Neave Crescent

Neave Crescent is a residential care home that provides personal care for up to ten people with learning and physical disabilities. At the time of the inspection there were seven people living at the service receiving care.

The service comprised of two adjoining purpose-built bungalows. The service is larger than recommended by best practice guidance. However, we have rated this service good because the provider arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community. The size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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 that 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

The service applied the principles and values Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

Staff were trained in safeguarding and knew what to do if they suspected abuse. People were risk assessed to monitor and mitigate risks to them. Regular health and safety checks were completed to ensure the property was safe for people. Relatives told us and records confirmed there were enough staff working. Staff were recruited safely. Medicines were safely managed. Staff understood infection control and relatives told us the service was clean. Incident and accidents were recorded, and lessons learned when things went wrong.

People’s needs were assessed to ensure the service could meet their needs. Staff received inductions to ready them in their new roles. Staff were trained to do their jobs and were supervised by the management team at the service. People were supported with their nutrition and hydration and the service followed instructions from dieticians where required. Staff communicated with other agencies to support people. People were supported with their health care needs. People were able to decorate their rooms how they pleased. 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 were treated well by staff and the service had received numerous compliments. Staff were trained in equality and diversity and the service supported people’s human rights. People and their relatives were involved in decisions about their care. People’s independence was promoted and their dignity and privacy respected.

People’s care plans recorded their needs and preferences, and these were reviewed regularly. Staff knew how to communicate with people. People were supported to take part in activities they enjoyed including going on holiday. Relatives knew how to make complaints and when this happened the registered manager responded appropriately. People’s end of life wishes were recorded.

People, relatives and staff thought the service was well managed. Staff knew their roles and responsibilities. The registered manager was supported in their role. People, relatives and staff were engaged and involved in the service and staff had received positive feedback from stakeholders. The service worked in partnership with other agencies. Quality assurance processes at service ensured people received a good standard of care and the service sought to improve where shortfalls were found.

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 good (published 20 September 2017.)

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.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements which had been signed by the registered manager as completed on 13 June 2016.

At this inspection, we found the provider had made the required improvements as outlined in their action plan. The service was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Neave Crescent is registered to accommodate ten people with profound and multiple learning and physical disabilities. People are accommodated in two adjacent bungalows which are purpose built. At the time of our inspection, the service was providing care and support to nine people.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

During this inspection, we found that people were protected against the risks associated with the unsafe management and use of medicines. Staff received regular competency checks to ensure they had the correct skills for administering medicines.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Systems were in place to minimise risk, to ensure that staff supported people as safely as possible.

The provider had systems to deal with foreseeable emergencies and there were safeguarding adult's policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. Staff were recruited safely and there were appropriate numbers of staff to meet people's needs.

Staff were knowledgeable about people's individual needs and how best to meet these. Staff had access to the support, supervision, training and on going professional development that they required to work effectively in their roles. The training and support they received helped them to provide an effective and responsive service.

Staff had received Mental Capacity Act 2005 (MCA) training and understood the systems in place to protect people who could not make independent decisions. The service followed the legal requirements outlined in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People received a person centred service and had detailed personalised plans of care in place. They were supported by kind, caring staff who treated them with respect. Their cultural and religious needs were respected and celebrated.

People were supported to maintain good health and nutrition.

People and their representatives knew how to raise a concern or make a complaint and effective systems were in place to manage complaints.

People lived in an environment that was suitable for their needs. Specialised equipment was available and used for those who needed this.

The quality of the service was monitored by the service's operations manager and the registered manager. The service had a positive ethos and an open culture.

Neave Crescent is registered to accommodate ten people with profound and multiple learning and physical disabilities. People are accommodated in two adjacent bungalows which are purpose built. At the time of our inspection the home was providing care and support to ten people.

The provider of the service is an organisation (The Avenues Group). The home had a registered manager in post. 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 at the service and were cared for by staff who were knowledgeable about safeguarding people. They knew how to report concerns.

However, we had concerns that medicines at the home were not managed safely. Protocols were not in place for the safe administration of medicines to be administered when required (PRN) for the people concerned. There were no records of regular effective systems in place to monitor and check safe medicines practice within the home.

Not all care plans we looked at included specific risk assessments which identified risks associated with people’s care. They did not sufficiently guide staff about how to minimise risks in order to keep people safe.

Staff were supported through regular supervision, and the provider is in the process of ensuring that systems were in place to ensure staff received an annual appraisal of their practice and performance.

There were sufficient qualified and experienced staff to meet people’s needs. Staff received the support and training they needed to provide an effective service that met people’s needs. The staffing levels were flexible to support with planned activities and appointments.

The recruitment process was robust to make sure that the right staff were recruited to keep people safe. Staff confirmed and personnel records showed that appropriate checks were carried out before they began working at the home.

Staff had received Mental Capacity Act (2005) training and understood the systems in place to protect people who could not make independent decisions. The service followed the legal requirements outlined in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People were supported to have a nutritionally balanced diet and had adequate fluids throughout the day to promote their health and wellbeing.

People were supported to see specialist healthcare professionals according to their needs in order to ensure their health and well being were adequately maintained.

People were looked after by staff who understood their needs, were caring, compassionate and promoted their privacy and dignity.

We found that not all care plans were based upon people’s specific individual needs and wishes. They were not regularly reviewed and updated according to people’s changing needs.

A pictorial complaints procedure was available. People’s relatives were made aware of the complaints procedure and they knew who to speak with if they had any concerns.

Systems were in place to evaluate and monitor the quality of the service. However, improvements were needed to ensure there was continued monitoring of the progress made where actions were identified.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People's care and support needs were regularly assessed and monitored. People were supported to take part in meaningful activities at home and in the wider community.

There were safe systems in place to provide people with a clean environment and to minimise the risk of cross infection.

The premises were appropriately maintained and were suitable for the needs of people using the service.

The staffing levels and skills mix of staff meant that people received the support they required to meet their holistic needs.

People using the service and/or their representatives were confident that any complaints would be taken seriously and properly managed.