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Inspection carried out on 4 December 2019

During a routine inspection

About the service:

The Crown is a residential care home which can accommodate up to seven people. The service has been designed to accommodate people living with a learning disability or autistic spectrum disorder primarily from the Jewish community. However, non-Jewish people can also access the service. The accommodation is arranged over three floors and includes seven individual living spaces - each with their own ensuite and kitchenette facilities. Three of the living spaces have been designed for people with physical disabilities. Accessibility is further promoted through the inclusion of a lift and accessible outside space, including parking. At the time of this inspection there were three people living at the service.

Overall, the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

There was limited evidence the provider checked to make sure people received good quality, safe care and support. We found areas that continued to require improvement. However, a new registered manager had already identified most of these and was making changes to improve the service and people’s experience of living at the service.

People were safe. Staff understood how to protect them from abuse and risks to people were managed, to ensure their safety and protect them from harm. Staff ensured people received their medicines when they needed them and ensured the premises were kept clean and hygienic.

There were enough staff to meet people’s needs. Staff treated people with kindness, respecting their privacy and dignity too.

People were supported to stay healthy. Staff ensured people had a choice of food and had enough to eat and drink. They also helped people to access healthcare services when they needed to.

People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Since the last inspection opportunities had improved for people to participate in a variety of meaningful activities, both in and out of the service.

The new registered manager promoted a positive culture that was person centred and open. People were given the opportunity to make suggestions and provide feedback about the service provided to them.

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 Requires Improvement (published 7 December 2018).

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

At this inspection we found improvements had been made.

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.

Inspection carried out on 7 November 2018

During a routine inspection

The Crown is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Crown has been designed to accommodate up to seven people living with a learning disability or autistic spectrum disorder primarily from the Jewish community. However, non-Jewish people can also access the service. The accommodation is arranged over three floors and includes seven individual living spaces - each with their own ensuite and kitchenette facilities. Three of the living spaces have been designed for people with some physical disabilities. Accessibility is further promoted through the inclusion of a passenger lift and accessible outside space, including parking. At the time of this inspection there was one person living at the service.

This was the first inspection of The Crown since it registered with CQC in September 2017. This means the service has not previously been rated. During this inspection, which took place on 7 November 2018, we found that the service had not fully complied with a number of legal requirements. We have therefore rated the service as Requires Improvement.

The registered manager acknowledged our findings. Shortly after the inspection they confirmed they were taking action to address all the areas we had identified for improvement.

Why we rated the service Requires Improvement:

The provider checked to make sure staff were safe to work at the service, but the checks made did not fully meet all the legal requirements.

People received their medicines as prescribed. However, medicine administration records did not always provide an audit trail to explain anomalies, such as a tablet being taken from the wrong day in medicine packaging.

Staff were not aware of some key legislation and good practice guidance.

The pre-admission process needed to be improved, to ensure staff had enough information to decide whether the service could meet people’s needs before they moved in.

Improvements were needed to ensure people had opportunities to participate in meaningful activities that were of interest to them and met with their individual aspirations.

Staff needed to establish people’s preferences for their end of life care, should the need arise.

Quality monitoring systems were not adequately robust. There were also no formal systems in place to get feedback from people, in order to develop the service.

The arrangements for out of hours cover, in the absence of the registered manager, were not adequate.

We did find that the service was providing a good service in other areas that we checked. For example:

Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely and they were protected by the prevention and control of infection.

There were enough staff, with the right training and support, to meet people’s needs and help them to stay safe.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People were supported to eat and drink enough. Arrangements were in place to ensure meals were prepared in a way that met the requirements of Jewish law and the provision of Kosher food,

Staff worked with external professionals to ensure people received effective care and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The building provided people with sufficient accessible space, including a garden, to meet their needs. The service operated in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

The service acted in line with legislation and guidance regarding se