This unannounced inspection took place over two days on 2 and 3 November 2016.

Crescent House is registered to provide residential care for up to 33 older people. At the time of this inspection there were 33 people living in the home.

There was a registered manager in post at the time of our inspection. 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 felt safe in the home and relatives said they had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. There were sufficient staff to meet the care needs of the people and recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Staff had good relationships with the people that lived in the home. Staff responded to complaints promptly and in line with the provider’s policy. People and staff were confident that issues would be addressed and that any concerns they had would be listened to and acted upon. There was a stable and accessible management team in place.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

Care plans were written in a person centred approach and detailed how people wished to be supported. Where possible people were involved in making decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People were not always able to access suitable levels of social interaction and activity. In response to feedback from people, relatives and staff the provider has reviewed and increased staffing levels to support this.

There were systems in place to monitor the quality and safety of the service. Where these had required strengthening in some areas the provider had acted promptly to ensure that people’s care and support needs were being met appropriately.

This inspection took place on 12 November 2014 and was unannounced. Crescent House is a family run care home located within the Abington area of Northampton town centre. The home provides residential care without nursing for up to 33 older people. There were 30 people living at the home at the time of the inspection.

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 2008 and associated Regulations about how the service is run.

At the last inspection on 13 June 2014 we asked the provider to take action to make improvements to the service. This was around the care and welfare of people and assessing and monitoring the quality of service provision. The provider had taken appropriate action to address the improvements required.

People said they felt safe at the home and that the staff worked hard to make sure they received the care and support they needed. The staff knew the support that people needed and were able to effectively deliver people’s essential care needs. People living at the home and relatives were very complimentary of the quality of care provided by staff in meeting their physical needs, although they said that staff found it hard to have the time to spend with them to engage in social and recreational activities.

Safe staff recruitment systems were practiced and staff received appropriate training and support to ensure that they had the right skills to support people living at the home.

Medicines were not always stored appropriately and the matter was being addressed by the provider.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and reports on what we find. DoLS are a code of practice to supplement the main MCA these safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that the manager had knowledge of the MCA 2005 and DoLS legislation. They confirmed that no people living at the home required a DoLS authorisation to be put in place.

People told us they were provided with a variety of meals and snacks. The provider used a catering company that supplied frozen meals that provided people with a variety of meals that were analysed against their nutritious content and catered for specialist diets. The staff supported people at risk of poor nutritional intake, by discreetly monitoring their food and drink intake.

People had individualised care plans in place and their healthcare needs were regularly monitored, and assistance was sought from the relevant professionals so that they were supported to maintain their health and wellbeing.

The manager worked closely alongside staff on a day to day basis and provided staff supervision and appraisals. The day to day administrative tasks were carried out by the company director. People were assured that improvements to their living environment, repairs and routine maintenance, were carried out in a timely way.

Quality audits, for example, reviews of people’s care records, staff recruitment and medicines were carried out. However it was noted the benchmarks were set against the standards of the Commission for Social Care Inspection (CSCI), which was one of the predecessor organisations of the Care Quality Commission. During the inspection it was pointed out to the provider that they focus their quality audits of the care provided, against the current Health and Social Care Act (HSCA) 2008 regulations and the five domains of safe, effective, caring, responsive and well led.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The staff on duty had a good understanding of how to meet the needs of people who used the service. We saw that people were relaxed and comfortable in the presence of the staff. All the people we spoke with told us that they felt safe living at the service and they were happy with their care

Staff received regular training and support which helped them to provide safe care. Staff knew who they should contact, should they have any concerns about the treatment of people who used the service. Health and safety checks were carried out to make sure the premises and equipment used were safe for people using the service.

People received an assessment of their needs so their needs could be met by staff. However, we found that some people did not have care plans and risk assessments put in place for care needs that had been identified. People’s care plans were also not always updated with changes in their care needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were involved in making decisions in how they wanted their needs to be met. They told us they were asked by staff how their care and treatment needs were to be met by them. They told us that they were happy with the care they received from staff. We saw staff had received the training and support they needed to meet people’s needs effectively.

Is the service caring?

We saw that staff approached people who used the service in a caring and respectful manner. People we spoke with told us that the staff were available when they required their support. They told us that the staff were kind and supported them. One person told us that they had “no complaints” and got on well with all the staff. The staff told us that they enjoyed working with the people and they worked well as a team.

Is the service responsive?

We saw that staff were available to support people who used the service. One person told us when they felt un-well; the staff rang the GP to visit them. Another person told us that they had review meetings with their family and the staff from the home. This was to discuss how their needs were being met at the service. They told us they felt listened to and supported by everyone at the meeting. They also told us when they rang the call bell; the staff came and helped them with their personal care needs.

Is the service well-led?

The provider had monitoring systems in place to ensure that medication administration records were fully completed. We saw that health and safety checks were also undertaken regularly to ensure all systems were kept up to date to keep people safe. However we found people’s care plans and risk assessments were not being monitored and updated to meet their current needs.

The service had a quality assurance system to obtain annual feedback from people who used services and their representatives to monitor the quality of service provided. However, we found that some identified improvements were not always acted upon. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve

We spoke with nine people that used the service. They all told us that liked living at Crescent House and that the food was good. One person told us “they get to know what you like and what you don’t like”. Another person told us “I feel safe and the staff are friendly”.

We spoke with four staff members who told us they felt well supported by the manager and that people who used the service received a good standard of care.

We found that people’s needs had been assessed and care plans were put in place to ensure their needs were met. We found they included information about people's preferences and usual routines. We saw that where risks relating to people’s care had been identified control measures had been put in place. We saw that people were protected from the risks of inadequate nutrition and dehydration.

However, we identified some concerns with pre-employment checks that had been undertaken and the way in which training records were being maintained. We also found that there no records kept of when cleaning had been carried out.

We spoke with four people who lived at Crescent House, who said they liked living there, one said “…love it here, everything is so clean, the staff are friendly and very kind”, another said “Its very nice, it’s a lovely place, we are looked after very well”.

We found that Crescent House staff had improved their monitoring of people's nutrition and the administration of medicines. However, we were unable to inspect the quality monitoring of the service as these were not available to us.