CQC report explained · a residential care home
What the CQC found at The Crescent
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Health risks were not always monitored or acted on. Inspectors also found incomplete medicine records, missed equipment checks and weaknesses in infection prevention and cleaning.
- Effective?
- Requires improvement
- Some staff refresher training and competency checks were overdue. Care plans and records did not always contain enough detail about people's needs, choices and health referrals.
- Caring?
- Good
- This question was not inspected during this focused inspection. The report says the previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused inspection. The report says the previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Quality audits did not identify or fix repeated gaps in records and care monitoring. However, managers were described as visible and approachable, and staff felt able to raise concerns.
What inspectors found, September 2022
Requires Improvement; inspectors found kind care, but ongoing risks in care records, medicines, staff training, cleanliness and management checks.
This was an unannounced focused inspection on 29 July and 9 August 2022. Inspectors spoke with people, relatives and staff, and checked care records, medicine records, staff files, training information and quality checks.
The home supported five people with learning disabilities and possible autism. People received kind and compassionate care, had choices, and were supported by staff who knew them well. Relatives gave positive feedback.
However, risks were not always monitored properly. Inspectors found missing or inconsistent care information, incomplete medicine records, gaps in staff refresher training, areas that were unclean, and quality checks that had not found or fixed repeated problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were also rated Requires Improvement. The home remained in breach of Regulations 12 and 17, and had been rated Requires Improvement at the previous inspection too.
Kind and respectful care
People received compassionate care. Staff respected privacy, dignity, equality and people's individual needs.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Choice and independence
People were supported to make choices, including decisions about their home, rooms, meals and medicines. Staff worked within best-interest and least-restrictive principles.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests” from the report
Staff knew people well
Low staff turnover helped people receive consistent support from staff familiar with their needs and communication.
“However, staff turnover was low, which supported people to receive consistent care from staff who knew them well.” from the report
Positive involvement
People were involved in weekly meetings about meals and the running of the home. Relatives could share their views and attend health reviews.
“Weekly meetings were held with the people so they could discuss meal options and design a menu that suited their preferences.” from the report
Supportive management culture
Managers were approachable and staff said they felt respected and able to raise concerns. The home also worked with health and social care organisations.
“Staff felt able to raise concerns with managers without fear of what might happen as a result.” from the report
Health risks were not always followed up
seriousWeight checks were inconsistent and significant weight loss had not been escalated. Equipment needed after a fall had also not been checked and was unavailable when needed.
“The risks to people had not always been monitored and managed.” from the report
Care plans lacked important detail
seriousSome people did not have support plans for known needs, including behaviour and mental wellbeing. Records were inconsistent and did not always guide staff fully.
“People's care, treatment and support plans did not always reflect their range of needs and support required.” from the report
Staff training was not always up to date
seriousSome refresher training and competency assessments were overdue, including training linked to manual handling and medicines. The report says this contributed to a breach of Regulation 12.
“Incidents had occurred involving staff who had outdated training in areas such as manual handling and medication.” from the report
Medicine records were incomplete
needs fixingPeople received medicines as prescribed, but administration records contained errors and missing signatures. The outcome of some as-needed medicines was not recorded.
“Errors were found in the administration records and signatures were missing from medicine charts.” from the report
Cleaning and quality checks were weak
needs fixingSome areas were unclean, cleaning tasks had been missed and schedules lacked signatures. Audits did not identify these problems or repeated gaps in records.
“Areas of the service were unclean on the day of the inspection which increased the risk of infection.” from the report
- 01What specific changes have been made to monitor weight loss, health deterioration and other risks?
- 02How are you checking that medicines are recorded correctly, including signatures and the results of as-needed medicines?
- 03Which staff training and competency checks were overdue, and are they now complete?
- 04How do you make sure care plans include behaviour, mental wellbeing and all other support needs?
- 05What changes have been made to cleaning checks and quality audits so repeated gaps are found and fixed?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 3 September 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
St Anne's Community Services - The Crescent was rated Requires Improvement; inspectors found kind care, but safety, records and management were not always reliable.
This was a planned inspection on 3 and 12 December 2019. Inspectors spoke with people living there, relatives, staff and health and social care professionals. They reviewed care, medicine and staff records, along with records about how the home was managed.
People were treated with kindness, dignity and respect. Staff supported people's choices, independence, communication and access to health care. Relatives and professionals gave positive feedback about the care and support provided.
However, inspectors found risks around medicines, cleanliness, fire safety, equipment checks and window restrictors. Some records and risk assessments were incomplete or out of date. There was also a high use of agency staff, gaps in induction and training, and no registered manager.
The overall rating was Requires Improvement. Safe, Effective and Well-led were also rated Requires Improvement. Caring and Responsive were rated Good. The home was rated Good at the previous inspection, published on 30 June 2017.
Kind and respectful care
People and professionals described staff as kind, caring and respectful. Staff supported privacy, dignity and independence.
“People were supported by kind and caring staff.” from the report
Choice and independence
People were involved in day-to-day decisions and were encouraged to do things for themselves. Staff sought consent and used the least restrictive approach.
“People were free to make decisions and told us they were not restricted by routines” from the report
Person-centred support
Care plans recorded people's likes, dislikes, preferences and communication needs. Staff helped people stay in touch with relatives and access health services.
“Care plans included person-centred information about people's likes, dislikes and personal preferences.” from the report
Positive response after inspection
The provider arranged a deep clean, repairs and extra management support straight away after inspectors raised concerns.
“The provider immediately responded to our concerns, arranging for the service to be deep cleaned, maintenance issues to be addressed and putting additional management support in place.” from the report
Medicines were not always safely recorded
seriousRecording and stock-control problems meant inspectors could not be sure medicines had been given safely. Some as-needed medicine guidance was missing and a pain relief patch had not been moved regularly.
“People were put at increased risk of harm; recording issues meant we could not be certain people's medicines had been administered safely.” from the report
Health and safety risks
seriousInspectors found unclean areas, inadequate window restrictors, fire doors that did not always close properly and missing fire drills for staff. Equipment checks were not always documented.
“The failure to adequately monitor and respond to risks was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Poor environment and maintenance
needs fixingParts of the home were worn, damaged or cluttered. This made it harder to support someone using mobility equipment.
“Cluttered communal areas made it harder to support people who used mobility aids.” from the report
Weak management and records
seriousAudits had not identified important problems. There was no registered manager, some care plans and risk assessments were not reviewed, and two required notifications had not been made.
“The failure to adequately maintain the quality and safety of the service was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Agency staff and induction gaps
needs fixingAlthough staffing levels were sufficient, the home used a high level of agency staff. New and agency workers had not always received a full induction, and some training needed updating.
“Although sufficient staff were deployed, there was a high level of agency staff used.” from the report
Limited activity opportunities
minorSome people had limited access to the wider community because suitable transport was not available. Records did not always show that regular activities had been offered.
“Records did not always show people had been offered or took part in regular activities.” from the report
- 01What has been done to make sure medicine administration records, as-needed medicine protocols, pain relief patches and medicine stock checks are now accurate?
- 02Have all fire safety actions, fire drills, window restrictors and equipment safety checks been completed and recorded?
- 03Who is now responsible for managing the home, and how much time do they spend there each week?
- 04What proportion of staff are permanent or agency workers, and how is each new or agency worker inducted before supporting residents?
- 05How are residents now being supported to take part in regular activities and access the wider community, especially where transport is a problem?
This was a planned inspection covering all five CQC questions and both the premises and care provided; the previous Good ratings for Caring and Responsive remained unchanged, while Safe, Effective and Well-led deteriorated from Good to Requires Improvement. This explanation was written from the published report of 25 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Crescent
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- September 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 15 March 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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28 live-in carers within about an hour of North Yorkshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.