The Crown

The Crown is a residential care home which can accommodate up to 7 adults who have a learning disability and / or autistic people. At the time of this inspection there were 2 people living at the service.

The accommodation is arranged over 3 floors and includes shared living and kitchen areas, with 7 individual bedrooms - each with their own ensuite and kitchenette facilities. Of these, 3 have been designed for people with additional physical disabilities. Accessibility is further promoted through the inclusion of a passenger lift and accessible outside space, including an enclosed garden and parking on site.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

We found areas requiring improvement such as: reporting potential safeguarding concerns to the relevant authorities, increasing staff awareness regarding CQC inspections and access, the quality and safe storage of records and quality assurance processes; which focused more on systems and processes, rather than people’s lived experience and quality of life.

The provider had installed CCTV in communal areas of the service however, they had not consulted with people living at the service or gained their consent to being filmed. This meant people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Despite this, a new manager was in post who demonstrated a strong commitment to improve the service and address all the inspection findings as quickly as possible. They made a number of changes before the inspection finished but these were too recent for us to assess the effectiveness of all the actions taken on this occasion.

Staff helped people to stay safe by managing known risks, such as falls and seizures. People were protected from the risk of infection because they lived in a clean, tidy environment.

Staff understood how to support people if they became distressed. They were kind, patient and respectful towards people at all times. Staff consistently followed agreed support plans to refocus people and ensure people’s behaviour was not controlled by excessive or inappropriate use of medication.

There were enough staff to spend quality time with people, as well as meeting their essential needs. However, plans sometimes needed to be made in advance to ensure there were always enough staff to enable people to have a bath, or go out if they wished to do so.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 January 2020).

The service went through a period of dormancy (when it was closed) from December 2020 until October 2022.

The overall rating has changed to Requires Improvement, based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about personal care, medicines, risk management, recording and reporting safeguarding concerns, and staffing levels.

We undertook a focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Crown on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Crown is a residential care home which can accommodate up to seven people. The service has been designed to accommodate people living with a learning disability or autistic spectrum disorder primarily from the Jewish community. However, non-Jewish people can also access the service. The accommodation is arranged over three floors and includes seven individual living spaces - each with their own ensuite and kitchenette facilities. Three of the living spaces have been designed for people with physical disabilities. Accessibility is further promoted through the inclusion of a lift and accessible outside space, including parking. At the time of this inspection there were three people living at the service.

Overall, the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

There was limited evidence the provider checked to make sure people received good quality, safe care and support. We found areas that continued to require improvement. However, a new registered manager had already identified most of these and was making changes to improve the service and people’s experience of living at the service.

People were safe. Staff understood how to protect them from abuse and risks to people were managed, to ensure their safety and protect them from harm. Staff ensured people received their medicines when they needed them and ensured the premises were kept clean and hygienic.

There were enough staff to meet people’s needs. Staff treated people with kindness, respecting their privacy and dignity too.

People were supported to stay healthy. Staff ensured people had a choice of food and had enough to eat and drink. They also helped people to access healthcare services when they needed to.

People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Since the last inspection opportunities had improved for people to participate in a variety of meaningful activities, both in and out of the service.

The new registered manager promoted a positive culture that was person centred and open. People were given the opportunity to make suggestions and provide feedback about the service provided to them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 7 December 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Crown on our website at www.cqc.org.uk.

At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Crown has been designed to accommodate up to seven people living with a learning disability or autistic spectrum disorder primarily from the Jewish community. However, non-Jewish people can also access the service. The accommodation is arranged over three floors and includes seven individual living spaces - each with their own ensuite and kitchenette facilities. Three of the living spaces have been designed for people with some physical disabilities. Accessibility is further promoted through the inclusion of a passenger lift and accessible outside space, including parking. At the time of this inspection there was one person living at the service.

This was the first inspection of The Crown since it registered with CQC in September 2017. This means the service has not previously been rated. During this inspection, which took place on 7 November 2018, we found that the service had not fully complied with a number of legal requirements. We have therefore rated the service as Requires Improvement.

The registered manager acknowledged our findings. Shortly after the inspection they confirmed they were taking action to address all the areas we had identified for improvement.

Why we rated the service Requires Improvement:

The provider checked to make sure staff were safe to work at the service, but the checks made did not fully meet all the legal requirements.

People received their medicines as prescribed. However, medicine administration records did not always provide an audit trail to explain anomalies, such as a tablet being taken from the wrong day in medicine packaging.

Staff were not aware of some key legislation and good practice guidance.

The pre-admission process needed to be improved, to ensure staff had enough information to decide whether the service could meet people’s needs before they moved in.

Improvements were needed to ensure people had opportunities to participate in meaningful activities that were of interest to them and met with their individual aspirations.

Staff needed to establish people’s preferences for their end of life care, should the need arise.

Quality monitoring systems were not adequately robust. There were also no formal systems in place to get feedback from people, in order to develop the service.

The arrangements for out of hours cover, in the absence of the registered manager, were not adequate.

We did find that the service was providing a good service in other areas that we checked. For example:

Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely and they were protected by the prevention and control of infection.

There were enough staff, with the right training and support, to meet people’s needs and help them to stay safe.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People were supported to eat and drink enough. Arrangements were in place to ensure meals were prepared in a way that met the requirements of Jewish law and the provision of Kosher food,

Staff worked with external professionals to ensure people received effective care and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The building provided people with sufficient accessible space, including a garden, to meet their needs. The service operated 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.

The service acted in line with legislation and guidance regarding seeking people’s consent. People were enabled to make decisions about their care and support.

Staff provided care and support in a kind and compassionate way. People’s privacy, dignity, and independence was respected and promoted.

Systems were in place for people to raise any concerns or complaints they might have about the service.

Further information can be found in the detailed findings below.