We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This inspection was a routine scheduled inspection and was unannounced.
Crystal Hall is located in a rural area of Preston. The property is a period farmhouse with purpose built extensions. There are well maintained grounds surrounding the property, which include an external aviary, enclosed courtyards, a sensory garden and Japanese ornamental garden. The Registered to accommodate a maximum of 67 people at any one time and at the time of our inspection 65 people lived there. Crystal Hall specialises in the care and treatment of Mental Health in younger adults and in particular specialist care categories of: Bipolar/Manic Depression • Challenging Behaviour • Head/Brain Injury • Huntington's disease • Multiple Sclerosis • Parkinson's disease and Schizophrenia.
The home is required by a condition of registration with the Care Quality Commission (CQC) to have a registered manager in post. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’ The service has had a registered manager in place since 2011. However this person had recently changed role in the organisation and whilst this person remained connected to the home in a quality assurance role for Crystal Hall, a new manager had been appointed and their application for registration with CQC had been submitted.
There were systems and processes in place to protect people from the risk of harm. All of the people we spoke with told us they felt safe in the home whilst all the staff we spoke with said they felt supported and encouraged to raise concerns.
Staff we spoke with were all able to demonstrate a good understanding of people who used the service and were able to tell us about different aspects of people’s care and triggers which may affect some people’s behaviour. Staff we spoke with all told us that there were sufficient numbers of staff to cope with difficult and challenging situations if they arose. This meant that people who used the service were protected against avoidable harm.
Care records reviewed showed a detailed assessment had taken place before people moved into Crystal Hall. Once there, the service engaged with people who used the service through an assessment and planning process. For those people who were unable to participate fully we saw evidence that the home had liaised with relatives and, where necessary, advocates. Where people may display behaviour which challenged the service, we saw evidence in the support records that assessments and risk management plans were in place. This meant that the home obtained sufficient information to manage people’s risks in an appropriate manner.
Crystal Hall was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) Codes of Practice. The MCA and DoLS provide legal safeguards for people who may lack the capacity to make some decisions for themselves and who may have restrictions placed on them in order to ensure they receive the care and treatment they need and to protect them from harm. The codes of practice are statutory guidance which people with responsibilities under the act are expected to follow.
The home had policies and procedures in relation to the MCA and DoLS. Care records we viewed showed that formal tests of people’s capacity to make certain decisions had been tested and documented. Staff we spoke with all had a good understanding of the MCA and DoLS. We saw evidence of the involvement of other professionals and Independent Mental Capacity Advocates (IMCAs). We saw that all paperwork for any person who was the subject of a DoLS authorisation was correct.
People who used the service who we spoke with all told us that they felt their needs were being met. One person told us: “I can't look after myself on the outside. I have dementia and this is the best place for me".
Prior to the inspection the provider had given us details of health and social care professionals involved with the service. We contacted these people and those that replied told us that people who used the service were well-cared for by all members of staff and their individual needs were well met.
Staff we spoke with across all three units of Crystal Hall during the inspection all told us that they felt supported. They confirmed having received induction and supervision regularly. Supervision records were checked which confirmed what we had been told. This meant that staff were and felt supported to perform their role.
The provider told us that staff had received regular training in mandatory subjects such as the safeguarding of vulnerable adults, the mental capacity act 2005, medication, infection control and control and restraint. Staff we spoke with confirmed they had received this training and people who lived there told us that staff were able to meet their needs. This meant that people were support by staff with sufficient knowledge to provide safe and appropriate care and support.
Each person had an individual, completed and updated care plan in accordance with a recognised model of care planning for people with mental health needs. Care plans contained a range of completed risk assessments which had been regularly reviewed and updated. We observed that where changes had been made care staff had implemented changes required. People who lived at Crystal Hall told us that they were happy at the home and received the care they needed. Which meant that staff followed and responded to people’s individual care plans.
We observed the lunchtime meal period and found that where necessary staff assisted people who needed assistance in a relaxed and un-hurried manner. This helped to ensure people found mealtimes a pleasurable experience.
A wide range of activities were provided both in-house and in the community. People who lived at Crystal Hall told us they had plenty to do. We observed people leaving and returning to the home throughout the day. Which meant people were able to involve themselves in meaningful activities or to spend time on their own or in the community.
All staff we spoke with had a good knowledge of individual people they cared for including their likes and dislikes. We observed staff demonstrate compassion in care by treating people in a kind and dignified manner. Staff told us that they always tried to provide a homely environment, with a friendly in approach. People who lived at Crystal Hall told us the staff were responsive, caring and treated them with dignity and respect.
Staff told us that they received support from the managers and were able to raise concerns. We were informed by all the staff we spoke with that regular and good quality handovers took place between shifts and that they found these were useful especially if they had been off for a period.
We saw that there was a compliments/complaints box which was accessible to people who used the service as well as others who visited the home. People who lived at Crystal Hall told us they led their own meetings, set the agenda and complaints and compliments were discussed freely and openly in this forum. People we spoke with told us that the manager investigated and responded to people’s complaints.
There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, and the following up of these ensured continuous improvement. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.
Observations on the day of our inspection told us that the home was in good repair. A slightly unpleasant odour in a couple areas of the home noticed at first had gone later in the day. We also saw some bumps in the carpet although these were not sufficient to pose a risk of harm to people walking over them. Cleaning schedules we looked at had been maintained and completed by the domestic staff on a daily basis and were up to date. All of the rooms for people who used the service we went in were clean and well maintained.