Crescent Office

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans were not detailed or person-centred. For example, for 1 person, it stated they were ‘diagnosed with dementia’ and ‘can be in a lot of pain’, but there was no other information about this or how staff could support them. Other areas of care plans were not accurate. For example, some were written based on a health or social care professionals’ assessment at the time the care package started and were not updated to reflect changes.

Care plans contained a 'task list'. This was to provide staff with an overview of the tasks and support the person required on each call. The care worker was required to 'tick off' the tasks when they were completed which demonstrated they had supported people in line with their care plan. This went some way to ensure people’s needs were met; however, it was not detailed enough to demonstrate person-centred care.

Most people and relatives told us staff knew people well and supported them in line with their needs and preferences. For example, a relative said, “They [staff] do understand his needs and communicate well with him.” This reduced the risk of people receiving unsafe care. However, some told us the staff with less experience did not provide care in the way they needed or preferred. We discussed our concerns about the lack of accurate and personalised information in care plans with the registered managers.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Most people and relatives were happy with the care they received, particularly when consistent staff supported them. They told us staff understood their health and care needs. However, other people and relatives said their care team was not consistent and some did not understand their needs.

Staff completed daily care notes with details of the care given. This helped staff to provide a continuity of care. We saw records that asked staff on the following shift to monitor a person’s condition or carry out a task they did not have time for such as drying clothes.

Most people had communication care plans in place. Staff told us they understood people's communication needs and people and relatives confirmed this. A registered manager told us they provided information to people in a way they understood. For example, by providing information in a large font for a person with impaired vision.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The registered managers told us there had been no complaints from people or relatives. However, some people and relatives told us they had complained and were unhappy with the outcome. The managers stated these were not recorded as complaints, as they did not consider them to be formal. The lack of a clear and effective complaints process meant concerns were not recognised or addressed, resulting in some people continuing to receive care they were unhappy with. The registered managers told us they would review and improve their complaints process.

Individual reviews of people’s care took place with them. Most people were positive about this process and said they felt listened to.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We received mixed feedback about whether call timings were at the right times for people. A registered manager told us they were working hard on meeting call timing requests. We saw from records that people's requests were acted on when they could be. People and relatives had access to an out of hours service should they need to speak with someone from the service during these times.

Staff understood people had a right to receive equal access to health and care support when needed, which included GPs and mental health team if needed.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

We received no concerns from people about how the service supported equity in experiences, and we saw staff had received training in equality, diversity and inclusion.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Care plans did not contain any information about people’s future life changes, including planning for end-of-life care. A registered manager told us people, and their relatives had not wanted to discuss end-of-life care with them, so they developed a form to help prompt this discussion. However, some people and relatives told us they were not asked about their wishes. Staff received training and told us they felt they provided good care to ensure a dignified and pain free death.