Palmer Crescent 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.

Palmer Crescent accommodates up to 24 people in four bungalows on one site, each of which has separate adapted facilities. The registered provider of the service is Welmede Housing Association Limited, part of the Avenues Group, which specialises in providing care to people with learning disabilities or autism.

There was no registered manager in place at the time of our inspection. The previous registered manager had left their post at the beginning of February 2018. A new manager had been appointed and was due to take up their post the week after 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. The provider’s cluster manager told us the new manager would apply for registration with CQC.

We found there was an over-reliance on agency staff which affected people’s experience of care. There was a high number of vacancies on the permanent staff across the four bungalows. The provider had maintained the staffing levels needed to keep people safe but the high use of agency staff meant people were often supported by staff who did not know them well. Relatives told us that it was important for their family members’ well-being to be supported by familiar staff who knew their needs well. They said the high use of agency staff was discomfiting for their family members. The high number of vacancies also placed pressure on the remaining permanent staff. They were working hard to ensure people received the care they needed but some staff were working excessive hours.

Shortages of permanent staff also affected people’s opportunities to take part in activities. There were not enough authorised drivers employed to take people to some of their planned activities and staff had to prioritise taking people to medical appointments. This meant that some people’s identified needs were not being met.

Following our inspection the provider’s regional manager acted promptly to develop an action plan to address the concerns we had identified. This plan set out how the consistency of care people received would be improved and how permanent staff would be supported. Actions included allocating experienced staff from elsewhere in the organisation to support the service until new permanent staff could be recruited and block-booking agency staff to ensure that regular agency staff were employed.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. Health and safety and fire safety checks were carried out regularly to ensure the home was safe and well maintained. The provider had developed a contingency plan to ensure that people’s care would continue in the event of an emergency. The bungalows were suitably adapted and designed to meet people’s needs. Adaptations and equipment had been installed where necessary to ensure people were able to mobilise safely.

Staff were recruited safely. The provider obtained evidence from agencies that the temporary staff supplied had undergone appropriate pre-employment checks. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. People received their medicines safely and as prescribed. Staff maintained appropriate standards of hygiene and cleanliness and followed safe infection control procedures.

People’s needs had been assessed before they move

Palmer Crescent provides accommodation, care and support for a maximum of 24 adults with learning disabilities. The service comprises four bungalows, each of which accommodates up to six people. There were 22 people using the service at the time of our inspection.

The inspection took place on 4 November 2015.

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 and associated Regulations about how the service is run.

There were enough staff on duty to keep people safe and meet their needs. Staff had the skills and knowledge they needed to support people effectively. Staff were well supported in their work. They had access to appropriate training, supervision and appraisal. Staff said morale was good and they worked well together as a team.

The provider’s recruitment procedures were robust and helped keep people safe as only suitable staff were employed. Staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Risks to people’s safety had been assessed and measures had been put in place to mitigate these risks.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when they needed support to make decisions and applications for DoLS authorisations had been submitted where restrictions were necessary to keep people safe.

People’s nutritional needs were assessed and any dietary needs were managed effectively. People were supported to have a balanced diet and their needs and preferences were known by staff.

People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals which ensured that people received the care and treatment they needed.

Staff treated people with respect and supported them in a way that maintained their privacy and dignity. People were involved in their local community and had opportunities to take part in activities and events.

People’s needs were assessed before they moved in to ensure that the service could provide the care and support they needed. Transitions from other services were planned and managed well.

People received personalised care and support based on their individual needs. Staff were motivated to provide good care and ensured that support was delivered in a consistent way.

The registered manager promoted an open culture in which people, their relatives and staff were encouraged to contribute their views.

There were effective systems of quality monitoring, which ensured that all areas of the service were working well and records were up to date. Records were accurate, up to date and stored appropriately.

The last inspection of the service took place on 8 May 2013 and there were no concerns identified.

We were unable to speak directly with people who used the service due to their complex needs. However, we observed staff treating people with kindness and saw that they were cared for appropriately and in a way that met their needs. A relative told us, “They know my daughter inside out. Staff are excellent”.

We visited each of the three bungalows and spoke with one relative, six staff and the registered manager.

We asked a relative who was visiting if staff gained consent for their daughter’s care. They told us that they were involved in decisions about their daughter’s care and, “If my daughter didn’t want to do something she wouldn’t”.

We made a visual inspection of the premises and noted that people’s rooms were clean and tidy, and communal living areas, kitchens and bathrooms, were clean and well maintained.

We spoke with staff about staffing levels as there had been concerns during our previous inspection. Most staff told us, “Things are much better now”. On the day of our visit we saw that there were sufficient staff to provide the care that people needed.

A relative told us that they had no cause for complaint but knew who to speak to if they did. We saw that the provider logged complaints and responded to them appropriately.

We looked at people’s care records, staff records and other records and saw that these were complete, reviewed regularly and up to date.

We were unable to speak to people who used the service as they had complex needs which meant they were unable to tell us their experiences. We spoke to the relatives of three people who lived at the service who all told us that they felt that people who used the service were well looked after.

One person told us they had "Never been more pleased with the home" and that staff had a good understanding of people's needs.

We saw that each bungalow was staffed with a team leader and two care staff. There were two absences due to staff sickness in two of the bungalows on that day where other staff had to be called upon to work to cover the absences. Staff told us that there were persistent problems with staffing and covering when people were absent due to illness.

During the inspection we saw that most people took part in a music activity which everyone appeared to enjoy. We observed that staff interacted well with people during this and encouraged people to participate.

We saw three care plans where only one was up to date. Only one had an up to date risk assessments. Staff told us that care plans and risk assessments were not up to date because they had not had the time to do them.

During our inspection we saw several examples of staff acting in a caring and supportive manner.

We did not on this occasion speak to people so cannot report what the people using the service said.