Cragston Court Rehabilitation Service

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection took place on 26 November 2018 and was unannounced.

The service did not have a registered manager in place at the time of 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 new manager was able to demonstrate they had begun the registration process with CQC.

People who used the service felt safe and at home in a welcoming and calm environment. Staff helped to ensure people felt at ease in their surroundings and their individualities were respected.

All staff demonstrated an understanding of people’s needs and knew how best to reduce the anxieties people faced. Specific risks were well managed and monitored through risk assessments which were regularly reviewed and contained input from external healthcare professionals. Risks to people’s finances were mitigated by robust procedures in place.

All aspects of medicines management were safe, including storage and disposal, administration and ongoing monitoring of ‘when required’ medicines. Areas where practice could be improved were proactively identified and addressed. Staff were suitably trained and knowledgeable with regard to medicines management.

There were sufficient staff to ensure people were safely supported.

The premises were well maintained and clean throughout.

Effective systems were in place to ensure the accurate documentation and update of people’s care needs. Staff understood these systems well and liaised effectively with external healthcare professionals.

People experienced good health and wellbeing outcomes thanks to the knowledge and actions of staff and their timely involvement of external professionals.

Staff received a range of mandatory training, which was refreshed regularly and appropriate to the needs of people who used the service. Training was well monitored and managed.

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 premises were well suited to people’s needs, with a range of quiet lounges and dining areas and a central outdoor garden space.

People were extremely complimentary about the care they received from staff and relatives were similarly impressed. Staff knew people extremely well, were able to anticipate their needs and concerns, and demonstrated genuine warmth towards them.

People were encouraged and enabled to take part in the planning of their care and the running of the service.

Activities were meaningful and varied and planned with people’s involvement. All staff helped organise and deliver these.

Residents’ meetings occurred regularly and were a forum for raising any ideas or concerns people may have about the running of the service.

Staff morale was high and the team worked well together.

The culture was strongly focussed on the needs of individuals and ensuring they had the opportunity to achieved good health and wellbeing outcomes in an environment they felt at home in. The new manager had embraced this culture and was keen to ensure the strengths of the service were maintained. All staff confirmed the management of the service was open, collaborative and approachable.

Further information is in the detailed findings below.

Cragston Court is a care home that provides nursing and personal care and support for up to 20 adults with long term mental health needs. At the time of our inspection there were 19 people living at the home.

The service had a registered manager. 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 found people were given support aimed at protecting them from risks without compromising their independence. Staff were trained to recognise and respond to abuse and any safeguarding issues that occurred had been notified to the relevant authorities.

The home provided a safe, clean and comfortable environment. Where necessary, people had individual aids and equipment for meeting their needs. Regular safety checks were undertaken and any accidents or incidents were properly reported and analysed.

There were sufficient numbers of staff to provide people with continuity of care and support the running of the home. The staff team were skilled and experienced in caring for people with mental health needs. They were provided with suitable training and supported in their roles to make sure people’s needs were met effectively.

Arrangements were well co-ordinated for meeting people’s health needs and accessing health care services. Prescribed medicines were stored safely and accurate records of medicine administration were kept. People had been consulted about their dietary requirements and preferences. There was a varied menu with choice of food and people could prepare their own meals, snacks and drinks.

People were fully involved in their recovery plans and, wherever possible, had given consent to their care and treatment. The management and staff had a good understanding of, and worked within the principles of mental health law to uphold people’s rights and act in their best interests. Self-advocacy was encouraged and provision was made for independent advocates, when needed, to represent people’s views.

Staff were caring and respectful in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care and the service to help them make decisions. Their opinions were routinely sought and acted on, enabling them to influence the service they received.

Care planning was tailored to each person’s diverse needs and was kept under regular review. Staff worked flexibly and were responsive to changes in people’s well-being. People were offered and engaged in a range of social activities and maintained links with the community. No complaints had been received and people told us they were happy with their support.

The home had an open culture where staff worked inclusively with people and their representatives. The quality of the service was monitored and there was an emphasis on obtaining people’s feedback about their care experiences. The management provided good leadership to the staff team and were committed to continually improving the service. There was a clear vision for the future of the service with a number of planned developments intended to benefit the people living at the home.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered our inspection findings to answer questions we always ask:-

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People told us that they were happy living at the home and were supported to remain independent as safely as possible. They also told us that their needs were met because staff supported them to do the things they wanted to do.

Appropriate risk assessments were in place, and the registered manager had suitable arrangements to safeguard people from foreseeable emergencies.

People told us that they felt safe living at the home and their relatives confirmed this. We saw safeguarding procedures were in place and that staff understood how to safeguard the people that they supported. At the time of the inspection, there was no one at the home subject to Deprivation of Liberty Safeguards.

There were regular quality checks and audits completed to make sure that the building and procedures were maintained and further improved and provided a safe environment for people to live in.

Is the service effective?

All of the people we spoke with, told us that they were happy with the care that was delivered and their needs were met. Staff had received training to meet the needs of the people who lived at the home and a member of staff had been appointed as a staff training lead. One relative told us that the service had improved over the last few months.

The home provided people with a choice of suitable and nutritious food and refreshments. We saw that people had a choice of where they ate meals. We also saw that the provider catered for the religious needs of people who lived at the home.

Is the service caring?

We asked twelve people if they had any concerns about the care provided by the home and they told us that were happy with the care provided and that the staff were caring. One relative told us, 'I am happy with the care provided here.'

Observations during the visit showed staff were compassionate and caring to the people they supported. During the day we found positive interactions took place and staff responded in a thoughtful and kind manner to people who lived at the home.

Is the service responsive?

Regular reviews were carried out with the people who used the service and their representatives to make sure the person's care and treatment needs had not changed. This helped ensure staff supplied the correct amount of care and treatment.

Information collected by the service also gave staff an insight into the interests, likes and dislikes and areas of importance to the people in their care. This helped staff to provide social activities that people could choose to be involved in.

Regular meetings took place with staff to discuss the running of the service. These ensured the service was responsive in meeting the changing needs of people who lived at the home.

People who lived at the home held regular meetings with staff to discuss their views on living at the home. This meant that people were involved in communications about the running of the home and staff listened and took action. People we spoke with confirmed they felt that they were listened to and knew who to contact if they had a problem.

Is the service well-led?

There was a registered manager in post at the home.

People who used the service had regular contact with the registered manager and other senior staff to check their wellbeing. The quality of service provided by care givers was monitored and this was done through quality audits and also through meetings arranged with the people who used the service.

Staff were knowledgeable about people's care needs and the service's ethos of maintaining safe independence and involvement of the person whatever their level of need.

One relative told us that they were kept regularly updated by the staff team if any changes occurred. The relative told us, 'Staff will ring me if I need to be made aware of anything.'

We saw the home had effective systems in place to manage medicines. We saw people were safe. We saw there was sufficient staff on duty to provide care and support.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

People who used the service were positive about the care and support provided. Comments included 'I love it here' and 'The staff treat me very well'.