Archived: Crann Dara

Crann Dara provides accommodation and personal care for up to 7 people, some of whom who have a learning and physical disability and are autistic. At the time of our inspection, there were 7 people living at the service.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People's medicines were managed safely. The provider recently commissioned an independent audit of medicines and found there were robust systems in place. The registered manager worked in partnership with other professionals to ensure people’s medicines were regularly reviewed. Staff and people co-operated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. 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; the policies and systems in the service supported this practice. Staff supported people to achieve their aspirations and goals in safe way. People were able to pursue their interests and live a fulfilling and meaningful everyday life in a safe environment. Governance systems monitored and assessed the quality of care regularly.

Right Care:

There was a consistent and stable staff group at Crann Dara which family members told us they found reassuring. Staff received training and told us they had regular group meetings. The registered manager was aware that one to one supervision with staff was not formalised and took measures to address this following this inspection. People received kind and compassionate care and their independence was promoted. Staff understood how to protect people from poor care and abuse. They had training on how to recognise and report abuse and knew how to apply it. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations and was focused on their quality of life.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people's wishes, needs, and rights at the heart of everything they did. People and those important to them, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people's views. People's quality of life was enhanced by the service's culture and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency and respect.

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 25 June 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the safe management of medicines. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

Follow up

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

Crann Dara is residential care home providing personal care to people with learning disabilities and associated behaviours which may challenge. There were five people being supported at the time of inspection. The service can support up to seven people in one adapted building.

People’s experience of using this service and what we found

There were safeguarding adults' procedures in place to guide staff. The registered manager and staff had a clear understanding of these procedures. There were appropriate recruitment checks before staff started work and there were enough staff available to meet people's care needs and to support people to take their medicines.

The provider and staff were following government guidance in relation to infection prevention and control. Staff had received training on COVID-19 and the use of personal protective equipment (PPE). The service had business continuity and COVID-19 contingency plans in place that made provisions for safe care in the event of an emergency, or an outbreak of COVID-19.

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; the policies and systems in the service supported this practice.

People received care which was person centred and was regularly reviewed to ensure it continued to meet their needs. Staff communicated with people according to their documented preferences and abilities and supported them to access the community and activities of their choice.

Quality assurance processes provided oversight of the service. The registered manager worked to continuously improve people's lives and valued working in partnership with and learning from others to achieve this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• People were supported to live within a setting that met their individual needs. Staff encouraged people to make day to day choices, including around food, activities and community access. The provider engaged with local healthcare and commissioning partnerships in order to provide the best care possible.

Right care:

• Care was provided in a person-centred way which promoted people's dignity and rights. Staff understood people's specific care needs and preferences and supported them in according to those wishes. Those who could told us they felt respected and for others, we spoke with a family member and other professionals who confirmed this view. Staff enabled people to make choices about how they wished to be supported in their day to day living.

Right culture:

• There was a positive culture in Crann Dara, where the leadership team and staff showed commitment to those whom they supported. They spoke with passion and knowledge about their role, central to which was to empower people to live the best life possible in the least restrictive way. Staff told us their vision was to continue to support people to lead as fulfilled a life as possible.

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 17 September 2019 ).

Why we inspected

This was a focused inspection based on the previous rating. We reviewed the information we held about the service. We inspected the key questions of safe, responsive and well-led. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

We found the following examples of good practice.

The premises were clean and well maintained. Additional cleaning schedules had been introduced since the beginning of the coronavirus pandemic. High touch areas such as door handles, and light switches were cleaned throughout the day. Hand sanitiser was readily available throughout the premises.

All staff had undertaken training in infection prevention and control (IPC) and were seen to be following correct IPC practices at all times. This included putting on and taking off PPE, hand hygiene and other COVID-19 related training. Each person had a bin in their room for the safe disposal of PPE worn by staff, and where a person tested positive for COVID-19, their clothes and bed linen were washed separately.

Staff and those who used the service undertook regular testing in line with government guidelines. Staff supported people to remain in contact with their families through video and information technology. The manager was aware of the most recent government guidance on care home visiting and had informed family members on how visits would be supported. Staff had planned an outdoor tea visit for one person to support them to meet with a family member.

Staff told us the manager spent much of their time interacting with those who used the service and that they were on hand to offer support to staff as the need arose. The manager was the designated IPC lead and shared all current policy government updates with staff and family members.

The manager sought support and advice from external agencies including the local health protection team, Surrey County Council and CQC and was open to all advice and guidance offered.

Crann Dara is a care home providing personal care to 7 people. The service can support up to 7 people in one adapted building.

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 that 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.

The service was a large building, bigger than most domestic style properties. It was registered for the support of up to 7 people. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Since the last inspection there had been a significant change in atmosphere, culture and care. The new manager had changed the home’s atmosphere so that now it felt like a family home. People were free and eager to chat with staff and anyone who came to the home. There was a busy schedule which involved most people going out each day with staff to different activities. People were cared for by a staff team who were kind and thoughtful.

Some records still needed to improve in areas such as end of life planning and some risk assessments. Care plans were becoming person centred and detailed with information for staff to follow.

There were enough well-trained staff to ensure people were supported safely at all times. Medicines were managed safely by staff. The home was open, spacious and welcoming. Peoples’ needs were supported and staff were engaged in finding the best way to make people happy and comfortable.

People, relatives and staff were engaged by the service through meetings, so that everyone could contribute to the development of the service. There was a credible strategy in place with plans for staffing improvements at the service. This was being implemented by the manager who was pro-active in considering how the service could be improved.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The service as a whole was in the process of imbedding practices and sustaining improvements in this area. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. 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.

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 Inadequate (25 April 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Crann Dara is a residential care home for people with learning disabilities. The home can accommodate up to seven people. At the time of the inspection there were six people living at the home. People at the home had a range of disabilities.

People’s experience of using this service:

People were not supported or cared for as they should have been. Although staff were aware of risks to people’s safety, the risks were not always monitored or managed properly. There were frequently days when there were not enough staff to safely care for the people living at the home. Medicines were not always managed safely or audited to ensure quality compliance.

Best practice and guidance was not always followed or adhered to. The care service had not been developed, designed or maintained in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using this service were not able to live as ordinary a life as any citizen.

People were not always supported to see medical professionals routinely. People did not have access to a range of apetising options for meals. People’s rights were not protected as the service did not comply with legislation. People were not cared for by staff who received frequent training.

People were not always treated with respect, compassion or kindness. There was little person-centred care which enabled people to take part in meaningful activities. People had no information regarding their end of life care preferences.

The home was not managed or led well. The processes in place to monitor the quality of the service were ineffective. There was no plan or strategy to improve or develop the service. The registered manager didn’t work with agencies, organisations or staff to deliver high quality, person-centred care.

People were supported by staff who respected their independence and privacy. People had access to a large, open home which was surrounded by a beautiful garden.

During our inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Rating at last inspection:

This service was rated ‘Good’ in July 2016

Why we inspected:

This was a scheduled comprehensive inspection. We inspect all services rated as 'Good' within 30 months to ensure that we regularly monitor and review the quality and safety of the service people receive.

Enforcement

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cran Dara is registered to provide accommodation with personal care for up to seven people. On the day of our inspection there were seven people living at the home. Cran Dara supports people with learning disabilities; some people also had physical disabilities.

The home had a registered manager in post. 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.

Staff understood their role in safeguarding people. They had received training and demonstrated a good understanding of how they would protect people from abuse of potential harm. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence.

We found that policies and procedures were in place to keep people safe in the event of emergencies. People had individual plans to keep them safe in the event of an emergency and there were contingency plans in place.

People were administered their prescribed medicines by staff who had received medicines training. Medicines were stored safely and systems were in place to ensure medicine stock could be monitored and audited.

Staff training was tailored to the individual needs of people who live at the home. Staff told us that they had good access to training and people and relative told us that staff were effective in their roles.

Staff provided care in line with the Mental Capacity Act (2005). However, we noted one instance where records required updating.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being involved in writing menus.

Staff treated people with dignity and respect. All caring interactions that we observed were positive and staff demonstrated a good understanding of how to respect people’s dignity.

Information in care plans that reflected the needs and personalities of people that we spoke to. People had choice about activities they wished to do and staff encouraged people to pursue new interests.

People were given the opportunity to provide feedback on the care they received through residents

meetings and keyworker sessions. We saw evidence that issues raised by people were responded to by management.

Staff told us that they were well supported by management and had regular supervision. People and relatives told us that they had a positive relationship with the registered manager.

People’s records were kept up to date and stored securely.