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Inspection carried out on 26 October 2017

During a routine inspection

This inspection took place on 26 October 2017 and was unannounced. Glebelands is a care home that provides accommodation for up to four adults with a learning disability There were four people living at the home when we visited. The home is based on one floor. There was a choice of communal rooms where people were able to socialise and people had access to garden areas

There was a registered manager at the home. 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 provider notified CQC about significant events that happened in the care home and had acted in line with regulatory requirements.

The registered manager was a prominent presence in the service and understood people’s needs well. There was a system of audits and quality assurance in place to monitor the quality and safety of the service.

People living at Glebelands were cared for by staff who understood their needs. Staff had undertaken a programme of training in induction which helped to give them the skills to work with people with complex needs. The registered manager provided bespoke staff training, induction and ongoing support tailored to the needs of people, which helped to ensure that staff were confident and competent in their role. The provider had robust systems in place to help ensure that appropriate recruitment choices were made.

There were sufficient numbers of staff in place in order to meet people’s needs. Staffs understood how to safeguard people from abuse and harm and were confident in reporting concerns to the registered manager.

People’s care plans were developed in partnership with people’s families and other stakeholders involved in people’s care. Care plans were very detailed and contained information for staff to support people to remain safe in the event of escalating anxiety and behaviours. Care plans were regularly reviewed as changes in people’s needs were identified through analysis of incidents and reflection on staff’s working practices.

The service was focussed on ensuring that restrictions that had been assessed as necessary to maintain people’s safety were regularly reviewed to ensure they were minimised as much as possible. There were policies and procedures in place to ensure that people’s rights and freedoms were respected and staff understood the need to gain consent before providing care.

People’s families told us that staff were caring and dedicated in their roles. People were encouraged to lead active lives and develop their everyday life skills which encouraged them to increase their independence. People were treated with dignity and respect and their individual needs were considered in the delivery of care by staff.

Staff were aware of people’s individual communication needs and were creative in ensuring there were systems in place to help people communicate their needs and make choices where possible. The provider had made adaptations to the environment which promoted people’s privacy and safety.

People were supported to access healthcare services as required and there were systems in place to manage their medicines effectively. People were supported to follow a diet in line with their requirements and preferences.

There were systems in place to gain people and relatives feedback about the service. There was a complaints policy in place and people’s relatives told us they were confident in raising concerns. Relatives told us that the service worked in partnership with them and communicated well with them when incidents occurred or to share updates about their wellbeing.

Inspection carried out on 14 and 20 July 2015

During a routine inspection

This unannounced inspection of Glebelands took place on 14 and 20 July 2015. The service offers accommodation and support for up to four people who have learning disabilities or autism. The primary aim at Glebelands is to support people to lead a full and active life within their local communities and continue with life-long learning and personal development. The service is a detached bungalow, with a substantial rear garden, within a residential area, which has been furnished to meet individual needs. At the time of the inspection there were four people living in the home. Three people had their own en-suite bedroom and one had a separate lounge, bathroom and bedroom, all of which had been specially adapted to meet their needs.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous manager left the service on 19 June 2015 and an experienced manager from within the provider’s care group was appointed to replace them on 1 July 2015. Records confirmed that this manager had started the process to become the registered manager of the service.

People and relatives told us they trusted the care staff who made them feel safe. Care staff had completed safeguarding training and had access to current legislation and guidance. Care staff had identified and responded appropriately to safeguarding incidents to protect people from harm. The provider had made changes to people’s care as a result of incidents to safeguard them. People were safeguarded from the risk of abuse as incidents were reported and acted upon.

Risks to people had been identified in their care plans and measures were in place to manage these. For example it had been identified that one person was at risk of seizures due to epilepsy. Care staff understood the potential risks to people’s health and welfare, and followed guidance to manage them safely. People were kept safe as appropriate risk assessments were in place, which were understood by care staff.

The manager completed a staffing needs analysis in order to ensure that there were sufficient care staff deployed with the necessary experience and skills to support people safely. We observed flexibility in the staffing levels which ensured sufficient suitably training care staff were deployed in order to meet people’s individual needs. Care staff had undergone required pre-employment checks, to ensure people were protected from being supported by unsuitable staff. Staff had received an induction into their role, on-going training, opportunities for professional development and regular supervision. People were cared for by sufficient numbers of trained and well supported care staff.

The manager completed a staffing needs analysis based on people’s dependency and behaviours to ensure there were always sufficient staff with the necessary experience and skills to support people safely. We observed there was flexibility in the staffing levels to ensure people’s individual needs were met. Staff had undergone required pre-employment checks, to ensure people were protected from being supported by unsuitable staff. Staff had received an induction into their role, on-going training, opportunities for professional development and regular supervision. People were cared for by sufficient numbers of trained and well supported care staff.

Medicines were administered safely in a way people preferred, by trained care staff who had their competency regularly assessed by the provider. Medicines were stored and disposed of safely, in accordance with current legislation and guidance.

The service was clean and hygienic. Cleaning staff were diligent and understood how their role was important to maintain people’s safety. The provider operated cleanliness and infection control policies and procedures, in accordance with current national guidance, to protect people from the risks of poor hygiene and infection.

People were actively involved in making decisions about their care and were always asked for their consent before any support was provided. Relationships between care staff and people were relaxed and positive. Care staff supported people to identify their individual wishes and needs by effectively using their individual and unique methods of communication. People were encouraged to be as independent as they were able to be, as safely as possible.

Care staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf. People were supported by care staff who supported them to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The manager had completed the required training and was aware of relevant case law. Since the last inspection the provider had made four DoLS applications, which had been authorised and appropriately notified to the CQC. The provider had taken the necessary action to ensure people’s rights were recognised and maintained.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

People’s dignity and privacy were respected and supported by care staff, who were skilled in using individual’s specific communication methods. Care staff were aware of changes in people’s needs, which were reported to relevant healthcare services promptly where required.

The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to pursue social activities which protected them from social isolation.

Relatives told us they knew how to complain and that the provider encouraged them to raise concerns. When complaints were made records showed they were investigated and action was taken by the provider to make improvements where required.

Care staff had received training in the values of the provider as part of their induction. Relatives and staff told us the service was well managed, with an open and positive culture. People and care staff told us the manager, specialist support workers and team leaders were very approachable, willing to listen and make any necessary changes to improve things for people. Care staff told us their greatest strength compared to other services was the team spirit and willingness to support each other without being asked. The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the service and drive improvements.

People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff. Processes were in place to protect staff and people’s confidential information.

Inspection carried out on 14 January 2014

During a routine inspection

At the time of the visit there were four people living in the home. Three people had their own ensuite bedroom and one had a separate lounge; bathroom and bedroom which had been specially adapted to meet their complex needs.

We met with three people and six staff. We were also able to speak with a relative on the telephone. People responded positively when asked about the food and if the staff were kind. A relative told us they were very satisfied with the care and support one person received and that any minor concerns they had raised had been addressed promptly. They were particularly complimentary about the manager of the home as was one respondent to the relative's questionnaire, "we are especially pleased with the manager, her contribution to our relative is wonderfully refreshing".

Staff were motivated and said they "loved" their job. One staff member attributed this to the effective and supportive team work at the home.

Staff demonstrated a good understanding of safeguarding and what this meant to them to protect people from abuse.

The home was clean but in need of some updating and repair in some areas. Furnishings were minimal to reflect the complex needs of the people living there.

People were able to participate in a range of activities and there were enough staff to enable them to do this. Staff focused on people's strengths and abilities and sought ways to improve their quality of life and reduce the number of adverse incidents for people.

Inspection carried out on 12 November 2012

During a routine inspection

The registered manager was on leave on the day of the inspection however the deputy manager was present throughout the inspection.

We found that the people living at Glebelands had profound disabilities and were not able to communicate with us. We spoke with three staff and families of people living in the home and examined records, meeting minutes and feedback forms. Families told us "The ethos of of Glebelands should be the ethos for all care homes" and that staff worked with them in planning their relatives care to ensure their relative got the best possible service. We saw that the staff were familiar with people's needs and gave them opportunities to make choices.

MInimum staffing levels were maintained and shortfalls in staffing were covered. Staff had received an appropriate induction and were also supported through a system of regular supervision and appraisals.

The provider had effective and robust systems in place to ensure the CQC were notified of safeguarding incidents. Staff were able to demonstrate a good understanding of the safeguarding reporting process.

The provider's quality assurance systems were effective in ensuring the performance of the home was adequately monitored, and that the needs of people living in the home were effectively assessed.

Reports under our old system of regulation (including those from before CQC was created)