Crescent Office

Crescent Office is a domiciliary care service providing personal care to 139 people at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People and their relatives told us the service was safe, people were protected from the risk of abuse by staff trained in safeguarding who would not hesitate to alert the registered manager if they had any concerns. Risks were assessed, and controls put in place to minimise the risk of harm to people. Staff were safely recruited and there were usually enough staff deployed to meet people’s needs. Staff were trained to support people with their medicines and to ensure that the risks of infection were minimised.

People’s needs were holistically assessed, and care plans were person-centred with more detailed plans for people who were not able to tell care staff how they wanted their care delivered. Staff told us they felt supported and participated in one to one meetings with their line manager regularly and received regular training and updates. People were happy with the support they received with nutrition. The provider was able to support people with specialist dietary needs. 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 and their relatives told us that staff were kind and caring and they were involved in decisions about their care. They were supported to maintain their independence and staff treated them respectfully.

People told us they spoke with the registered manager before commencing a care package and that their care plans were regularly reviewed. Information was available to people in several different formats on request and the provider had met their responsibilities under the Accessible Information Standard. The provider supported a few people to access the community and several relatives told us they were grateful for the respite having a sitting service provided them with. There was a complaints procedure in place and people knew who they should complain to and if necessary would speak to the registered manager, however they had not had any reason to complain. End of life care planning needed to be more fully embedded into care planning.

People and their relatives thought the service was well-led and that the management team were approachable. The service provided was person centred and the registered manager and their team were committed to supporting people to achieve positive outcomes. Feedback was sought from people and their relatives which was mainly positive, negative comments were addressed when received. Good working relationships were in place with health and social care professionals,

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 requires improvement (published 18 September 2018) and there were multiple breaches of regulation. 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.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crescent Office on our website at www.cqc.org.uk.

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.

This was the first inspection since the service registered with the Care Quality Commission on 30 June 2017. The service location had previously been registered under another name and at that last inspection they were rated Good.

The inspection involved visits to the agency's office and conversations with people, their relatives and staff. The agency provided approximately 180 people with a domiciliary service. People received a range of different support in their own homes. Many of the people were older persons, including people living with dementia and a physical disability.

The service is required to have a registered manager and there was one in post who was also the co-director of the service. 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.

Risks associated with the management of medicines had not been identified. Information about people’s medicines was not always recorded. Medication administration charts were not used and it was not always clear that people had received their medicines as prescribed. Staff had not been effectively trained in medicines and did not have their competency checked. People using the service and their relatives who spoke with us, told us their medicines had been administered safely.

Training records could not evidence staff had received the training they needed to meet people’s needs effectively. Whilst most staff told us they felt supported, the registered manager had not provided staff with regular supervision or appraisal. The registered manager did not regularly monitor staff’s performance when they worked with people in their own homes.

People told us they were always asked for their permission before personal care was provided, however their ability to make decisions was not always assessed in line with the Mental Capacity Act, 2005 (MCA). Staff’s understanding of the MCA was limited.

There was not a robust quality assurance process in place. Audits to assess the quality of service provision were not in place and action plans were not developed to ensure improvements were made.

The registered persons had not always notified CQC of significant events that occurred in the service.

Accidents and incidents had been documented at the service, although records lacked detail about actions taken to prevent further occurrences. Risk assessments identified risks for each person, although some needed more detail.

People’s needs had been assessed prior to receiving care so their needs and wishes could be identified and recorded. Some people had detailed and personalised care plans in place but others were more basic and were largely a list of tasks.

There were enough staff to ensure people did not experience missed visits, however some people and their relatives told us visits were sometimes late. People were appreciative of the support they received from their regular care staff, but some people received care from staff they did not know.

Staff had been recruited in a safe way to ensure new members of staff were safe to support people. Staff were supported with a planned induction.

People and relatives said they felt people were being cared for safely. Staff knew what to do if they thought people were at risk or harm or abuse.

Most people told us kind and caring staff supported them and relatives said staff were usually professional in their approach. Staff were mindful of protecting people’s rights to choice, dignity and respect.

People’s needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People’s communication needs were assessed and staff demonstrated an understanding of how to meet these.

People were protected from the risk of infection as staff understood infection control procedures and used protective equipment when needed. Staff assisted people with meal preparation and people were supported to access other healthcare services when needed.

Feedback from people was sought and there was a complaints procedure in place. Staff were not formally asked for their feedback about the running of the service but they told us they could make suggestions and these were acted on.

Staff worked well together and mostly felt supported by the registered manager, the co-director and the office staff.

We identified 4 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.