13 Manor Crescent

Glenholme Specialist Healthcare (Southern Region) Limited - 13 Manor Crescent is a care home providing accommodation and personal care for up to 4 people with learning disabilities and/or autism. There were 4 people living at the home at the time of our inspection.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

There were enough staff on each shift to keep people safe and meet their individual needs. Staffing levels had increased since our last inspection and the use of agency staff had reduced due to the recruitment of permanent staff. This had improved the consistency of care people received and increased opportunities for people to access their community.

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

Right care:

Staff attended safeguarding training and understood their responsibilities in protecting people from abuse. Staff were able to describe the potential signs of abuse and the action they would take if they observed these. The provider’s recruitment procedures helped ensure only suitable staff were employed.

Medicines were managed safely. Risk assessments were in place to help keep people safe. Accidents and incidents were reviewed to identify learning, which was shared among the staff team. The home was clean and hygienic and staff understood how to minimise the risk of infection.

Right culture:

People were supported to express their views at meetings with their keyworkers and relatives told us their views were listened to and acted upon. Relatives said staff kept them up to date about their family members’ wellbeing and involved them in the life of the home.

The management team maintained an effective oversight of the service. Quality checks and audits were completed regularly. Staff were well-supported by the management team and told us advice and support was available to them when they needed it. Staff shared and communicated important information effectively and worked well as a team to ensure people’s needs were met.

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

Rating at last inspection

The last rating for the service was good, published on 10 November 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

13 Manor Crescent provides accommodation and personal care for up to four people with learning disabilities who may also have a physical disability. The accommodation is on one level and consists of four bedrooms with ensuite bathrooms. There were three people living in the home at the time of our inspection.

There is a care home for people with learning disabilities next door which is owned by the same provider. The registered manager of 13 Manor Crescent was responsible for both locations and all members of staff work between both houses.

People’s experience of using this service and what we found

Risks to people were identified and recorded and staff knew how to respond to these risks in order to keep people safe. There were enough staff to meet people's needs and staff were recruited safely. Since the last inspection, the provider had introduced an additional member of staff on the daytime and night shifts. People received the medicines they required. The service was clean, tidy and well-presented and staff were seen following good infection control practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff were seen to continuously encourage people to share their views and support them to make individual choices and the provider completed decision specific mental capacity assessments for each person since the last inspection. The internal and external environments were much improved, people’s rooms were personalised and the home had been redecorated.

The provider ensured that people had access to timely healthcare. There was increased involvement from health and social care professionals since the time of the last inspection and they spoke positively about the support people received. People had access to sufficient and varied food and their nutritional and hydrational needs were met and monitored. Staff had the skills and knowledge to meet people's needs and preferences. They received training, regular supervision and attended team meetings to support them in their roles.

We observed a kind and caring culture at 13 Manor Crescent. Relatives said staff maintained regular contact and updated them on how their family member was. We observed throughout our inspection that people enjoyed spending time with staff and were confident to be in their company.

People’s care plans had been reviewed since the last inspection. They were person centred and gave staff the information they needed to support people. We saw people were supported with their communication needs and there was a focus on facilitating people’s preferred activities in accordance with their care plans.

Robust good governance arrangements were introduced since the last inspection. Systems were in place to monitor the service and management acted to address to any identified shortfalls. The registered manager looked for ways to improve the quality of service people received.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• 13 Manor Crescent is a small care home which can accommodate four people. The building is similar to other houses in the area and has no external identifying features. There were three people living there at the time of inspection. Staff were observed to enable people to make day to day choices, including around food and activities. The care home is located within walking distance of local shops and amenities. Whilst people are not able to travel independently, staff supported them to access the community and there were sufficient car drivers to enable longer trips. The provider engaged with local commissioning partnerships as well as healthcare agencies in order to strive for continuous improvement.

Right care:

• People received personalised support and were enabled and supported by staff to be as independent as possible. Care records were person centred and staff could tell us about an individual's specific care needs and preferences. There were personalised positive behaviour support plans in place. People were supported to access specialist health and social care support in the community. We saw that people's dignity was respected and any personal care required was done discreetly and the person's dignity was not compromised. Staff enabled people to make choices about how they wished to be supported in any given activity. People had been supported to personalise their own rooms and communal areas.

Right culture:

• The service had a positive staff culture that was person-centred and inclusive. Leadership and staff showed commitment to those whom they supported. They spoke with passion about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us how the needs and views of those whom they supported must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 November 2020), when we carried out a focused inspection in the safe and well-led domains. There were other breaches of regulation found during our fully comprehensive inspection (published 25 March 2020). The provider completed an action plan after that inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the previous fully comprehensive inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Generation Care Limited - 13 Manor Crescent on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

13 Manor Crescent provides accommodation for up to four people with learning disabilities who may also have a physical disability. The accommodation is on one level and consists of four bedrooms with ensuite bathrooms. There were three people living in the home at the time of our inspection.

There is a care home for people with learning disabilities next door which is owned by the same provider. The manager of 13 Manor Crescent was responsible for both locations and all members of staff work between both houses.

People’s experience of using this service and what we found

It is a condition of registration that the registered provider must ensure that the regulated activity is managed by an individual who is registered as a manager in respect of that activity. The manager in post at the time of this inspection was not registered with CQC, which has an effect on the rating of the service.

The provider had made improvements since our last inspection. There was increased recording and reporting of accidents and incidents. Staff levels were increased which meant people received care that was tailored to their needs. The general environment was well maintained and nicely decorated. Staff felt supported and valued by the provider.

People were protected from the risks of abuse. Safeguarding incidents were identified and notified to the local authority and CQC. Accidents and incidents were fully investigated, and an action plan developed to minimise further risk. Family members told us staff provided safe care and were kind and supportive to their relatives. They also said communication from staff with them increased during this COVID-19 period.

Quality assurance processes identified and actioned required improvements to the service to ensure people received consistent and safe care in line with their needs. The leadership team listened to staff, made them feel valued and supported them to deliver the most appropriate care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• 13 Manor Crescent is a small care home which can accommodate four people. The building is a house in a residential community, with no external identifying features. There were three people living there at the time of inspection. Staff were observed to enable people to make day to day choices, including around food and activities. The care home is located within walking distance of local shops and amenities. Whilst people are not able to travel independently, staff supported them to access the community. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• Care records were person centred and staff could tell us about an individual’s specific care needs and preferences. There were personalised positive behaviour support plans in place. We saw that people’s dignity was respected and any personal care required was done so discretely and the person’s dignity was not compromised. Staff enabled people to make choices about how they wished to be supported in any given activity. People had been supported to personalise their own rooms and communal areas.

Right culture:

• Leadership and staff showed commitment to those whom they supported. They spoke with passion about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us they viewed themselves as visitors and as such, the needs and views of those whom they supported were paramount and must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 25 March 2020) and there were multiple breaches of regulation. We served warning notices for breaches of regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served requirement notices for regulations 9, 10, 11, 13, 15 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 18 of the (Registration) Regulations 2009. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvement had been made in the key questions we inspected, and the provider was no longer in breach of regulations 12, 13,15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations, as well as regulation 18 of the (Registration) Regulations 2009.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements in the Key Questions Safe and Well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Generation Care Limited - 13 Manor Crescent on our website at www.cqc.org.uk.

There is a care home for people with learning disabilities next door owned by the same provider. The registered manager manages both locations and all members of staff work between both houses.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance; however, the principles and values were not always being upheld. We expect that services that uphold these principles and values ensure that people living with learning disabilities and/or autism are supported to live meaningful lives that include control choice and independence. We found this was not always happening in practice.

People’s experience of using this service and what we found

People were not always being protected from the risks of abuse. Safeguarding incidents were not always identified and were not notified to the local authority or CQC. Accidents and incidents were not fully investigated, and no actions were identified to mitigate the risks. There were not sufficient staff deployed to support people’s needs.

Although staff received training and supervision, this was not effective in ensuring good practice within the service. People did not always receive personalised care in line with their care needs and staff did not always work with agencies to provide timely care. Care plans lacked guidance around the needs of people and when changes occurred in people’s needs these were not always updated in their care plans. People did not always have access to meaningful activities.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. For example, people had limited independence in the care they received, the activities they engaged in and the food they ate. Menus were developed by staff with no evidence of input from people who lived at the service. People were not involved in reviewing their own care or setting their own goals.

Quality assurance processes were not effective in identifying and delivering required improvements to the service which meant people were at risk of not receiving a consistent or safe service in line with their needs. The leadership needed to be more effective in ensuring staff were able to deliver the most appropriate care.

Family members told us that staff were kind and caring to their relatives. They also said staff were welcoming and communicated well with them.

The provider had systems in place to ensure safe recruitment of staff. Medicines were managed in a safe way and competency checks took place to ensure that staff were appropriately administering medicines. Staff meetings were held regularly.

Enforcement:

We have identified breaches that relate to people not being protected from abuse, risks to people were not being managed in a safe way, staff were not always following the principles of the Mental Capacity Act. There were not always sufficient staff to ensure people’s needs were met, people’s nutritional and hydration needs were not managed appropriately, people did not always receive person centred care and there was lack of robust effective oversight of the service.

Please see the action we have told the provider to take at the end of this report. The last rating for this service was Good (published 18 July 2016)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

13 Manor Crescent provides accommodation for up to four people with learning disabilities and who may also have a physical disability. The accommodation is on one level and consists of four bedrooms with ensuite bathrooms. The home is owned and operated by New Generation Care Limited. There is also a care home for people with learning disabilities next door that is run by the same organisation and shares the same staff team and manager.

The home 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 and associated Regulations about how the service is run.

In June 2013, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People were happy living at the home and most relatives with the service provided. Some relatives and a healthcare professional expressed concerns about staff turnover and the level of support received by the manager, from the organisation. During our visit there was a welcoming, friendly atmosphere with people out doing activities and interacting positively with staff. People chose their activities with staff support and, attended them within a risk assessed environment. The house also provided a safe environment to live in. The activities were varied and took place at home and within the community.

The records were kept up to date, covered all aspects of the care and support people received, their choices, activities and safety. People’s care plans were fully completed and the information contained was regularly reviewed. This supported staff to perform their duties efficiently and professionally. People were encouraged to discuss their health needs with staff and had access to GP’s and other community based health professionals, as required. People were supported to choose healthy and balanced diets that also met their likes, dislikes and preferences. This enabled them to be protected from nutrition and hydration associated risks. They said they were happy with the choice and quality of meals they ate.

The person who was at home, knew who the staff that supported them was and the staff knew them, their likes and dislikes. They were well supported and they liked the way their care was delivered. Relatives also said staff worked well as a team and provided them with updated information. They had appropriate skills and provided care and support in a professional, friendly and supportive way that was focussed on people as individuals. The staff were trained and accessible to people using the service and their relatives. Staff said they enjoyed working at the home. They received good training and support from the manager.

Relatives said the manager was approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

We looked at two care files, records of health care appointments and daily notes maintained at the service. We spoke to three relatives, two members of staff and the registered manager.