About the service:

The Crescent is a residential care home that was providing personal care to four people who had a learning disability and/or autism at the time of the inspection.

People’s experience of using this service:

Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. The managers worked with the local authority safeguarding adults team to protect people.

Staff were supported in their roles and received an effective level of training. They told us they were happy with the level of training and support they received and we observed them supporting people in a competent manner.

People continued to be supported by an established team of staff who provided kind and personalised care to people living in the home. Safe recruitment of staff ensured people were supported by staff of good character.

People were protected from harm by the provider having effective systems in place to monitor medicine management, staffing, infection control and upkeep of the premises.

Staff promoted people's dignity and privacy. Staff provided person-centred support by listening to people and engaging them at every opportunity. Staff were caring and understanding towards people. People using the service appeared comfortable in the presence of staff working in the service.

The premises provided suitable accommodation for people with communal areas and bedrooms which were personalised to people's individual interests.

Support plans were detailed and reviewed with the person and their relatives when possible. Staff worked with and took advice from health care professionals. People's health care needs were met.

People had a variety of internal activities and external activities, which they enjoyed on a regular basis. Relatives' views were sought, and opportunities taken to improve the service. Formal supervision meetings were carried out with staff. They told us they were supported and clear about what was expected of them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

This care service supported people in line with the values that underpin the Registering the Right Support and other best practice guidelines. 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.

Audits and checks were carried out, and any issues identified and rectified.

The home continued to meet the characteristics of a rating of good in all areas. More information about the inspection is in the full report.

Rating at last inspection:

The home was rated Good at the last inspection (report published in July 2016).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Our inspection took place on 14 June 2016 and was unannounced. We last inspected the service on 15 May 2014 and the service was found to be compliant with the Regulations.

The Crescent provides accommodation and personal care for up to 4 adults with a learning disability. At the time of our inspection 3 people were living there.

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 living at the home. There were sufficient staff to respond to people’s needs and support people safely. People were supported by staff who had been recruited safely and had the skills and knowledge to meet people’s care and support needs. People were supported by staff who knew how to recognise and report potential abuse. Risks to the health, safety and well-being of people were identified and managed. Staff had a good understanding of how care and support should be provided in order to keep people safe. People’s medicines were stored and managed safely and people received their medicines as prescribed by their GP.

People had enough to eat and drink and were involved in the planning of meals. People were given choices of food and drink and were encouraged and supported to prepare meals for themselves. People had good access to a range of healthcare professionals when required. The principles of the Mental Capacity Act 2005 were understood and followed.

People and their relatives felt they were supported by staff who were friendly and caring. People’s individual needs were understood and met by staff. Staff supported people in a way that maintained their privacy and dignity and were aware of, and responded to, people’s anxieties. People’s independence was promoted.

Staff had a good understanding of people’s life histories, personal needs and preferences. People were encouraged and supported to follow their individual interests and had choice and control in how they lived their lives. People and their relatives felt involved in making decisions and choices about how their care was delivered and planned. People and their relatives knew how to complain and expressed confidence that concerns would be dealt with efficiently by the registered manager.

People, relatives and staff were involved in the development of the service.

The registered manager had effective systems in place to monitor the quality and consistency of the care provided and was committed to driving continuous improvement.

On the day of the inspection three people were living at the home. We spoke with people living at the home. People were not able to express their views about their experience in any detail. This was due to their learning disability. People using the service told us they were happy at the home. During the inspection we sampled people’s care records and spoke with staff. They helped us to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. Care plans were very personalised and identified people’s needs. These were reviewed regularly. People were given choices and supported to make decisions themselves. Risk assessments were in place and control measures identified. This meant that people’s needs were met and people were kept safe.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had received training in the Mental Capacity Act and Deprivation of Liberty safeguards. This meant that systems were in place to safeguard people as required.

The service was safe, clean and hygienic. We saw effective systems were in place to prevent and control the spread of infection. Regular audits were undertaken to identify areas for improvement. Cleaning schedules were in place and regular checks were made. Waste was segregated and disposed of appropriately. This meant that people were protected from the risk of cross infection.

Staff received appropriate professional development and were able to obtain further relevant qualifications. This ensured that people were kept safe and their needs met.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed. People were involved in the development of their care plans which were in an easy read format. This helped people to understand and participate in decisions about their health and care. People we spoke with confirmed they were happy at the home.

People were able to move around the home freely and safely. Systems were in place to protect people who were able to access the local community independently. For example people carried contact details of the home just in case they needed help.

Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people’s needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People’s privacy and dignity were respected and people were encouraged to express what dignity meant to them. We asked people if staff were caring. One person told us they were caring and showed us some seeds they had been supported to plant.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. People’s birthdays were celebrated. We saw that people’s diversity and individuality were promoted and respected

Is the service responsive?

We saw staff that responded quickly to meet people’s needs and ensured people’s safety was maintained. For example, we saw staff talked to people to help them reduce anxieties about their plans for the day. We saw that people were supported to express their views and these were acted on. People had the opportunity to engage in activities both in the home and within the community.

People were supported to understand their right to make a complaint. No complaints had recently been received. People told us they liked the staff. We saw the service had responded quickly to ensure identified maintenance and repairs were actioned.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened too.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. We saw feedback from professionals. One professional made positive comments on the fire and evacuation procedures. This meant the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Some staff felt the staff team supported each other. This helped to ensure that people received a good quality service at all times.

There were three people living in the home when we visited. Although we met two of them, they were not able to express their views about the service they received in any detail. However, one person told us that the staff were, "Very good” and that they were, “Happy” in the home.

We found that people were supported to make decisions and that their choices were respected. We saw evidence that people’s best interests were considered when decisions were taken on their behalf.

We saw that care plans were comprehensive and person centred. We saw that people's personal goals, choices, likes and dislikes were recorded in their care plans. The care plans also contained details of how each person expressed their dissatisfaction or disagreement. We saw staff treating people with respect and kindness throughout our visit.

We found that medicines were safely stored, handled and administered. Medicine records were accurate and doctors’ instructions were properly acted upon.

We found that appropriate checks were properly carried out on staff before they were allowed to start work.

The provider had a suitable complaints procedure in place. It had been made available to people’s relatives and representatives and was available in an easy to read format for those who needed it.

We visited the service on 10 May 2012. We used a number of methods to help us understand the experience of three people who used the service, because people were not all able to tell us their views.

We spoke with two people; one person did not want to talk with us. We spoke with three staff and the manager. We observed the way staff and the manager interacted with people. We looked at a few records about care and medication for three people and a few accident records. We saw the provider's quality surveys completed by people which were positive. We looked at records about staff training and records about running the home.

People were happy in the home and led active, meaningful lives. Everyone took part in looking after their belongings, the household and cooking in line with their individual choices. People went out socially, had regular visitors and separate holidays or outings with staff support.

Information in appropriate formats or staff explanation helped people to choose meals and activities to suit their tastes and moods. Information about the service was not accurate.

Privacy was respected and people held keys to their rooms. We saw that people had individual attention when they needed or requested it.

People had timely access to doctors. Relatives and professionals were consulted as agreed with people or in their best interests about care, medicines and health checks.

One relative commented in a provider quality survey that staff were excellent and “always tried new ways to keep people integrated into the community”.

People got along together without incident. People had support to budget for their needs and there were effective controls to account for people's money and how it was spent.

Staff knew how to recognise and report possible abuse within the service and to outside agencies. No concerns arose in the past year.

There was a small staff team who made sure people had consistent support. Most staff were trained for their roles and were regularly supervised.

People and relatives were often consulted about the quality of care and the environment, and comments were acted upon. There were no complaints.

The home was clean and tidy. There were regular checks of the environment and action taken reduced most potential health and safety risks.