Date of assessment: 26 September 2025 until 29 October 2025. Crestar Healthcare Ltd is a domiciliary care service that provides support and care for people living in their own home. This assessment was conducted following a technological error that affected the previous rating. Additionally, previously there was a breach identified relating to good governance. At this assessment we looked at the key questions safe and well-led. We found the provider had taken appropriate action to address and comply with the previously identified breach. Improvements had been made to ensure governance standards were met. An assessment has been undertaken of a specialist service registered for use by autistic people or people with a learning disability. At the time of the assessment, the service did not provide care to people with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. Where accidents and incidents had occurred, appropriate actions were taken to reduce the risk of a reoccurrence. Staff were knowledgeable about people’s care and support needs. People were assured they would be protected from the risk of potential abuse, as staff were aware of how to safeguard them. Risk assessments were specific to the person and supported staff’s understanding about how to reduce the risk to people. Recruitment processes ensured staff were safely recruited and suitable to work with people. Sufficient staffing levels were provided to ensure people’s assessed needs were met. Systems and practices ensured people were protected from the risk of avoidable infections. People were supported by trained staff to take their prescribed medicines. The culture of the service promoted equality and diversity and provided a person-centred approach. The registered manager was skilled and experienced within their role and had aspirations to develop the service. Systems were in place to encourage people to have a say about the service they received. Staff had access to regular meetings and supervision sessions enabling them to take part in decisions about the delivery of the service. The registered manager worked with other healthcare professionals to ensure people received a seamless service. Good governance ensured people received a safe and effective service and ensured staff were skilled and kept abreast of changes to people’s care needs.
PDF cached but not yet analysed by Claude; set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-2106265434.
Crestar Healthcare was rated Requires Improvement overall, with breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) due to inadequate electronic care records failing to reflect risk assessments and medication administration requirements. Despite warm, person-centred care from committed staff, governance systems were insufficiently robust to identify and remediate recording inaccuracies, leaving people at potential risk of harm.
Concerns (6)
criticalRecord keeping: “some topical ointments did not have appropriate body-maps within the Electronic Care Records (ECR). Staff told us that they read instructions for application from the package”
criticalMedication management: “poor record keeping meant that staff who were not familiar with the person receiving care would not be able to gain easy access to records of how to apply ointments and creams.”
criticalGovernance: “we found all call records reviewed to contain inaccuracies. For example, we saw that a person had received calls of 0 minutes and 2 minutes on numerous occasions over a period of 3 months.”
moderateCare planning: “People's Electronic Care Records (ECR) had limited information about peoples personalised care needs, life history and things that were important to them.”
moderateGovernance: “Audits undertaken had not identified or effectively prioritised where improvements needed to be made or improvements had not been made in a timely manner.”
moderatePerson-centred care: “People's ECR contained minimal information about people's communication needs. This meant that staff did not have access to relevant information and so could miss verbal and non-verbal cues.”
Strengths
· Staff were kind, caring and treated people with dignity and respect; people consistently praised named carers and felt genuinely cared for.
· Safe recruitment processes were in place with full pre-employment checks including DBS, references and right-to-work verification.
· Staff received good-quality training, comprehensive induction and regular one-to-one supervision supporting skill development.
· Incidents and accidents were managed effectively with action plans and target dates to reduce risk of reoccurrence.
· Provider made efforts to match staff personalities, culture and language skills with people receiving care.
Quality-Statement breakdown (21)
safe: Using medicines safely; Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Crestar healthcare is a domiciliary care service providing personal care to people living in their homes. CQC only inspects where people receive a regulated activity of personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. During this assessment 17 people were receiving support with personal care. The service supports people with a variety of care needs including those living with dementia, people with physical disabilities, people being discharged from hospital. The assessment was prompted by a review of information we held about the service. We found risk management was not always reviewed to mitigate safe protocols in keeping people and staff safe. Medicine procedures in recording homely remedies and prescribed creams and ointments were not embedded in the service following National Institute for Health and Care Excellence (NICE) guidance. Systems to ensure care was provided safely and appropriately were not always robust.
PDF cached but not yet analysed by Claude; set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-2106265434.
Crestar Healthcare achieved a Good rating across all five key questions at this December 2016 inspection, demonstrating significant improvements since a 2015 inspection that identified concerns around staffing, medicines, complaints and governance. The service was found to be safe, caring and well-led, with the only minor gap being inconsistent detail and frequency in quality assurance audits.
Concerns (1)
minorGovernance: “Audits were not always carried out regularly or comprehensively. This meant that the effectiveness of the quality assurance of the service was inconsistent”
Strengths
· Staff supported people to keep them safe and risk assessments were in place and regularly reviewed
· Medication administration was well managed with completed MAR charts and medication risk assessments in place
· Staff received thorough induction including Care Certificate, ongoing training, regular supervision and appraisals
· Staff demonstrated good knowledge of the Mental Capacity Act and gained consent before assisting people
· People felt listened to, respected and that their dignity was maintained by kind and caring staff
Crestar Healthcare received an overall rating of Requires Improvement at its first inspection in December 2015, with breaches identified around failure to notify CQC of incidents, unsafe medication recording, insufficient weekend staffing, and absent quality assurance audits. The service demonstrated genuine strengths in caring practice, staff training and person-centred care planning, but significant governance and leadership weaknesses undermined overall safety and responsiveness.
Concerns (8)
criticalIncident learning: “No notifications had been sent to us, despite incidents occurring, including one within the previous six months where a person was found bruised following a fall.”
moderateMedication management: “Medicines were not recorded in a way that clearly showed an audit trail of what had been administered. There was no number available to show the initial amount of medicines.”
moderateGovernance: “There were no audits or quality assurance checks available for us to view.”
moderateStaffing levels: “Some carers can turn up very late and weekends are worst. There are enough staff during the week, but the weekends can be a nightmare.”
moderateSafeguarding: “Staff were very unsure about whistleblowing and didn't fully understand the concept. I am not sure who I would go to above the manager.”
moderateComplaints handling: “We did not see any written complaints in files although the registered manager agreed that complaints had been made and dealt with. There were no audits available.”
moderateRecord keeping: “Paperwork which was in place was often left blank, so that any issues could not be followed up to people's satisfaction.”
moderateLeadership: “I am a great supporter of Crestar and the manager, but I have concerns that he just isn't running the place right.”
Strengths
· Staff knew people well and interacted with them in a kind and compassionate manner, maintaining privacy and dignity.
· People were encouraged to maintain their independence and were involved in planning their own care.
· Staff received training, regular monthly supervision and annual appraisals.
· Staff had a basic understanding of the Mental Capacity Act 2005 and obtained consent before carrying out actions.
· People were supported to meet their nutritional, hydration and healthcare needs.
Quality-Statement breakdown (18)
safe: Medicines administration and recordingRequires improvement
safe: Staffing levels at weekendsRequires improvement
safe: Incident and accident recordingRequires improvement
safe: DBS risk assessments for staff with disclosuresRequires improvement
safe: Safeguarding awarenessRequires improvement
effective: Staff training and inductionGood
effective: Mental Capacity Act and consentGood
effective: Nutrition, hydration and healthcare supportGood
Crestar Healthcare deteriorated from Good to Requires Improvement across all five key questions, with regulatory breaches identified for unsafe recruitment practices (Regulation 19) and ineffective governance systems (Regulation 17). While people felt safe and reported kind staff, care records lacked detail, supervision was infrequent, and audit systems failed to identify or address known shortfalls in a timely manner.
Concerns (7)
criticalStaffing levels: “Staff who had left and re-joined the agency had commenced care calls before all the necessary pre-employment checks had been completed, without a recorded risk assessment in place.”
criticalGovernance: “The providers systems had not been effective at identifying risks and improving the quality of the service. This is a breach of regulation 17 'Good governance'”
moderateCare planning: “People's care records had limited information about peoples personalised care needs, life history and things that were important to them.”
moderateSupervision / appraisal: “Staff did not receive regular supervision. The provider told us in their PIR that this would be provided at least four times a year, however staff were receiving supervision...less frequently.”
moderateIncident learning: “These had not been fully implemented to show when things had not gone to plan, the lessons that had been learnt from this to improve the service.”
moderatePerson-centred care: “People's personalised care needs had not been asked for and recorded to ensure they received consistent care from staff.”
minorRecord keeping: “We saw that not all complaints had been captured in the providers records.”
Strengths
· People and relatives felt safe and reported no missed calls, with staff running only slightly late within acceptable range.
· Medicines were administered safely and records of medication taken were completed.
· Staff had received safeguarding training and knew how to report concerns.
· Staff wore PPE including gloves, protecting people from infection risk.
· People's privacy, dignity and independence were respected by care staff.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and process to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
Requires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; promoting a positive cultureGood
well-led: Continuous learning and improving care; working in partnership with othersGood