Crewton Care

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe, and they and their relatives spoke highly of the support they received. They told us staff were introduced to them before they transferred to the services provided by Crewton Care. People and their relatives were involved in decisions to reduce risk, which included a proactive approach in supporting them to take positive risks to increase their experiences and promote independence. People and their relatives told us support was provided by a core team of staff who understood their needs and who they had developed positive and supportive relationships with. People and their relatives were involved in decisions relating to their medicine. Safe practices were used to support people to transfer between services this included the development of a transfer plan to support the person with the move. Staff demonstrated a good understanding of people’s needs and of their role in promoting people’s safety, health and welfare. Staff spoke positively of the support they received to promote and monitor people’s safety. Staff liaised with health and social care partners to promote people’s safety and wellbeing. Staff underwent a robust recruitment process and received ongoing training and support. Policies and procedures were in place to promote people’s safety and welfare, which included safeguarding, whistleblowing and staff recruitment practices. Systems and processes were in place which monitored the safety of the care provided, which included audits and the analysis of incidents and events.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff confirmed the provider had systems and processes to assess people’s needs before they transferred to the service. Staff confirmed transition plans were developed, which gave them guidance about people’s needs before providing their care and support. A staff member said, “Information is shared about people’s needs before they transfer to us. Plans are made to assist with the transition, staff may shadow the person at their placement, the person may have a number of visits before they move in. The training we receives includes specific training relevant to the person.”

We received mixed feedback from partner agencies prior to the assessment. Whilst there had been initial concerns raised by the local authority in 2023 around the provider’s pre-assessment and transition process, the provider had worked well with the local authority in making improvement and the local authority reported the progress and changes had been sustained.

The provider had systems and processes and a multi-disciplinary approach to supporting people to transition between services, this approached supported continuity of care and the development of relationships between people and staff. The provider completed their own pre-assessment and developed a transition plan in agreement and discussion with the person’s support network. This included the person themselves if possible, family members, social worker, the previous care provider and the crisis response intensive support team. The C.R.I.S.T provides support for people with a learning disability to enable them to stay in the community who are using behaviour that hurts themselves or others. Information was shared with other agencies such as ambulance and hospital staff via a hospital booklet along with health actions plans to facilitate continuity of people’s care. In the event of a person moving on from the service, the provider ensures information was shared with new care providers.

People received safe care and support from a regular staff team that were experienced and competent. Relatives spoke highly of the caring and supportive approach of the staff, and of the management oversight and overall service received. A person told us how they felt safe living in their tenancy with the staff team that supported them. A relative said, “There have been wonderful improvements with my relative now that routines are in place. My relative is safe because there is always someone with them.” Another relative said, “I have nothing bad to say; it is a good placement.” A relative spoke of the G.P.’s involvement in best interest decisions.

Staff were aware of their role and responsibility to protect people from abuse and avoidable harm. Staff had received safeguarding training and demonstrated a comprehensive understanding of the types of abuse. Staff had access to the provider’s safeguarding policy. A staff member said, “It is about protecting individuals from any type of abuse or harm. Any concerns I record and report. I’m confident the management team would report and act.” Staff were also aware of the provider’s whistleblowing policy. A staff member said, “I’m aware of the whistleblowing policy if I noticed anything not right about how staff were treating a person, I know I would be protected. I feel confident to use it.”

The provider had a safeguarding policy and procedure. Safeguarding information was available in an easy read format to support the people’s understanding who used the service. The provider had acted following the previous inspection, to enhance their understanding and practice around safeguarding, including delivering additional training and reviewing the internal policy and procedure. The provider had an incident management policy and procedure; whilst there was some analysis to support themes, patterns and learning, this could be further strengthened. The management team and staff had a very clear and detailed understanding of people’s needs and risks, and monthly meetings included discussion and sharing of lessons learnt along with multi-disciplinary team meetings which supported the staff team. Court of protection applications had been submitted where people did not have the mental capacity to consent to their care and support. However, mental capacity assessment and best interest decisions had not been undertaken for people with fluctuating capacity. The management team confirmed they would make the necessary improvements.

People were as involved as possible in how knowns risk were managed and mitigated. A person told us how their previous lifestyle choices had put them at risk, and now, with the support of staff they now made different choices, which had reduced risks. Relatives told us they were involved in the assessment of risk, including positive risk taking which ensured risks were managed safely and effectively. A relative said, “ My relatives does have emotional times and the staff listen to them, offer distractions like massage or a pamper session. Nothing phases these staff.”

Staff provided examples about how they support people to manage and mitigate risk. Staff confirmed they had received training in how to support people when they were anxious or distressed. Staff referred to the positive behavioural support plans which provided guidance on how to support people safely. Staff confirmed they attended regular meetings and received support from the management team, which supported them in promoting people’s safety through lessons learnt and evaluation of what worked well. A staff member said, “Restrictive physical intervention is always used as a last resort, we are aware of what can trigger a behaviour and how we can use distraction and diversion.” Another staff member said, “If there has been an incident, we have de-brief meetings to discuss what’s happened, to try and identify any triggers , and discuss how to manage and resolve from happening again.”

The provider had policies and procedures to support safe and effective use of restrictive physical intervention and incident management. Staff had received training in PBS (positive behaviour support) and PMVA (prevention management violence aggression). Staff were supported by a PBS lead staff member who worked in all the supported living sites. People’s communication needs and preference were documented and there was a positive approach to risk taking. This enabled and encouraged people to have new experiences and develop new skills. Risk were discussed with the person, their relative and external professionals.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received consistent safe care and support from a regular staff team that knew them well. A person told us about their staff team, they confirmed they were the same staff that supported them and said how well staff knew and understood their care and support needs. Relatives spoke highly of the staff team. They too confirmed their relative received care and support from an experienced, competent and consistent staff team that understood their relatives care and support needs. A relative said, “There has never been a staff member my relative doesn’t know. The staff here go over and beyond to support my relative.” Another relative said,” I would describe the staff as well mannered, very friendly, happy, and they use kind words. They understand the need for routine for my relative. They are good at what they do.“

Staff were positive about the deployment of staff. They confirmed people received their allocated assessed care and support hours from a regular group of staff. A staff member said, “There is a core staff team of 9 or 10. We are a stable, experienced staff team. There is always someone able to cover I have no concerns about staffing.”

Staff were recruited in line with the provider's policy. Staff records included all required information, to evidence their suitability to work with people, which included a Disclosure and Barring Service check (DBS). Staff undertook a period of induction, which included undertaking training in learning disability, mental health awareness and in topics related to the promotion of health, safety and welfare. Staff induction including ‘shadowing’, which meant they worked alongside experienced staff. Staff were matched to work with particular people, considering experience and any common interests. Staff were introduced to people before care and support was provided. People had an identified regular core group of staff that provided consistency and continuity. Staff received ongoing support and monitoring, which included assessments of their competence, spot checks, supervision and an annual appraisal. In addition monthly meetings involving the core team of staff were held for the person they supported. Staff training was continually monitored and records showed training was up to date. Staff deployment checks confirmed people received their assessed allocated hours. The management team had a robust assessment and transition plan and only accept a new care package when they are fully assured, they can meet the person's needs effectively and safely.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines safely and at the right time. People were supported to be as independent as possible to manage their medicines, which included being supported to self-administer their medicines where they were able to and wished to do so. People were supported by care plans, which detailed the medicine they were prescribed and the support needed. Relatives told us medicines which were prescribed were administered and that they had no concerns as to how medicines were managed. Relatives confirmed people’s medicine had been reviewed and in some instances the quantity and dosage of medicine had been reduced. A relative spoke of how medicine was effectively used to manage pain, which had improved the mental health and well-being of their relative.

Staff had a good understanding of the medicines people were prescribed, which included their role in monitoring for potential side effects. Staff confirmed they received training on medicine management and had their competency regularly assessed. Staff spoke of the good relationship they had with health care professionals to ensure people’s medicines were regularly reviewed and of the support and guidance they received about medicines.

The provider had a medicines policy, which included current and relevant professional guidance about the management of medicines. There was a person centred approach to support people with medicines which were administered as and when needed. The effectiveness of the medicine once administered was documented to support future decisions about the prescribing and the administration of medicine given, which included medicines given to support people during periods of distress or anxiety. Audits were undertaken to ensure medicines were delivered safely and effectively; any actions identified as requiring improvements were undertaken.