This inspection took place on 16 and 19 January 2018 and was announced. The provider was given 48 hours' notice because the location was a small care home for people who are often out during the day, and we needed to be sure that someone would be in.

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

The Crescent Care Home is registered to provide care for up to nine people in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. On the day of our inspection there were six people using the service.

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

We last inspected the service in February 2016 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The provider and registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at The Crescent Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Activities and work placements were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had a complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service, family members and staff were regularly

The inspection took place on 9 and 26 February 2016. This inspection was announced.

The Crescent Care Home is a large grade II listed building situated in Hartlepool. The accommodation is provided over three floors for up to nine people living with a learning disability and autism. At the time of the visit seven people were using the service.

There was a registered manager at the service at the time of the 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.

We last inspected the service on 12 and 18 November 2014 and breaches of legal requirements were found. We told the provider there were no robust systems in place to identify risks and how they would be managed and reviewed. The provider did not have an effective system for monitoring the service. Staff had not received all the training they needed or professional development, supervision and appraisal.

We asked the provider to take action to make improvements. The provider submitted an action plan detailing how they would achieve improvements. The service was expected to be compliant by 31 October 2015.

During the inspection on 9 and 26 February 2016 we found improvements had been made.

We found that the service had reviewed their care planning process and had made improvements to care planning and risk assessments. The service gained confirmation from Employment Link, (the service that supports people into work) that risk assessments were carried out as part of the process undertaken when they support people in to work in the community. The registered manager told us and records confirmed they had contacted the local authority for evidence of risk assessments for those who are accessing day services.

We saw that the provider had sought the views of people who used the service as well as relatives and other stake holders. Views were analysed and finding were used in the plan to develop the service. The registered manager had completed an infection control audit, medication audit and a full review of care plans. However, the quality assurance process still required development to ensure the provider could demonstrate an auditing process in all areas of service delivery.

Staff had received training, regular supervision and appraisal. One staff member told us, “Supervisions are more in-depth now.”

The people who lived at The Cresent Care Home were able to give us their views on the service. One person told us, “They look after me, and help me to meet my brother.” Another said, “I am really settled here, I have lots of things to do.”

We spoke to relatives to get their views on the service. Relatives gave positive comments about the service and said people enjoyed being at the home. One relative told us, “There is a professional side and a caring side, they always let [family member] be his own person.”

Staff had an understanding of safeguarding and whistleblowing and were confident that any concerns they had would be listened to by the registered manager. One staff member told us, “I would report it to [registered manager] and if needed I would go to the safeguarding team.” Staff gave examples of abuse such as physical, financial and emotional, and how behaviours may change if someone had been or was subject to abuse.

Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were aware of who had a DoLS in place and why. The registered manager had a good insight into the principles of the MCA and explained the processes used by the service in meeting their responsibilities. We found support plans were linked to DoLS.

Recruitment practices were robust and safe. This meant that only people who were suitable to

We found people experienced care, treatment and support that met their needs and protected their rights. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We found that where people did not have capacity to consent, formal assessments were not undertaken to ensure that the provider acted in accordance with legal requirements.

People who used the service, staff and visitors were protected against the risks of usafe or unsuitable premises.

People were protected from unsafe or unsuitable equipment.

We spoke with five people who used the service and one relative. People who used the service told us, "It's wonderful here", and "I love it here, I would not want to live anywhere else". The relative we spoke with told us, "I cannot speak more highly of them here, it really is wonderful. They have put their whole lives into it and I know I couldn't ask for anything more."

People who lived at The Crescent Care Home told us that staff were; "Wonderful", "Brilliant", "Lovely" and "Always make me laugh". People felt that they were respected. They were given choices and we saw that they had access to a wide variety of activities. They were supported to maintain their independence.

The care and welfare needs of people were met. People had access to dentists, opticians and other health professionals. There was evidence that when people were unwell, appropriate action was taken. One person told us, “When I wasn’t feeling very well they called the doctor for me”.

Staff were aware of their responsibilities relating to safeguarding vulnerable adults and the people who lived at The Crescent Care Home felt safe and happy to live there.

The service had systems in place to monitor the quality of the service it provided and made sure that people were able to make their wishes and opinions known. They were given choice and involved in decisions about the way their support was delivered.

The records held by the service relating to people who lived there were in need of improvement because some were out of date and some had not been reviewed regularly to make sure they were still relevant.

The inspection took place on 12 and 18 November 2014. The inspection was unannounced. We last inspected The Crescent Care Home in July 2013. At that inspection we found the home was meeting all the regulations that we inspected.

The Crescent Care Home is a large Grade II listed mid terraced Victorian property situated on the Headland in Hartlepool. It provides accommodation over three floors for up to nine people with a learning disability and broad spectrum autism.

There was a registered manager at the service 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 2008 and associated Regulations about how the service is run.

The experiences of people who lived at the home were overall positive. People told us they felt safe living at the home, staff were kind and considerate and the care they received was good.

People told us they liked the food in the home, and there was plenty of food and drink available.

We observed people in the communal areas and people’s bedrooms were clean and comfortable. We identified concerns about a potential breach of hygiene standards in the kitchen. This involved allowing the family’s pet dog’s free access to the kitchen areas when in the home. We have made a recommendation that the service explores the Department of Health guidance regarding precautions to adopt when pets are brought into the home.

People’s health needs were monitored and staff worked well with other professionals such as GP’s to ensure their needs were met.

We saw no up to date supervision or appraisal records for all members of the staff. Therefore staff were not adequately supported to acquire and maintain the skills and knowledge to meet people’s needs effectively.

The management of care records required improvement. We found the care records in use at the home and the information contained in them was not consistent. Risk assessments did not refer to any of the potential risks and possible hazards relating to people working away from the home and attending other services out in the community. This meant people may be put at risk, as staff may not have the most up-to-date information on people’s care.

People told us they were pleased with the care they received, these views were shared by people’s relatives. We saw staff were kind and caring towards people and treated them with respect. We saw staff responded to people’s needs quickly and in a caring way manner.

Current systems to regularly assess and monitor the quality of services or identify, assess and manage risks relating to people’s health, welfare and safety were ineffective. There were no records to show the provider regularly requested feedback from staff or people or their representatives on how the service could improve.

You can see what action we told the provider to take at the back of the full version of the report.