Archived: Crowhurst Care Home

The care service has been developed and designed 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Crowhurst Care Home provides accommodation and personal care for up to nine people who have learning disabilities and some associated physical and/or sensory disabilities. There were five people using the service at the time of inspection. The building was situated over two floors, with people's bedrooms located on both. Some people had their own bathrooms attached to their bedrooms and there were communal facilities for those that did not. There was a kitchen, dining-room, large lounge and day room for people to relax in. People also had access to a large garden area at the back of the property and another at the front, with benches, a fountain and a variety of colourful flowers.

At our last inspection in February 2017, the service was rated 'Requires Improvement' with two breaches to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

The service had a registered manager. 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.

People were safe. Staff had a good understanding of how to recognise potential signs of abuse and knowledge of risks specific to people. There were risk assessments for people and for the building, with relevant safety checks completed by the registered manager each month. Staff were recruited safely and there were suitable numbers so people’s needs were consistently met. People received their medicines safely from staff that were trained to do so. Incidents were investigated within relevant timescales and appropriate actions taken to ensure they did not happen again.

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 practise.

Staff had the skills and knowledge to support people and meet all their needs. They spoke highly of their induction and the support given in getting to know people, their routines and preferences. Further support was provided in supervisions, appraisals and team meetings.

People's nutritional needs were met and they were encouraged to be as independent as possible with preparing food. Any risks associated with eating were highlighted in people’s care plans and appropriate support given during mealtimes. Records showed that the provider sought guidance from health professionals where additional support needs were identified. Professionals we spoke with felt that staff had a good understanding of people’s needs and were responsive to any feedback given.

People, their relatives and professionals all felt that people were supported by a kind and caring staff team. People's dignity, independence and privacy was promoted and encouraged. Staff knew people, their preferences and support needs well.

Care plans were tailored to individual's and highlighted areas where additional support was required. Staff were knowledgeable of people’s communication support needs and used a variety of tools to support them with this. People and their relatives knew about the complaints procedure and felt confident raising concerns. People had choice and control over the activities they wanted to participate in each day. These were tailor-made to people's likes and dislikes.

Since their previous inspection, the registered manager had made improvements to the quality and quantity of audits. People, staff, relatives and professionals spoke positively about the management team. They felt that the service was well-led and that an open, transparent and supportive culture was promoted.

Further information is in the detailed findings below.

There was an acting manager in post. They had started working for the provider in September 2016. At the time of our inspection they were waiting for their application to become the registered manager to be processed by the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Although people told us they felt safe living at the service, we found the provider had not taken appropriate action to ensure people’s safety in relation to security risks involving two exit doors. The provider’s fire risk assessment required updating to reflect changes of use to parts of the building.

The administration of medicines was safe and people told us they received their medicines correctly. However, the provider had not followed their own medicines policy in regard to ‘as required’ PRN medicines.

We found nutritional guidance received from a health care professional had not been clearly communicated with staff to ensure support was consistent.

Although people said they were able to tell staff how they felt about the service, the provider did not have a robust system in place to collect feedback from people’s relatives and other stakeholders. An accessible complaints procedure was not on display within the service.

The provider had not responded in a timely manner to address identified environmental concerns in regard to security, routine maintenance and servicing of equipment. The provider had not made sure peoples’ and staffs records were securely protected.

Senior staff did not have a clear oversight of the service because the systems in place to monitor, analyse and drive improvements in the quality of the service were not robust. Some records in relation to staff documentation were not complete.

Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s needs.

It was clear staff had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

Staff received training and had an understanding of the Mental Capacity Act 2005 and acted in accordance with its principles.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and epilepsy. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. People’s health and wellbeing was monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

People told us staff were kind and we observed positive interactions between people and staff.

Staff had a clear understanding of their roles and spoke enthusiastically about working at the service and positively about senior staff.

People were supported to be involved in activities which were of interest to them. People were encouraged to take an active role in decision making regarding their own daily routines and the general flow of their home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The concerns related to the security of the building and lack of robust quality assurance systems. You can see what action we told the provider to take at the back of the full version of this report.