The inspection at Crystal Hall was undertaken on 15 and 16 May 2017and was unannounced.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the (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 2008 and associated Regulations about how the service is run. The last inspection was carried out on 14 November 2014, when there were no concerns identified and we rated the service as GOOD in all five areas of service delivery, and Good overall.

Crystal Hall is located in a rural area of Preston. The property is a period farmhouse with purpose built extensions. There are well maintained grounds surrounding the property, enclosed courtyards, a sensory garden and Japanese ornamental garden. The home is registered to accommodate a maximum of 67 people at any one time and at the time of our inspection 65 people lived there. Crystal Hall specialises in the care and treatment of mental health in younger adults and in particular specialist care categories, bipolar/manic depression, head/brain injury, Huntington's disease, multiple sclerosis, Parkinson's disease and schizophrenia.

Staff worked within a well-trained team and had ample time to support individuals in a meaningful way. This was because there were sufficient staff numbers who were deployed to provide person centred approach to care and people’s safety. We found that the recordkeeping systems at the service were thorough and consistent. However, we have made a recommendation in relation to staff recruitment, to ensure that the service provider ensures that appropriate employment references are always sought when appointing new staff.

Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely. We found care records contained detailed, personalised and specific care plans, risk assessments and medicines management care plans. We observed staff followed these in a safe and caring way when meeting people’s assessment needs. Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions taken by the home to protect people.

Staff recorded best interest meetings and transparently documented mental capacity assessments and decision-making processes. We saw this followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We observed staff treated people with respect, and were offered options whenever they engaged with them.

People and their representatives said staff worked collaboratively with them to ensure they received high standards of care. We found Crystal Hall had a warm and welcoming atmosphere throughout. We saw people were relaxed and staff had a caring attitude. Food standards were maintained to a high level. When we discussed the quality of meals with people and their relatives, they said food was of a high quality.

Relatives told us they felt extremely well supported and encouraged to maintain their important relationships with those who lived at Crystal Hall.

We saw staff were responsive to each person’s changing needs and adapted care plans accordingly. The management team provided opportunities for people to engage social activities. People were supported to maintain their own health and appropriate referrals were made on people’s behalf to healthcare professionals as and when required. We observed people’s dignity and privacy were actively promoted by the staff supporting them. People living in and visiting the home spoke highly of the staff and told us they were very happy with their care and support.

There was a clear management structure in place and staff were happy with the level of suppor

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was a routine scheduled inspection and was unannounced.

Crystal Hall is located in a rural area of Preston. The property is a period farmhouse with purpose built extensions. There are well maintained grounds surrounding the property, which include an external aviary, enclosed courtyards, a sensory garden and Japanese ornamental garden. The Registered to accommodate a maximum of 67 people at any one time and at the time of our inspection 65 people lived there. Crystal Hall specialises in the care and treatment of Mental Health in younger adults and in particular specialist care categories of: Bipolar/Manic Depression • Challenging Behaviour • Head/Brain Injury • Huntington's disease • Multiple Sclerosis • Parkinson's disease and Schizophrenia.

The home is required by a condition of registration with the Care Quality Commission (CQC) to have a registered manager in post. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’ The service has had a registered manager in place since 2011. However this person had recently changed role in the organisation and whilst this person remained connected to the home in a quality assurance role for Crystal Hall, a new manager had been appointed and their application for registration with CQC had been submitted.

There were systems and processes in place to protect people from the risk of harm. All of the people we spoke with told us they felt safe in the home whilst all the staff we spoke with said they felt supported and encouraged to raise concerns.

Staff we spoke with were all able to demonstrate a good understanding of people who used the service and were able to tell us about different aspects of people’s care and triggers which may affect some people’s behaviour. Staff we spoke with all told us that there were sufficient numbers of staff to cope with difficult and challenging situations if they arose. This meant that people who used the service were protected against avoidable harm.

Care records reviewed showed a detailed assessment had taken place before people moved into Crystal Hall. Once there, the service engaged with people who used the service through an assessment and planning process. For those people who were unable to participate fully we saw evidence that the home had liaised with relatives and, where necessary, advocates. Where people may display behaviour which challenged the service, we saw evidence in the support records that assessments and risk management plans were in place. This meant that the home obtained sufficient information to manage people’s risks in an appropriate manner.

Crystal Hall was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) Codes of Practice. The MCA and DoLS provide legal safeguards for people who may lack the capacity to make some decisions for themselves and who may have restrictions placed on them in order to ensure they receive the care and treatment they need and to protect them from harm. The codes of practice are statutory guidance which people with responsibilities under the act are expected to follow.

The home had policies and procedures in relation to the MCA and DoLS. Care records we viewed showed that formal tests of people’s capacity to make certain decisions had been tested and documented. Staff we spoke with all had a good understanding of the MCA and DoLS. We saw evidence of the involvement of other professionals and Independent Mental Capacity Advocates (IMCAs). We saw that all paperwork for any person who was the subject of a DoLS authorisation was correct.

People who used the service who we spoke with all told us that they felt their needs were being met. One person told us: “I can't look after myself on the outside. I have dementia and this is the best place for me".

Prior to the inspection the provider had given us details of health and social care professionals involved with the service. We contacted these people and those that replied told us that people who used the service were well-cared for by all members of staff and their individual needs were well met.

Staff we spoke with across all three units of Crystal Hall during the inspection all told us that they felt supported. They confirmed having received induction and supervision regularly. Supervision records were checked which confirmed what we had been told. This meant that staff were and felt supported to perform their role.

The provider told us that staff had received regular training in mandatory subjects such as the safeguarding of vulnerable adults, the mental capacity act 2005, medication, infection control and control and restraint. Staff we spoke with confirmed they had received this training and people who lived there told us that staff were able to meet their needs. This meant that people were support by staff with sufficient knowledge to provide safe and appropriate care and support.

Each person had an individual, completed and updated care plan in accordance with a recognised model of care planning for people with mental health needs. Care plans contained a range of completed risk assessments which had been regularly reviewed and updated. We observed that where changes had been made care staff had implemented changes required. People who lived at Crystal Hall told us that they were happy at the home and received the care they needed. Which meant that staff followed and responded to people’s individual care plans.

We observed the lunchtime meal period and found that where necessary staff assisted people who needed assistance in a relaxed and un-hurried manner. This helped to ensure people found mealtimes a pleasurable experience.

A wide range of activities were provided both in-house and in the community. People who lived at Crystal Hall told us they had plenty to do. We observed people leaving and returning to the home throughout the day. Which meant people were able to involve themselves in meaningful activities or to spend time on their own or in the community.

All staff we spoke with had a good knowledge of individual people they cared for including their likes and dislikes. We observed staff demonstrate compassion in care by treating people in a kind and dignified manner. Staff told us that they always tried to provide a homely environment, with a friendly in approach. People who lived at Crystal Hall told us the staff were responsive, caring and treated them with dignity and respect.

Staff told us that they received support from the managers and were able to raise concerns. We were informed by all the staff we spoke with that regular and good quality handovers took place between shifts and that they found these were useful especially if they had been off for a period.

We saw that there was a compliments/complaints box which was accessible to people who used the service as well as others who visited the home. People who lived at Crystal Hall told us they led their own meetings, set the agenda and complaints and compliments were discussed freely and openly in this forum. People we spoke with told us that the manager investigated and responded to people’s complaints.

There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, and the following up of these ensured continuous improvement. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.

Observations on the day of our inspection told us that the home was in good repair. A slightly unpleasant odour in a couple areas of the home noticed at first had gone later in the day. We also saw some bumps in the carpet although these were not sufficient to pose a risk of harm to people walking over them. Cleaning schedules we looked at had been maintained and completed by the domestic staff on a daily basis and were up to date. All of the rooms for people who used the service we went in were clean and well maintained.

We found care and support was planned and delivered in a way that ensured people’s safety and welfare. Care plans reflected people’s needs, preferences and diversity. They were sufficiently detailed to make sure peoples’ care and support would be provided according to their needs and safety.

We found things that were important to people had been recognised and accommodated. One person told us they had been allowed to bring their dog with them. "I was very unhappy when I had to leave my dog. I'm much happier now." Another person also told us, "I had only had my cat a few months when I moved here and she came too."

People told us they were looked after very well. They said, “It’s good here”. “I’m very comfortable, no complaints.” One person said, "I was going to write to you to tell you how much I like living here.” We found all the people spoke highly of the staff. We saw there was an obvious warm relationship and friendly atmoshere that existed.

People were involved in the local community. Leisure time was arranged around what they wanted to do. One person said "We can lead a fairly independent life here, shopping and cooking and if we want to, keep our rooms tidy." We found people's rooms had been personalised and the premises were kept clean.

Staff had written guidance on how to support and protect people in difficult situations. There was enough staff who were recruited properly and trained to support people as and when they required it.

We spoke with two people about their medicines and both said they were happy with the way their medicines were handled.

Overall we found improvements had been made and people were given their medicines safely.

We found that there had been improvements in how the service looked at assessments and planned care according to individual needs. People were given an opportunity to consent fully to their care.

We found there had been some improvements in planning people’s care and support. We also found areas that needed to improve.

People told us “Staff are great here I have no problems’’, ‘’They look after me well’’, ‘’I like living here’’. And ‘’I get my medicines when I need them’’

We found improvements were needed in how medication was managed and administered.

We found there had been improvements in the environment with a designated area being prepared for people with dementia care needs.

We found plans were in place and being implemented to improve the monitoring of service delivery. We also found improvements were needed in how the service assesses and monitors the quality of service provided.

People using the service were able to walk about freely in the units. Staff were observant and attentive to people’s needs. People described staff as being “good” and “helpful”. They did different things such as going out with relatives, shopping; going to church and enjoyed the food they were served. There was plenty of activities on offer they could join in. People told us staff treated them well and they had no cause for concern. We were told, “They are all very nice”. And “We can have a laugh, they’re all right”. We were also told staff spoke to them properly and were respectful. Where people needed additional support this was provided. People who could give their views told us they liked living in the home. They commented, “It’s good here.” And, “I’m very comfortable, no complaints”.

We talked to people who receive support and care and spoke with staff that supports them. We asked people about their views about the service and the care and support staff provide. People said the service was an enjoyable place to live and they felt important by the way staff treated them.

The people we spoke to told us they were very happy with the support provided. They told us that, “Staff are friendly and good listeners”. Staff was described as helpful and “Would do anything for you”.

People told us they had been included in agreeing the care to be provided by the service. People said they knew they had care or support plans so staff knew how to support them.

People told us they felt safe living at the home. They said they knew who they could speak to if they had a concern or complaint. We asked the local council contracts department for information about the home and they told us they had visited recently and found improvements in the service.