Crescent Office

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment, including the way people’s medicines were managed.

This service scored 47 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Staff mostly recorded accidents, incidents and concerns, and alerted the office staff. Office staff would then arrange for appropriate support for the person. However, action taken was not always clear and there were no records to demonstrate what learning was identified. For example, after 1 person had fallen. There was no analysis of accidents, incidents or concerns for patterns and trends. This meant opportunities for learning and the chance to improve the service provided were missed.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

A registered manager told us they assessed people’s needs prior to them using the service by using previous assessments either by external health or social care partners. They would then meet the person and family and develop the plan of care required. However, care plans did not contain sufficient detail. This increased the risk that people’s needs, preferences, and risks were not fully understood or met.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People and relatives mostly told us they felt safe with the service people received. For example, a relative said, “[Person] feels safe, and I know he gets on with them [staff]”. However, some people and relatives shared concerns that some inexperienced care staff members did not always know how to provide safe care. This is detailed more in the safe and effective staffing section of this report. There was a policy to guide staff in how to safeguard people from the risk of abuse and harm and staff had undertaken safeguarding training. However, daily records showed safeguarding concerns that were not identified by staff. This included concerns about 1 person’s emotional distress, people not provided with the correct diet and potential medication errors. We raised these as safeguarding concerns with the local authority. Following our inspection, a registered manager told us these had been closed by the local authority.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some people had health conditions and support needs that increased their risk of harm. The provider did not ensure adequate risk assessment and management plans were in place for staff to safely manage these conditions. For example, diabetes. Diabetes can cause people to experience too high or too low sugar levels in their blood and require medical attention. Some people had mobility problems which increased their risk of falls. Others received support from care workers to manage the care of their catheter. Catheters are tubes used to drain a person's urine into an external bag. These can get blocked, and there is a higher chance a person with a catheter will get an infection. Some people stayed in bed which increased the risk of pressure ulcers and others were at risk of choking. The guidance for staff about how to reduce these risks was either not in place, lacked detail or was not followed.

Another person displayed behavioural and psychological symptoms of dementia. There was no risk assessment about how staff should support them, and daily records showed this person frequently experienced emotional distress. There was a lack of information they were supported in a way to minimise this, and the lack of risk assessment increased the risk of emotional distress.

Staff's knowledge about people's conditions and associated risks was variable. For example, 1 staff member could tell us what support a person needed with their health condition, while another staff member who supported the person did not know what health condition the person lived with. This placed people at risk of harm.

The provider detected and controlled potential risks in people’s homes. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider carried out a risk assessment of people’s homes and arranged for external agencies to support if needed. People told us they were happy with the support they received with home safety. For example, a relative told us, “A fire officer came round to check for the fire risks. There was a general check for risks for tripping and falling as well”.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Not all staff could tell us how to safely support people to reduce risks. They also did not demonstrate a good understanding about aspects of their role, such as how to apply the Mental Capacity Act 2005 in their day-to-day work.

We received mixed feedback from people and relatives about staff competence and skills. Comments included, “Some of the carers I find really nice. Some don’t seem to do all of the jobs I would really like. On the whole they’re ok.”, “They’re a good team. I’ve got no complaints at all.” and “They [staff] don’t even know [how to carry out a care task]. The girls [staff] can’t help that. I don’t think they’re given training.”

Staff received an induction, a variety of training and had their competency assessed by senior staff. However, we were not assured the quality of these enabled staff to fulfil the requirements of their role. Some staff had undertaken numerous training courses in a very short time frame, which would make it difficult to understand and retain information.

We also received mixed feedback about visit timings. Examples included, “Usually they’re [staff] not [late], but just occasionally they’re up to half an hour late. If someone can’t come because of illness, Crescent is quite good at finding a replacement. There have been no missed days, and nobody’s been any later than that.”, “Some [staff] do arrive late, and some don’t stay as long as they should. I know they have been struggling with staff, and we have been very flexible, but [Person] does get cross when they arrive after 9 as he likes his breakfast early. To be totally honest some of his carers are fantastic and some not quite so good.” and “Sometimes they’re late or sometimes they’re early. It depends on whether they’re held up.” We discussed our findings with a registered manager who told us they were continually working on ensuring people received their visits when they should.

Staff were safely recruited.

The provider did not always assess or manage the risk of infection.

The provider had an infection, prevention and control policy and staff told us they were provided with clear guidance and training. They confirmed they had access to personal protective equipment (PPE) when needed. However, we received mixed feedback from relatives and people about staff’s infection prevention and control practices. Comments included, “They [staff] do wear gloves when dealing with his breakfast and always wash their hands first”, “Some of them [staff] don’t know how to clean up”, and “Staff don’t wear gloves or aprons.” We discussed this feedback with the registered managers, who told us they had not received these concerns before and would review their processes to ensure safe infection control practice.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Information in people’s care plans did not clearly demonstrate how staff should support people with medicines management. Additionally, care plans did not specify what medicines people took, what support they required with their medicines, whether there were any special instructions or whether any had side effects. This meant staff did not have clear guidance about their role in supporting people with their medicines, increasing the risk of inconsistent or unsafe medicines practices. A relative told us, “There was an issue where they [staff] don’t use the same [pre-packed medication box] for the entire week so it gets confusing for us all. Recently [Person] ran out of tablets, and they didn’t give her the meds. They [staff] didn’t let us know about it and I personally collected them for her and gave them to her. The manager has apologised, and we are now all on the same page.”

Medicine administration records were not detailed or clear, and the dose of each medicine was not recorded. Some people were prescribed medicines that required a minimum 4-hour gap between administration. However, records demonstrated doses were given less than 4 hours apart. Although the registered managers told us this was not happening in practice, poor record keeping increased the risk of medicine errors. The provider implemented measures to ensure recording was accurate at the time of our inspection.

Some people were prescribed 'as required' (PRN) medicines. PRN protocols were not always in place, and when they were, they lacked detail and personalised information. This increased the risk of people not receiving their medicines in the most effective way. Some people were prescribed creams to help skin conditions. There was insufficient guidance related to the application of the creams, and their application was not consistently recorded. This meant people were at increased risk of issues with their skin. When we discussed our concerns with the registered managers, they told us of issues with the electronic medicines recording system and would look to change this.