staff supported people with their medicines but their approach did not follow best practice to ensure safe administration in a way that promoted independence and upheld people’s privacy and dignity.

Right Care

Not all staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and some staff knew how to apply it. Incidents were recorded electronically for senior managers to access and review remotely.

The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe. This was due to a high use of agency staff which did not support people to receive consistent care from staff who knew them well.

People who had individual ways of communicating, such as using body language, sounds, Makaton (a form of sign language), pictures and symbols could not interact comfortably with staff and others involved in their care and support because staff did not have the necessary skills to understand them.

People did not receive care that supported their needs and aspirations, and did not focus on their quality of life, or follow best practice. People did not have interests that were tailored to them. The service gave people little opportunity to try new activities that enhanced and enriched their lives.

Staff did not accurately or fully assess risks people might face. Where appropriate, staff did not encourage and enable people to take positive risks.

Right culture

People did not lead inclusive and empowered lives because the ethos, values, attitudes and behaviours of the management and staff did not promote this. People were supported by staff who did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not receive compassionate and empowering care that was tailored to their needs.

Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate. People and those important to them, told us they were not always involved in planning their care.

Staff did not ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. There was a reliance on internal resources, the service had not been supported by the provider to ensure they were aware of and implementing current best practice and guidelines.

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

Why we inspected

We received concerns in relation to fire safety, risk management and the quality of care. We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. The provider was in breach of regulations in relation to restrictive practices, management oversight, personalised care, how they managed risks to people and staffing levels and skills. Please see the safe, effective, caring, responsive and well-led sections of this full 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 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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have issued four warning notices to the provider in response to breaches of regulations 11 (consent), 12 (safe care and treatment), 17 (good governance) and 18 (staffing). We have imposed a timescale of three months from the date they were served for the required improvements to be completed.

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

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection on 25 November 2015 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe. Staff spoken with were aware of how to keep people safe from harm and demonstrated their awareness to us of identifying when a person may be at risk of harm or abuse. Risks to people’s physical and mental health were assessed and appropriate measures put in place to mitigate the risks. People’s medicines were managed safely.

Where people had been diagnosed with a mental health condition, staff sought the advice of a psychiatrist who regularly reviewed people’s mental health needs and was on hand should people’s mental health decline.

Staff completed a range of training and they felt supported by the managers at the home to carry out their roles effectively. Staff demonstrated their awareness of how to support people who may not be able to make their own decisions about their care or treatment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat a nutritious and healthy diet and could choose what they ate. Staff involved health and social care professionals in people`s care.

People told us that staff were kind, caring and patient and they were treated in a dignified and respectful manner and staff understood the importance of respecting their dignity and privacy.

People were actively involved in developing and shaping their care in a manner that was important to them. People's care plans were reviewed regularly to help ensure they continued to meet people's needs. Where people’s care was reviewed by a multi-disciplinary team, that involved the person, their key worker, occupational and behavioural therapists, the manager along with any other relevant professionals.

People told us they were supported to pursue individual interests and leisure activities with support from staff. People told us that staff responded when they made a complaint or raised a concern. Complaints were listened to, recorded and responded to appropriately.

There were quality assurance systems in place effectively used by the manager and the provider to constantly improve the service provided to people.

Further information is in the detailed findings below