Crownwise Limited - St Andrews

Crownwise Limited - St Andrews is a residential care home providing the regulated activity of accommodation and personal to up to 8 people with a mental health condition. Crownwise Limited - St Andrews accommodates people in one adapted building. At the time of our inspection there were 8 people using the service.

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

People and their relatives were happy with the care provided. Comments included, “I like it here. I am happy” and “I have friends here. The [staff] are friendly and always helpful.” People were protected from the risk of avoidable harm. Comments included, “I feel safe here” and “We have a good security system. [Staff] treat us so well. I don’t have any concerns.”

Staff knew their responsibility to protect people from harm. They knew how to identify and report abuse, and when to whistle blow concerns. Risk assessments were undertaken and guidance put in place. This enabled staff to provide care to people in a safe manner. Enough staff were deployed to deliver care. The provider followed safe recruitment processes to ensure only suitable staff were employed to support people. New staff underwent induction before they started providing care. Medicines were managed and administered safely. Staff followed infection control and prevention guidance and minimised the risk of cross contamination.

Staff were supported to undertake their roles. They received regular training and supervision which enabled them to do their work effectively. People received support to maintain good health and their well-being.

A consistent and regular team of staff delivered care to people. This enabled them to develop positive and meaningful caring relationships. People’s care delivery respected and upheld their dignity and privacy. People were asked for their consent before staff provided care to them. Staff supported people to maintain their independence and to make choices about their day to day living.

People’s needs were assessed and met. Care plans were reviewed and updated to reflect changes to each person’s needs and support they required. People received the support they required to access health services when required. People and their relatives felt confident and knew how to make a complaint if they were unhappy with any aspect of their care.

People, their relatives and staff were happy with the way the service was managed. They described the provider as open, transparent and approachable. The provider listened to people and valued and considered their views. Audits were undertaken for quality assurance on the care provided. Improvements were made when needed. The provider encouraged and ensured staff learnt lessons when things went wrong. Plans were put in place to minimise the risk of incidents from happening again. The provider worked in partnership with health and social care professionals and other agencies to ensure people received care appropriate to their needs.

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.

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 this service was good (14/03/2018).

Why we inspected

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

Follow up

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

Crownwise St Andrews is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Andrews accommodates up to eight people with a mental health condition, in one large house over three floor house, in the London Borough of Lambeth.

The service had a registered manager in place. 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 service continued to develop and regularly review risk management plans to keep people safe. Risk management plans gave staff clear guidance on managing identified risks and minimising the risk of a breakdown in their mental health.

People continued to be protected against the risk of harm and avoidable abuse. Staff were aware of the providers safeguarding policy, how to escalate concerns and where appropriate whistleblow.

People received support from familiar staff that underwent rigorous checks to ensure their suitability for the role. Staffing levels were monitored to reflect people’s level of needs. Staff underwent training to effectively meet people’s needs, and received regular supervisions and annual appraisals to reflect and improve their working practices and the delivery of care.

Medicines were managed appropriately and regular audits carried out to quickly identify issues, so that the impact to people was minimal. Medicines were administered in line with the prescribing G.P.

The service had an embedded culture of ensuring 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. Staff had sufficient knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People continued to receive care and support from staff that respected and embraced their differences. People were encouraged to recognise and celebrate their culture and beliefs as and when they desired.

People were provided with foods that met their dietary needs and requirements, in line with guidance from a dietician and other healthcare professionals. People who required specific dietary requirements were provided with this and encouraged to make healthy choices.

The service had devised in collaboration with people, their relatives and healthcare professionals, care plans that identified their needs and gave staff guidance on how to meet their needs. Care plans were reviewed regularly to reflect people’s changing needs.

The service supported people to engage in activities of their choice and that met their social needs. People were encouraged to attend day centres and other community based activities as well as in-house activities organised by the activities coordinators.

The service had an embedded culture of undertaking audits to drive improvements within the service. Audits that identified issues were actioned swiftly. The provider continued to seek people's views through regular meetings, quality assurance questions and consultations

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.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures are robust and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly.

A member of the management team was available on call in case of emergencies. Staff had received training to meet the needs of the people living at the home.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Areas of the support required for each person had been identified in care plans where required and records and our observations confirmed that this support was provided.

Is the service caring?

People were supported by kind and attentive staff. Our discussions with staff on duty and our observations of the care and support provided confirmed this. We saw that care workers showed patience and gave encouragement when supporting people.

Is the service responsive?

The staff responded quickly when people needed extra support from their health professionals. People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy and had been frequently surveyed for their views of the service. We saw that the provider used this feedback to improve the service. People can therefore be assured that their views are taken into consideration in regards to the running of the service.

Is the service well-led?

The service was well- led. The manager was registered and had been in post for many years. The provider visited the service often and followed up on any quality issues identified. The service worked well with other agencies and services to make sure people received their care in a joined up way.

One person told us " I am very happy here. I enjoy having a cigarette in the garden. I like the staff. They are polite and not at all abusive. There are lots of meetings and activities to do. I enjoyed the recent day trip to the seaside".

Another person told us " The staff are nice. They help me wash my hair and have a bath".

We asked another person if they were happy at St Andrews and the person smiled broadly and gave us a 'thumbs up' sign that things were good. They told us they were very happy at St Andrews and enjoyed a good joke with the staff.

We found that staff responded to people's requests for help and their changing needs. Staff were seen to be encouraging and supportive with a good understanding of people's preferences and routines.

People were being supported to maintain their physical and mental health and encouraged and supported to take part in activities in the community and at home. Staff encouraged people to be independent where possible.