About the service: Crosby Close provides accommodation and care with nursing for up to 12 people with a learning disability and/or autism. Some people also have additional physical disabilities. People are accommodated within two large detached bungalows with surrounding grounds. At the time of our inspection there were 12 people using the service.

The provider and staff were working within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service:

¿ People’s relatives felt their family members were safe and very well cared for. Staff demonstrated a good understanding of the risks people faced in their day to day lives and the ways they could support them to minimise those risks.

¿ People were supported by sufficient numbers of staff who were well trained and competent to support people with complex health and care needs.

¿ People’s medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

¿ People’s healthcare was well monitored, and interventions were appropriately timed to ensure people remained as healthy as possible.

¿ People were supported by staff who understood the importance of respecting their choices and providing the support required whilst promoting and maintaining people’s independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

¿ 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.

¿ The registered manager was respected by the staff and promoted an open and transparent culture. The registered manager and staff understood their roles and responsibilities.

Rating at last inspection: The service was rated ‘Good’ at our last inspection. The report following that inspection was published on 18 August 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

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

This inspection was carried out on 26, 27 and 28 July 2016 and was unannounced. At their last inspection on 11 December 2015 they were found to not be meeting all the standards we inspected. This was in relation to safeguarding people from the risk of abuse and management of medicines. We also found that management systems required improvements. The provider sent us an action plan setting out how they would make the necessary changes. At this inspection we found that they had made sufficient improvements and were meeting all the standards.

1-2 Crosby Close provides accommodation, care, nursing and support for up to 12 people with learning and physical difficulties. At this inspection 10 people were living at the service.

A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. The manager had applied to become registered with the CQC. 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.

People received care that met their needs and support plans gave staff clear guidance on how to support them safely. Staff had received appropriate training for their role and felt supported. We saw that there were sufficient staff to meet people’s needs in a timely way which was person centred.

Staff had been through a robust recruitment process to help ensure they were fit to work in a care setting. They were able to identify and report any concerns. People had their individual risks assessed and staff knew how to mitigate these. Medicines were also managed safely.

People had support to ensure they had enough to eat and drink and had access to health professionals when needed. Most people went out most days and there was one to one spent with people when they were at home.

People’s individual preferences, choices and lifestyles were known by staff. People were not always able to be involved in the planning of their care but relatives took an active role. Advocacy was available if it was needed.

There were systems in place to oversee the quality of the service and to ensure they complied with regulation. Feedback about the manager and leadership in the home was positive.

When we visited Crosby House on the 13 February 2014, we observed good interactions between people and staff. People looked relaxed and comfortable in the company of staff. We saw staff demonstrated genuine affection, care and concern for people.

Staff ensured that people were respected and treated as individuals in their own rights. People’s appearance was well presented and they were appropriately dressed to suit the weather and their age.

We found that the home had systems in place to reduce the risk and spread of infection. Regular infection control audits were undertaken and areas requiring attention were addressed.

We found that the premises were safe and adequately maintained. This meant that people were not at risk of unsafe premises.

Suitable arrangements were in place to ensure that staff were appropriately recruited. Checks were undertaken to ensure that those staff registered with the Nursing and Midwifery Council (NMC) were allowed to work by that body.

We found that the home’s quality assurance processes ensured that the care provided to people was regularly reviewed and that it was safe and effective.

People who lived at Crosby Close had significant care needs and were unable to verbally communicate satisfaction with the care they received. We made observations and talked to a relative who was visiting the service.

One of the people’s relatives told us that they were satisfied with the care provided to their relative. They told us, “there is an open door policy here which is very good” and that “when my relative came here they needed a lot of support, Crosby Close sought advice from other professionals and have learned a great deal”.

Staff also told us Crosby Close was a nice place to work and that they felt supported by management. We were also told that people’s privacy and dignity was respected and that staff always closed the doors when they’re helping with personal care. We observed the home to be visibly clean on the day. All the people appeared to have had their personal care needs met.

Overall we found that standards were met.

The people who live at Crosby Close depend on staff to interpret their needs and were not able to give us their views directly. We spent time observing how people interacted with the staff and their surroundings. The staff showed us aids they use, to assist people to communicate, which included things to hold, favourite pictures and photographs. Together with individuals who live at Crosby Close staff showed us photographs of holidays they had been on and important events and celebrations. We observed sensitive communication between residents and staff as people made their needs known. There was a positive relaxed atmosphere.

This inspection was carried out on the 7 and 11 December 2015 and was unannounced.

1 & 2 Crosby close provides nursing care and support for up to 12 people with physical and learning disabilities.The location consists of two houses side by side and 6 people reside in each House. There were five people living at 1 Crosby close and 6 people living at 2 Crosby close on the two days of our inspection.

People were not always kept safe, although there were risk assessments in place they were not always followed. Medicines were not managed safely. Permanent staff employed at the service had received appropriate training for their role, but the interim manager told us they did not know what training agency staff had completed and this may well have compromised people’s safety. We saw that agency staff had a ‘profile’ which provided some information but not in relation to training they had undertaken. Staff told us they felt supported and had recently had one to one meetings with their line manager.

There were systems in place to monitor the quality of the service and action plans developed to address any issues found. However, actions relating to the improvement of the safe administration of medicines had not been addressed at the time of our inspection.

There was not a registered manager in post. The registered manager had recently left the service and the provider was in the process of recruiting a new manager for the service. There was an interim manager who was overseeing the day to day management of the service. 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 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS)

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that most people living at the service were able to make their own decisions and those who were unable had their capacity assessed. The manager and staff understood their roles in relation to DoLS. DoLS applications had been completed for people who received constant supervision and were awaiting an outcome.

People received care that met their needs and we observed staff knew them well. People were unable to contribute to planning their care, however in the case of some people, family and relatives had been involved.

People attended day centres and were supported with other activities both in the home and the community.

You can see what actions we have asked the provider to take in the full version of the report.