We carried out this unannounced comprehensive inspection on 20 August 2017. At our last comprehensive inspection of 28 February 2017 and 6 March 2017 we found the registered manager and provider were in breach of regulations related to safe care and treatment, good governance, fit and proper persons employed and notification of incidents.

After the inspection, the Care Quality Commission took enforcement action (issued a notice of proposal to cancel the provider’s registration) due to the high risk posed to people’s health and well-being. The provider sent us an action plan and told us what they had done to meet legal requirements in relation to the breaches identified. We carried out this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection, we found that the issues identified in our previous inspection were resolved and the provider now met all the relevant requirements.

Crystal Homes provides accommodation and personal care for up to four people with mental health needs. At the time of the inspection, three people were using the service.

The service had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 registered manager had overall responsibility for the service, but a manager conducted the day to day management of the service. The manager had started an application process for registration with the CQC.

People were safe at the service. Staff understood their responsibility to identify and report abuse to keep people safe. Staff identified risks to people’s well-being and had sufficient guidance on how to provide safe care.

The registered manager deployed sufficient numbers of staff to meet people’s needs safely. The provider had appropriate recruitment and selection procedures in place to ensure that they only employed staff suitable to provide safe care.

The premises were safe for people using the service. Fire doors had the appropriate seals, intumescent strips, and suitable door closing mechanisms. The provider carried out repairs and maintenance of the service in a timely manner.

Staff were trained and skilled to undertake their roles effectively. Staff understood people’s needs and the support they required. People received care provided by staff who received regular supervisions, annual appraisal and training.

Staff delivered people’s care in accordance with the requirements of the Mental Capacity Act 2005. People consented to care and treatment.

People received food that met their nutrition and hydration needs. Staff encouraged people to eat healthy foods and to maintain a balanced diet. People had access to healthcare services when needed to maintain their health and well-being.

People were treated with respect, kindness and compassion. Staff maintained people’s dignity and privacy. People were supported to develop skills for independent living and to take part in activities they liked.

People received care that was responsive to their individualised needs. People had their needs identified and assessed. Support plans provided guidance to staff about how to deliver care.

People gave their views about the service and the provider considered their feedback. People knew how to make a complaint and were confident that they concerns would be addressed.

People using the service and staff were happy about the management of the service. Staff understood their responsibilities and were valued at the service. The manager maintained a high presence at the service and was available to talk to people and to offer guidance to staff.

Quality assurance systems were effective to identify sho

Crystal Homes is a residential care home. It provides accommodation and personal care for up to four people with mental health needs. At the time of the inspection three people were living in the home.

We carried out this inspection on 28 February, 2 March and 6 March 2017. The first day of the inspection was unannounced. At our last comprehensive inspection on November 2015 we identified a number of regulatory breaches. These included people being unsafely supported with their medicines, staff being unsafely recruited and inadequate audits. The overall rating for this service was Inadequate and the service was placed in special measures. We followed up with inspections in May and November 2016 when we found improvements had been made.

The service had a registered manager at the time of the 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.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were regulation 12 safe care and treatment, regulation 17 good governance and regulation 19 fit and proper persons employed. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. This was regulation 18 notification of incidents.

People were at risk in the event of a fire. The provider had not implemented all of the urgent actions identified during a fire risk assessment in 2016. Not all of the doors at the service were fire doors and appropriate door closing mechanisms had not been installed throughout the service. People were at risk of injury because repairs had not been carried out in a timely manner. For example the television in the lounge had been broken for three months.

Staff were not always recruited safely. A member of staff was working at the service without appropriate references or checks. Audits did not always pick up shortfalls and the registered manager did not always act when shortfalls were identified. The registered manager failed to notify CQC when serious events occurred at the service.

People received care and support from staff who participated in a programme of on-going training. Staff received training in safeguarding and people were supported with detailed risk assessments. Staff performance was reviewed and evaluated in one to one supervision meetings alongside their appraisals. People’s rights under the Mental Capacity Act 2005 were respected. People had regular and on-going input from mental healthcare specialists.

People’s needs were comprehensively assessed by health and social care professionals. Care plans were regularly reviewed for relevance, effectiveness and people’s preferences. People participated in varied activities and were supported to participate in faith activities. People were supported to share their views through residents meetings, keyworking meetings and surveys.

Staff told us there was an open culture at the service and that the registered manager encouraged and supported them. The service worked closely with health and social care professionals.

This unannounced focused inspection took place on 22 November 2016.

We carried out a comprehensive inspection of Crystal Homes on 26 and 27 November 2015. We found breaches in seven regulations. The provider failed to manage medicines and recruitment safely. Staff did not receive supervisions or appraisals and feedback from people and their relatives had not been sought. The provider failed to audit the quality of the service or notify CQC about changes to management arrangements.

We returned to the service to undertake a focused inspection on 26 May and 2 June 2016. We found improvements in the provider’s notification processes and gathering feedback from people and their relatives. However, the provider continued to be in breach of four regulations.

This report only covers our findings in relation to those legal requirements that were not met by the provider at our previous inspection. You can read the report of our last comprehensive inspection by selecting the ‘All reports’ link for Crystal Homes on our website at www.cqc.org.uk

Crystal Homes is a residential care home situated in Brockley, South East London. It provides accommodation for up to four people with mental health needs. The service is provided by Crystal Management Services Limited. At the time of the inspection there were four people were living in the home.

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 this inspection we found the service had addressed our concerns. People were safely supported to receive their medicines. Staff received medicines management training and appropriately recorded medicines administration. The process for recruiting staff was safe with robust checks introduced.

Staff were supported by the manager in their role. Staff were supervised and had regular one to one meetings with the manager. Staff in post for over one year received an annual appraisal from their manager.

The manager had introduced a robust quality assurance process to monitor and measure the care people received and drive improvements. Health and social care professionals spoke positively about the leadership of the service. We could not improve the rating for well-led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This unannounced focused inspection took place on 26 May and 2 June 2016.

We carried out a comprehensive inspection of Crystal Homes on 26 and 27 November 2015. We found breaches in seven regulations. The provider failed to manage medicines and recruitment safely. Staff did not receive supervisions or appraisals and feedback from people and their relatives had not been sought. The provider failed to audit the quality of the service or notify CQC about changes to management arrangements.

This report only covers our findings in relation to those legal requirements that were not met by the provider at our previous inspection. You can read the report of our last comprehensive inspection by selecting the ‘All reports’ link for Crystal Homes on our website at www.cqc.org.uk

Crystal Homes is a residential care home situated in Brockley, South East London. It provides accommodation for up to four people with mental health needs. The service is provided by Crystal Management Services Limited. At the time of the inspection there were three people were living in the home.

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 this inspection we found the service had addressed some of our concerns but required further improvements to be made. We found people were not receiving safe care and treatment. People’s medicines were not balanced checked, recorded or disposed of safely. Staff were insufficiently trained to use medicines, audits failed to detect failings and where required risk assessments had not been carried out.

People were at risk of being supported by unsuitable staff as the provider did not operate a robust recruitment process. The provider had not verified the employment histories of staff. People were not receiving effective care because some staff were unsupervised and did not their performance appraised by the manager.

The provider had gathered the views of people on an on-going basis through a number of methods including meetings and surveys. The views of relatives were also actively sought and relatives were informed of forthcoming health and social care appointments they could attend.

The registered manager was in post and submitted notifications to CQC as required. Quality auditing failed to detect and act upon shortfalls in service delivery.

The overall rating for this service is ‘requires improvement.’ However the service remains inadequate in one key question and therefore remains in 'Special measures'. The service will be kept under review and will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The inspection was carried out in order to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw records confirming that all staff in the service had received training in the safe administration of people's medicines and the registered manager had checked their competence in this area. Records showed that staff had recorded how they supported people to receive their medicines safely as prescribed.

Individual risks to people were assessed and plans were put in place to promote their safety. We saw that staff put into practice these risk management guidelines when working with people. There were arrangements in place to check the premises were safe and suitable for people.

Staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We confirmed that the service met legal requirements in relation to DoLS and there were no unauthorised deprivations of people's liberty.

Is the service effective?

People's needs and preferences had been assessed and they had an individual support plan which set out how the service supported them. The service worked closely with community mental health teams to plan and deliver people's support.

Is the service caring?

We observed that people were supported by kind and attentive staff. Staff knew about people's individual background, interests and preferences and used this information when communicating with people and offering support. A community psychiatric nurse told us staff in the service had formed positive relationships with people.

Is the service responsive?

People's records demonstrated they were asked how they would like to be supported. Their support arrangements reflected their views. People went out of the service to a range of activities of their choice and followed their own interests.

Is the service well-led?

When we last inspected the service in February 2014 we found that the Care Quality Commission (CQC) had not been appropriately notified of an incident which may have affected people's safety. We asked for improvements to be made. At this inspection we confirmed that staff knew the correct procedures and the required standard was met.

The service has a registered manager who has been in post since the service opened in July 2012. Professionals told us that the service worked effectively in partnership with them to promote people's wellbeing.

People were asked to give their views of the service. The provider had made changes in response to improve people's experience of the service.

We carried out this inspection to assess the action taken by the provider to rectify the issues we found at our inspection last October. We were unable to speak to people using the service on this occasion as none were present during our visit.

We found that people using the service had up to date care plans and risk assessments. Key working was being carried out and recorded.

Staff were able to demonstrate a better understanding of safeguarding, and staff were enabled to attend safeguarding training.

Staff recruitment had improved, albeit the provider had engaged a volunteer without waiting for a police check to be carried out. The manager told us the volunteer was supervised at all times.

Systems had been put into place to review the quality of the service including the use of an external consultant, regular health and safety checks and sending out satisfaction surveys.

People were treated with dignity and respect. One person using the service told us "staff are kind and treat me well. They do their best for me".

People who used the service were given appropriate information and support regarding their care or treatment. This included a copy of the house rules, a resident's contract and the service's policy regarding illicit drug or alcohol use.

We found that care records for people using the service contained care plans however these did not always match the assessed needs of the person. Staff had not carried out risk assessments, which compromised the safety of people using the service.

The service had a safeguarding policy in place however staff were unable to demonstrate knowledge of safeguarding reporting procedures.

Recruitment and selection processes were in place however we found not all appropriate checks were undertaken before staff began work.

The manager told us they were in the process of identifying appropriate training courses for staff. They said staff received regular supervision although this was not being recorded. We could not confirm this with staff as only the manager was on duty at the time of our visit.

At the time of this inspection the service did not have systems in place to review the quality of the service being provided.

This inspection took place on 26 and 27 November 2015. It was unannounced.

Crystal Homes is a residential care home in Brockley, South East London. It provides accommodation for people who require nursing or personal care for up to four people with mental health needs. The service is provided by Crystal Management Services Limited. At the time of the inspection four people were living in the home, one of whom was in hospital.

The service had 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. The registered manager was not managing the day to day operations of the service. People, their relatives and health and social care professionals did not know who the registered manager was. CQC had not been notified of the registered manager’s absence. Another individual was managing regulated activities at the care home. CQC had not been notified of this change.

We found people were not receiving safe care and treatment. The provider had arrangements for managing medicines which were unsafe and against current legislation. This put people at risk of not receiving their prescribed medicines. The provider also failed to consistently record the administration of medicines correctly.

The provider operated staff recruitment processes which were not safe. Staff were working in the service without references and checks to make sure they were suitable to work with vulnerable people. The provider had not obtained employment history checks or satisfactory background checks undertaken by the Disclosure and Barring Service.

Staff did not receive the support they required to ensure they met people’s needs effectively. None of the staff working in the service had received one to one supervision from the manager. There was no appraisal system in place to review performance and plan staff development.

People and their relatives thought the staff were caring and that dignity and privacy were respected. The provider supported people to maintain family links. However, people and their relatives had little formal opportunity to feedback their views on the service being provided.

People were supported using clear and detailed care plans which they were involved in developing in partnership with healthcare professionals and the provider. Care plans and risk assessments were regularly evaluated and updated. People had timely and regular access to health and social care services. Health records were maintained and were reflected in care plans.

Audits and checks of quality were carried out but they did not result in improvements in the care people received. Where audits identified shortfalls these were not acted upon.

We found that people were at risk of receiving unsafe care. We found multiple breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) and two breaches of Care Quality Commission (Registration) Regulations 2009 (Part 4). We are taking enforcement action against the registered provider and will report further on this when it is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.