The inspection was carried out on 7 September 2016 and was unannounced.

The Crescent is registered to provide accommodation with personal care needs to a maximum of five people who have a learning disability or autistic spectrum disorder. There were five people living at the home on the day of the inspection.

There was a registered manager in post who was present during 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.

Relatives felt staff kept their family members and their belongings safe. Staff knew how to identify poor practice and signs of abuse and how to report concerns. Where concerns had been identified these had been dealt with appropriately and action taken to prevent reoccurrence.

There were enough staff to support people’s health and social needs. The provider had carried out recruitment checks to ensure prospective new employees were suitable to work with people living at the home.

People needs were assessed prior to moving into the home to ensure that the service could meet their needs and aspirations. Staff were aware of the risk associated with people’s needs and took action to minimise these without restricting people’s choice. Staff took appropriate action to deal with incidents and stop them happening again.

People were supported to take their medicines as prescribed and accurate records were maintained. Staff monitored people’s health and arranged medicine reviews and health care appointments as required.

Staff sought people’s consent before supporting them. Staff enabled to make their own decisions by explaining things to them in a way they could understand. Where people were unable to make certain decisions for themselves these were made in their best interest to protect their rights.

People were supported to choose and prepare their own meals and drinks. People’s nutritional needs were routinely assessed monitored and reviewed. Staff provided support and equipment to enable people to eat independently.

People and relatives found staff friendly and caring. People were supported to keep in contact with friends and relatives. Staff treated people with dignity and respect and supported them to increase their independent living skills.

People were supported to lead fulfilled lives. Staff sought opportunities to broaden people’s life experiences. People were supported to follow their dreams and aspirations.

Relatives had not found reason to complain but were confident that prompt actions would be taken to address them. The provider had a clear complaints procedure that was available in different formats.

There was a positive working culture at the home which encouraged open and honest communication. The registered manager had a clear vision for the service which was shared by staff. The provider sought the views of people, relatives and staff to drive improvements. The provider had a range of checks in place to monitor the quality and safety of the service.

We met all four people who lived at the home. People were unable to share their views or experiences of living at The Crescent due to their complex needs. We therefore observed how staff interacted with them and how they were supported in their daily lives.

We saw people were supported by staff who knew them well. People appeared happy and relaxed in the company of staff and their peers. We found people’s care and support needs were assessed and regularly reviewed with them. People were supported to maintain good health. We saw people’s health and wellbeing was closely monitored and reviewed in their best interests.

Staff we spoke with were confident to recognise and report any concern or possible abuse. Discussions with them demonstrated they were aware of the different forms of abuse and had received training in safeguarding vulnerable adults.

There were sufficient staff on duty to meet people’s assessed needs. We saw staffing was flexible and based on people’s individual needs and activities for daily living.

Systems were in place to gain people’s views and to monitor and assess the quality of the service.

We tried to talk with people but they were unable to tell us their views and were unwell. We observed as staff worked as a team to care for people and to disinfect the home to prevent spread of infection. Staff interaction with people was caring and attentive to their individual needs. Privacy and dignity was respected. Medical advice had been sought and staff kept people hydrated. Staff consulted each other to make best interest decisions about suitable food to offer people when they showed signs of recovery.

We looked at two people’s care records. We spoke with their relatives, two health professionals, three staff and two managers. All were involved in care planning and best interest decisions about care and treatment. A relative commented, “X is more active, calmer and is doing things beyond my expectations.”

People usually attended college and their independence was encouraged. Services in the community were used by people for regular exercise and leisure activities. People took part in food preparation and daily living tasks if they wanted to. Staff worked with other services to improve people’s health, wellbeing and personal development.

We looked at records about staff and the running of the home. The provider carried out checks and made sure that staff were safe and trained for their roles. There were effective systems in place to act upon and learn from incidents and complaints should they arise.

Due to the complex needs of the individuals using the service not everyone was able to verbally share their experiences of what it’s like living at The Crescent. We spent time observing staff interaction across both homes and talking with staff about how they meet the needs of the people they support. Staff demonstrated a sound understanding of people’s needs and they engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and their peers. People said they enjoyed living at the home and liked the staff. They indicated they liked their bedrooms and enjoyed their meals.

We spoke with four representatives and seven staff to include the manager and two senior managers. We also spoke with two health and social care professionals to gain their views about the service provided. Feedback gained was very positive. People said the home meets the individual needs of the people accommodated and that staff “always” work in people’s best interests.

Staff were motivated and enthusiastic about their work. They told us staff morale is “very good” and they are provided with “very good” training opportunities to keep people safe and meet their needs. One person said, “The training is impressive and people are offered lots of choices and opportunities here”. Staff considered that the support plans were reflective of people’s needs and that risk assessments minimalised risks and promoted rights and independence.

Staff told us they received regular formal supervision to discuss their work practice, performance and identify any training needs. One person said, “We get opportunities to reflect on our practice to drive improvement”. They told us that regular team meetings are held in addition to daily handovers so that they are kept well informed about any changing needs. They considered they were “definitely” able to meet peoples’ individual needs and felt there was sufficient staff on duty to ensure people experienced positive lifestyles. Comments included, “We work well as a team”. “We provide a very person centred service”. “We always do the best for the guys here”.