Crescent Nursing Home

About the service

The Crescent is a residential care home providing accommodation for people who require nursing and personal care to up to 28 people. The service provides support to people living with a range of physical and psychological needs, including dementia, mental health and learning disabilities. At the time of our inspection there were 25 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Care

Medicines were not always administered safely. Information which was recorded within the medicine administration record (MAR) was not always clear or accurate. Guidance for staff was not consistent within records or person centred.

A recruitment process was in place. Staffing levels were appropriate to meet the needs of people safely.

Staff received training which equipped them with the skills for their role.

All staff were positive and motivated in their role. This supported a positive atmosphere and environment for people to live in.

Staff were passionate about the people they cared for and understood the importance of providing care, which was dignified, respectful and which enabled independence.

Right Support

Risk assessments and care plans had been completed. Not all of the records contained person centred information.

People were supported to maintain personal friendships and links within the community.

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.

Right Culture

The quality assurance processes and systems in place were not robust in identifying and addressing the shortfalls of the service.

People were supported by a familiar staff team.

People, their relatives and staff spoke positively of the registered manager who they found to be approachable.

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 Outstanding (published 04 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of Safe, Responsive, and Well-Led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to the safe administration of medicine and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People could nominate three named visitors, and the essential care giver role was available in addition to this. Visitors were required to produce a negative rapid COVID-19 test prior to visiting their relative. Additionally, health declaration and temperature checks were completed. The essential care giver role included enhanced COVID-19 testing which was supported by staff.

External health and social care professionals, and visitors, evidenced COVID-19 vaccination status, and had to produce a negative rapid COVID-19 test before entering the care home. Furthermore, health declaration and temperature checks were completed. The only exception to this was for emergency workers, to ensure no delay of their review and care for people.

People were regularly monitored by staff for health changes, and a new clinical system had been implemented at the care home. This system allowed staff to escalate concerns directly with healthcare professionals, which led to people receiving a prompt review.

Personal protective equipment (PPE) was available at the care home, and guidance for PPE usage was displayed. Staff were observed to wear PPE correctly, and wore uniforms whilst at work. The registered manager had ensured ongoing training and competencies had taken place with staff, to confirm their safe use of equipment.

The care home was visibly clean and hygienic. Frequently touched areas, such as door handles and handrails, received enhanced cleaning. Robust cleaning schedules were in place which identified the cleaning products to use, and the required frequency of cleaning. Staff told us they had access to the required equipment, and cleaning products, to maintain a safe environment.

At the last inspection on 25 March 2015 we rated the service overall Good, however they Required Improvement under safe. On 29 July 2015 we carried out a focused inspection to check if the necessary improvements were made. We found that the service improved, however we did not change the rating to ensure that the improvements were sustained over a longer period of time. At this inspection we found that the improvements were sustained and further improved. At this inspection we rated the service Outstanding.

The home has 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.

Without exception people told us that staff were extremely responsive to their needs and preferences and that their care was personalised about them as an individual person. Relatives were highly complementary about the exceptional care and support their family member received.

People were able to maintain hobbies and interests that they enjoyed prior to moving to the home and develop others. Staff enabled people to live the life they wanted and organised social activities, group activities and individual activities. People were able to decide what they wanted to do every day or participate in planned activities, which took place in the day service. This gave people a sense of being in control of their life and empowered them to do what they wanted.

The service was exceptionally well led. There was visible and effective leadership within the service. The service was effectively organised and well run with an open and transparent culture. The registered manager was supported by a dynamic management team that demonstrated a holistic approach and had clear oversight of how the service was meeting people’s physical, emotional and social needs.

People received care and support from competent and dedicated staff because the management team encouraged them to learn and develop new skills and ideas. Staff when asked about the culture and values of the service told us that they felt an integral part of a team and enjoyed their work. They were extremely passionate and committed to providing quality care and were clear on their roles and responsibilities.

The service promoted a culture that was open and transparent. The registered manager operated an open door policy and people, relatives and staff felt able to make suggestions on the quality of the care provided. Quality assurance systems were in place and these were used to obtain feedback about the service, monitor performance and manage risks.

The provider was actively involved in pilot projects and different local groups to constantly improve and broaden the services and opportunities they offered to people living at the home.

People were actively encouraged to voice their opinions regarding all aspects of their care and support. They told us they felt valued and included in making decisions that affected them and were actively involved in their on-going care arrangements. People and their relatives could voice their views and opinions which the management team listened and acted on.

People told us they felt safe and protected from harm in Crescent Nursing home. Staff were knowledgeable about people`s vulnerability and demonstrated good understanding about safeguarding procedures and signs of possible abuse. They told us they always reported their concerns to managers and they were knowledgeable about whistleblowing procedures to report their concerns externally to local safeguarding authorities.

People told us there were sufficient staff employed to meet their needs at all times. Recruitment procedures were robust and ensured that staff working at the home had the right to do so.

People were supported to take their medicines safely by appropriately trained staff who had their competencies regularly assessed.

Risks to people`s well-being were assessed and measures were in place to mitigate these, however staff had a positive approach towards taking risks and enabled people to live the life they wanted.

People`s consent to the care and support they received was sought and staff worked following the principles of the Mental Capacity Act 2005 for people who lacked capacity to take certain decisions to ensure that the care and support they received was in their best interest.

People told us they were provided with sufficient food and drinks and the quality of the meals were good and satisfied their needs.

Staff told us they received regular training and updates to keep them skilled and knowledgeable about the roles they performed. Staff had regular supervisions and they felt supported by the management team at the home.

Is the service safe?

People told us they felt safe. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The service had sufficient staff, who were appropriately trained and knowledgeable about people's care and support needs.

Is the service effective?

People were provided with appropriate care and treatment, and their needs had been met. Staff received training to support people with various care needs. Some of the people had complex needs which meant they were not able to understand their care plans. However, we saw multi-disciplinary involvement in assessing people's needs.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. They were able to communicate effectively with people with limited verbal communication. The staff obtained people's consent before any care or treatment was provided. One person said, "Staff are friendly and caring. They always help you if you need anything."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals were made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to access a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

We spoke with three people about their experience of living at the home and the care and support they were offered. People told us they liked living at the home and were happy. They told us they felt safe in the environment and with the care they were given by staff. One person said, "Staff do everything for me. They are really kind and I like them all." Another said, "It's ok here."

Some of the people were unable to express their views directly because of complex communication problems so we observed engagement between them and staff. It was evident that staff interacted positively with people and respected their individual needs and abilities. We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support.

We observed evidence of effective record keeping and robust recruitment processes. We were given free access to all information we required as part of this inspection.

We used different methods, such as observations, to help us understand peoples' experiences and to ensure that they were being treated with dignity and respect. Some people had complex needs which meant that they were not fully able to tell us about their experiences, so we communicated in a way that was appropriate for them.

We observed a relaxed atmosphere in the home with positive interactions between staff and people who were engaged in activities of their choice, either within the day centre or on a more individual basis. Although we noted there was a planned activity schedule in place, we saw that people had the choice to participate as they pleased with staff offering choices as to how they spent their time.

Staff were friendly and polite in their approach and interacted effectively with people. This showed that staff understood the needs of the people they were supporting. One person said, "Staff do what I want them to and know me well."

During our visit, we spoke with four members of staff who told us they were happy working at the home and felt supported to carry out their roles, receiving a robust programme of training and supervision, including Safeguarding of Vulnerable Adults and Mental Capacity Act 2005.

We spoke with one person's relative who told us they 'couldn't fault' the care and support given to their family member. They said they were made to feel "part of the family" and staff were very supportive and understanding of both their needs and those of their relative.

We observed a friendly atmosphere with good interactions between staff and people living in the home. Some people displayed behaviour which at times impacted on other people living in the home. However, we observed that staff managed this appropriately and respectfully, and were able to engage with people to meet their needs.

We saw people were involved in decisions about their care and that people were treated with respect and dignity. Staff we spoke with told us they enjoyed working in the home.