About the service:

Creedy Court is a residential care home without nursing for up to 18 people who live with a diagnosis of learning disability and/or autism. The service was providing personal and nursing care to 18 younger and older people at the time of the inspection.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people as accommodation was split into two distinct wings, Eastleigh and Westleigh as well as two semi-independent studio apartments. The home was in keeping with other residential properties in the local area.

People’s experience of using this service:

¿ People said they liked living at Creedy Court. They said they felt safe and happy at the home.

¿ People and relatives said that staff were kind and knowledgeable about the people they supported.

¿ Staff worked in partnership with health and social care professionals to ensure people received the support they needed if they became unwell or if their presentation changed. Health professionals described how staff referred people to them appropriately and worked with them to support people’s health needs.

¿ People were supported to receive the right medicine at the right time, by staff who had been trained to administer and manage medicines.

¿ Care records described individualised care for people living at Creedy Court, taking into account their risks, needs and preferences.

¿ Staff were observed working with people in a kind and caring way, taking time to find out what the person wanted before supporting them appropriately.

¿ People were encouraged to live as independently as possible, doing activities of their choice. People were involved in choosing food they liked and were encouraged to eat healthily.

¿ The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting their choice and independence as well as through inclusion in the local community.

¿ Staff were recruited safely and underwent an induction to ensure they understood the principles of good care. Staff were expected to refresh training at regular intervals. Although not all staff were up to date with their training, the registered manager and senior staff were aware of this and were taking action to address it.

¿ There was a risk of infection in the laundry on the first day of inspection. Improvements to the layout of laundry room and the procedures that staff had to follow were undertaken during the inspection. This meant that people were better protected from the risk of infection. Other areas of the home were clean and well maintained.

¿ The décor of some areas was being improved. Staff working at Creedy Court ensured that people were kept safe and disruption to them was minimised when environmental improvements were being undertaken.

¿ Where people were subject to restrictions to ensure their safety, staff worked within the requirements of the Mental Capacity Act 2005.

¿ People were protected from the risks of abuse by staff who were understood how to keep vulnerable people safe.

¿ There was an experienced manager in post who had been registered with the Care Quality Commission for a number of years.

¿ Monitoring the quality and safety of the service had not identified some environmental issues.

¿ The providers visited the service frequently and were aware of their role in ensuring the service was providing safe, effective care which supported people well.

¿ When incidents and accidents happened, these were reported appropriately, investigated to learn why they occurred. Learning was used to improve the service.

We have made one recommendation about involving people, families and staff in service improvement.

Rating at last inspection: Good (The last report was published on 13 June 2018)

Why we inspected:

This was a responsive focussed inspection br

Creedy Court is a residential care home without nursing for up to 18 people who live with a diagnosis of learning disability and/or autism. Some people living at Creedy Court also have physical disabilities. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home was made up of two wings, Eastleigh and Westleigh. Both wings opened onto a central courtyard. There were also two apartments used by two people who were able to live more independently. These apartments also opened onto the courtyard.

At the time of the inspection there were 18 people living at the service; most people had been resident at the service for a number of years.

We undertook an unannounced comprehensive inspection on 18 and 25 April 2018.

Creedy Court is owned by a provider, who has two other homes for people with a learning disability and/or autism. Both the other homes are within a five mile radius. All three homes were managed by the same registered manager, supported by two deputy managers as well as a senior team. The registered manager had registered with the CQC. 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.

The providers visited frequently to meet with the registered manager, staff and people living at Creedy Court.

The home had previously been inspected in December 2015, when it had been rated as Good overall. However, the Safe domain, which is one of five domains we inspect, had been rated as requiring improvement. This was because people were not protected against the risks associated with the unsafe use and management of medicines. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Improvements to the medicines administration systems and practices had been implemented which meant these were now safe.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated as Good

The service had 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. Although the home was larger than the recommended size, it had been split into distinctive areas, which each had a homely ambience. People were supported to be as independent as possible. This included doing activities of their choice, individually and in groups. Many of these activities were carried out in the community.

There was a quality assurance and governance framework which helped to ensure the home was safe, well maintained and clean and free of infection.

The home had a complaints policy and process. No complaints had been received since the last inspection.

People were relaxed and happy in the home; staff and people chatted and laughed together. Staff knew people well and communicated with them using both verbal and non-verbal methods. People were supported to eat healthy food they liked and stay hydrated.

Families and professionals were positive about the care and support provided in the home. Comment included “They make us very welcome.” Families also said staff helped their relative stay in touch with them.

Care records contained risk assessments and care plans which described

An unannounced inspection was completed at this service on 1 December 2015. Creedy Court is registered to provider accommodation and support for up to 18 people with learning disabilities. The service is divided into two homes within one site.

A registered manager was in post who is also registered to manage another home which is part of the same limited company. 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 2014 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, applications had been made to the local authority in relation to people who lived at the service. The registered manager told us these were waiting to be approved.

Some improvements were needed to ensure medicines management was robust and fully protected people from errors. Some records were incorrect or incomplete and the current checks in place had not identified this.

People indicated they felt safe and well cared for. Staff knew people’s needs and preferences and had the right training and support to enable them to deliver care safely and effectively. Care and support was being well planned and any risks were identified and actions put in place to minimise these. This included triggers for what may cause a person to become distressed and anxious and how staff should work to divert people and encourage positive behaviours.

People were offered a variety of activities and outings and their human rights was respected promoted. People had opportunities to access the local community. This included work placements at a local farm as well as social clubs in the local town and vicinity.

Healthcare professionals said people’s healthcare needs were being well met and the staff team were proactive in seeking advice in a timely way to ensure this.

There were enough staff available to meet people's needs. We observed care and support being delivered in a kind and compassionate way. Relatives said their views were considered and they were kept informed of any changes in people’s needs and wishes. Some relatives said they would like more regular contact and information about what their relative had been doing each month. The registered manager agreed to facilitate this.

Staff knew how to protect people from potential risk of harm and who they should report any concerns to. They also understood how to ensure people’s human rights were being considered and how to work in a way which respected people’s diversity.

The provider ensured the home was safe and that audits were used to review the quality of care and support being provided, taking into consideration the views of people using the service and the staff working there. There were also some audit systems in place to look at infection control and medicines.

The ethos of the service was to promote people’s independence and provide care and support in the least restrictive way, but also ensuring the service understood people’s complex needs. Staff had specialist training in understanding autism and working with behaviour which challenge.

There was one breach in regulation and you can see what action we have asked the provider to take at the end of the report.

We completed this responsive inspection as we had received some information of concern which indicated people living at the service may not have been receiving the right support to enable them to be actively engaged. We also heard that care staff may not be skilled at working with people with complex needs. We spent time in Eastleigh unit where the concerns had been highlighted. Eastleigh had ten people living there when we visited and one additional person came in for day care each weekday. We talked to three people about their experience of living at Creedy Court and we also spent time observing how care and support was being delivered to people. Most people at Eastleigh had complex needs which, meant their ability to give an informed view of their experiences was limited or difficult to gain during one visit. We therefore spoke with a number of health care professionals , funding authorities and families following the inspection visit. This helped us make a judgement about how well the service was meeting peoples needs.

We heard from three health care professionals who have regular contact with Creedy Court. Their view was that people living at the service had complex needs which were being managed well with activities and detailed care plans which gave staff the information to support them. One healthcare professional said they were ''impressed by the way the service worked to avoid excessive institutionalisation, were very responsive to needs and worked hard to get the balance right for giving people boundaries but assisting them to be involved in everyday life.'' They gave the example of being assisted to attend appointments in clinics instead of having services come to the home. Another healthcare professional said ''The service always make sure people's healthcare needs are monitored, and they listen to any advice offered.'' One professional from a funding authority described Creedy Court as being a ''very open culture where advice is sought when people present with complex challenges.'' We spoke with two family members of people who live at Creedy Court and heard positive feedback. One family member said ''They have done wonders.'' another commented ''We are very happy with the care. Staff are helpful but don't get us involved in the micro-details. We are always asked for our views for big decisions and staff seem very helpful and supportive.''

We saw people were engaged in different activities throughout the day. We observed people enjoying a Tai Chi session and heard people enjoying a music session in the afternoon. One person told us about a trip they were planning to take the following day to a place of local interest. We heard from people and staff about other trips and outlines people enjoyed doing. We saw from daily records and care plans, people's likes, interests and hobbies were followed up with planned outings and activities. We saw there was a weekly programme of paid therapist who came to Creedy Court to provide music, Tai chi, pottery, art, drama and aromatherapy.

We spoke with 13 members of staff during our inspection. We heard how staff felt well trained and supported to do their job. There was a comprehensive induction programme and ongoing training to enable staff to understand the needs of people with learning disabilities and behaviour which can challenge. Most staff felt there were sufficient staff available on each shift, however some felt there should be at least one extra staff member per shift to meet the number and needs of people they currently care for. The registered manager said this was an area they were currently addressing and were going to increase staffing once they had recruited suitable people to provide this additional cover. In the interim, the manager told us, he and his assistant manager provided additional cover at key times to ensure people's needs were being met.

We found the service compliant with all three outcomes we looked at. We did not find any evidence to support the concerns expressed about people's needs not being met or that practice was institutional. We have asked the provider to consider some minor areas and these are detailed within the main body of the report.

At the time of this inspection there were 17 people living in the home. During our visit we met and spoke with, or observed care given to most people who lived in the home. We tracked the care provided to three people who lived in the home and also looked at the process followed for one person who was due to move in permanently in the near future.

We spoke with the manager, providers, and ten staff. We also spoke with four people who lived in the home in detail about their daily lives at Creedy Court. We carried out a tour of the home; we checked food and nutrition, safe storage and administration of medicines, and the procedures followed by the home when appointing new staff.

People told us they were happy living at Creedy Court. They talked to us about the things they enjoyed doing every day, and how their needs were met. They told us they enjoyed the meals and told us there was plenty of choices and alternatives. We saw their bedrooms and heard how the staff had worked with each person to personalise their rooms with furniture and decorations of their choice. We found all areas of the home were well maintained, safe and homely. One person told us the accommodation was “Excellent.”

Safe procedures were followed before new staff began working unsupervised with people who lived in the home. People told us they liked all of the staff and said staff always listened to them and treated them with respect.

We spoke with four people who lived in the home, two of the providers, the manager, deputy manager and four members of staff. After our visit we spoke with, or heard from, two relatives and two health or social care professionals.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they were happy living at Creedy Court. Comments included “I love living here! It’s a nice place. I can do what I like.”

People experienced care, treatment and support that met their needs and protected their rights. The home had consulted with people, relatives and professionals to ensure all care needs were fully met. For example, a relative we spoke with told us “They look for solutions to make things easier for X.”

People who used the service told us they felt safe. We found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were well trained and supported. People told us they liked all of the staff. Comments included “The staff are ok – very nice people, always kind.” A relative told us “The staff are brilliant!” A social care professional told us the staff team were “Very professional and very caring. I can’t praise them enough!”

The provider had systems to regularly assess and monitor the quality of services.

There is accommodation in single rooms for up to 16 people at Creedy Court. One of these rooms is for respite accommodation. On the day we visited 15 people were living at the home. Several people were out with staff shopping or attending scheduled appointments. We spoke with people who live in Westleigh. Generally people were happy living at the home, although they did express frustrations, from time to time, with group living and the impact of other people’s personalities on how well they perceived their day to be. People told us that they got along well with staff and found them helpful and supportive. People said there were enough staff on duty to help them.