We carried out a review of the data available to us about Stroud & District Supported Living Service on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Stroud & District Supported Living Service, you can give feedback on this service.
The Gables can accommodate up to five people who have a learning disability and autism. At the time of our inspection five people were living there. People at The Gables had their own bedrooms with access to a shower and bathroom. They shared a lounge and two dining rooms. Grounds around the property were accessible. The supported living settings can accommodate up to 24 people who have a learning disability in four houses within the locality of Stroud.
The Gables had been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.
This inspection took place on 14 and 21 November 2018. At the last comprehensive inspection in March 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
At this inspection we found the service remained Good.
There were two registered managers in post to manage the two services. They had been registered with the Care Quality Commission (CQC) in 2010. 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 registered manager of the supported living service was also the Group Manager for all services provided by Stroud and District Homes Foundation Limited.
People’s care and support individualised, reflecting their personal wishes and lifestyle choices. They were treated with compassion, kindness and care. They had positive relationships with staff, who understood them well. People enjoyed being in the company of staff. The atmosphere in their homes was light hearted with much laughter and happiness. Staff understood and respected people’s diverse needs. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were well managed encouraging people’s independence. There were enough staff to meet people’s needs. Staff recruitment and selection procedures were satisfactory with the necessary checks being completed prior to employment.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They made choices about their day to day lives. People and those important to them were involved in the planning and review of their care and support. They chose the activities they wish to take part in. They said they liked to work on a farm, to the gym and to garden centres. They went on holidays, day trips, to social clubs and local places of worship. People kept in touch with those important to them.
People’s preferred forms of communication were promoted. Staff were observed effectively communicating with people, taking time to engage with them. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about safeguarding, complaints, staff on duty, activities and menus.
People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. Special diets were catered for. People helped to prepare and cook their meals. They had access to a range of health care professionals and had annual health checks. People’s medicines were safely managed. People had expressed their wishes about how they would like to be cared for at the end of their life.
People’s views and those of their relatives and staff were sought to monitor the quality of the service. This was provided through quality assurance surveys, reviews, meetings, complaints and compliments. People had information about how to raise a complaint. The registered managers and board of trustees completed a range of quality assurance audits to monitor and assess people’s experience of the service. Any actions identified for improvement were monitored to ensure they had been carried out. The registered managers worked closely with local organisations and agencies and national organisations to keep up to date with current best practice and guidance. Comments about The Gables included, “I have been really impressed with the care,” “It’s brilliant; it’s magic” and “It’s amazing.”
Further information is in the detailed findings below.
At the time of this inspection we saw evidence of safeguarding incidents being reported. People’s daily notes provided an accurate account of the activities they completed. The service was meeting legal requirements at the time of this inspection.
The Gables is registered to provide accommodation for up to five people in the care home and also provides a personal care service (domiciliary care) to 20 people who live in three shared houses (supported living arrangements). The three supported living houses are Barn Lodge and Stonehaven on the same site as The Gables in Stroud and Cotswold Grange in nearby Stonehouse. For the purposes of this report we have referred to the personal care service as the community service and used The Gables when referring to the care home. Both services care for people who have a learning disability...
There are two registered managers in post, one for The Gables and one for the community service. 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.
There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines.
Risk assessments were implemented and reflected current level of risk.
People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with staff members and other health and social care professionals.
People were supported to access and attend a range of activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.
People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities.
The staff at the home had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLs). These safeguards aim to protect people from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.
Where people lacked capacity, best interests meetings had taken place involving other professionals ensuring decisions were made in peoples’ best interests.
The staff recruitment process was robust to ensure the staff employed would have the skills to support people. Staff were knowledgeable about people. They had received suitable training to support people safely enabling them to respond to their care and support needs.
The service maintained daily records of how people’s support needs were met. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.
There was a complaints procedure for people, families and friends to use and compliments could also be recorded. We saw that the service took time to work with and understand people’s individual way of communicating so that the service staff could respond appropriately to the person.
Regular audits of the service were being carried out in the community service. The residential service had recently implemented a new audits system which were due to be completed shortly after the inspection.
The inspection was announced. We gave the provider 24 hours’ notice of the inspection of the regulated activity personal care (the domiciliary care service provided to people in the three supported living houses) to ensure that the people we needed to meet with were available. The last inspection of this service was in April 2014 and no breaches of legal requirements were found at that time.
The Gables is registered to provide accommodation for up to five people in the care home and also provides a personal care service (domiciliary care) to 20 people who live in three shared houses (supported living arrangements). The three supported living houses are Barn Lodge and Stonehaven on the same site as The Gables in Stroud and Cotswold Grange in nearby Stonehouse For the purposes of this report we have referred to the personal care service as the community service and used The Gables when referring to the care home. Both services care for people who predominantly have learning disabilities needs.
There are two registered managers in post, one for The Gables and one for the community service. 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 registered managers and staff teams for both The Gables and the community service were knowledgeable about safeguarding issues however we found that a significant safeguarding event had occurred and not been reported to the managers, the local authority or CQC. The failure to report this event may have placed people at further harm.
Any risks to people’s health and welfare were assessed and appropriate management plans were in place. Where people needed support with moving and handling, there were safe plans in place. Medicines were well managed and staff followed safe work practices to ensure that errors were not made. Staffing numbers on each shift in The Gables were sufficient to meet people’s care and support needs. There were sufficient staff to provide the agreed level of support to the people in the three shared houses.
Staff were provided with the training they needed to do their jobs and were well supported by the managers and their colleagues. The staff ensured people had sufficient food and drink and encouraged people to eat a healthy diet. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.
There were good long-term relationships between people who lived in The Gables and those who received a community service and the staff spoke respectfully about the people they were looking after. People were treated with respect and dignity and were involved in making decisions about how they were looked after and supported.
People received care and support that met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.
Both The Gables and the community service were well managed with a strong leadership team for the support workers. People’s feedback was valued and used to make changes to service provision. The quality of service provision and care was monitored to ensure that people’s needs were met safely.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used both services, the staff supporting them and from looking at records.
When we last inspected the supported living service (regulated activity personal care) we found that there had been a breach in regulation 10 (assessing and monitoring the quality and safety of service provision) and regulation 20 (records).
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were able to make choices about their everyday lives. Risk assessments were in place and steps were taken to reduce or eliminate that risk.
Senior staff we spoke with had a good working knowledge of the Mental Capacity Act 2005. This included how to care for people in their best interests in the line with Deprivation of Liberty Safeguards.
There were always sufficient staff on duty to make sure that people were safe and well looked after. Staffing levels were adapted to meet people's social needs and when peoples care needs had changed.
People were protected from the risks of receiving inappropriate or unsafe care because the standards of record keeping had improved. The service was fully aware of where further improvements were needed in record keeping and had an action plan in place to address this.
There were good quality assurances systems in place to assess and monitor the quality and safety of the service. This meant that staff learnt from events such as accidents and incidents, concerns and complaints. This reduced the risks to people and helped the service to continually improve.
Is the service effective?
People's individual care and support needs were assessed and they were involved in deciding the care delivery arrangements. People's preferences and individual needs had been recorded and care and support had been provided in accordance with people's wishes.
The service knew that there was still some work to do to ensure that each person's care and support plan and support worker allocation, reflected a service provided within their own home. The service had a plan in place to address this.
Is the service caring?
People received their care and support from staff who knew them well. Staff spoke knowledgeably and caringly about the people they supported.
People we spoke said, 'I am happy', 'They help me', 'I like going out shopping' and 'They know what I like'.
People were able to make everyday choices, took part in everyday activities and were supported to have friendships and relationships. People were supported to access the health and social care services that they needed.
Is the service responsive?
Both services provided care and support that met people's individual needs, choices and preferences. Regular care plan reviews ensured that care delivery arrangements and care plans were amended when peoples care and support needs changed. Staff responded to any incidents and events effectively and promptly.
People were supported to attend health and social care appointments and staff worked in partnership with health and social care providers to make sure people's needs were met.
People knew how to raise concerns if they were unhappy. Copies of the complaints procedure were made available and were printed in an appropriate format. No complaints had been received this year but there was a clear procedure to follow if complaints were raised. People could therefore be assured that complaints were investigated and action was taken as necessary.
Is the service well-led?
The service had an effective quality assurance system in place. The manager was fully aware of where improvements were needed and had a plan in place to address those areas.
The senior staff team were clear about their individual roles and responsibilities and provided good leadership for the two teams of staff. The leadership team for the supported living service had a plan in place to ensure that each person received individualised support as per their agreed personal funding budget. Progress in achieving this had been compromised by other government agencies. Both services ensured that people received a good quality service at all times.
People who used the service had been supported for many years by the staff and the service. They had copies of their care and support plans in their rooms. People made positive comments about how their care and support needs were met. They said 'I like cooking, the staff take me shopping and help me organise my weekly menu plans', 'They are very nice to me and we all get on well', 'They have been helping me a long time' and 'They help me and remind me to do things'.
People were looked after by staff who had been recruited following safe and effective recruitment procedures. Staff were well supported to do their job and received regular training and supervision.
Systems were in place to monitor the quality of service provision but the policies and procedures did not reflect that people were supported by a domiciliary care service. The homes records and practices did not reflect that this was a domiciliary care service and not a care home. We have asked the provider to make improvements with how they monitor the service, the way the service is run and how they maintain their records.
People were supported to access the community and to go on trips and holidays of their choice. People were involved in the planning of their care and had made decisions about their life style.
Staff understood how people should be protected from harm and knew how to report incidents of abuse. Staff had been supported in attending training and had been supervised regularly. This helped them to support people with their individual needs in a safe way.
There were clear processes in place that monitored the quality of care people received. These included asking people and their families for their views about the service. All aspects of the management of the home had been monitored on a regular basis.
The people who lived in The Gables had limited verbal communication skills and learning disabilities, but were given the opportunity to make decisions about their daily lives. Care staff demonstrated they had a good understanding of each person's individual needs and were able to interpret signs and behaviours to determine well being.
We spent time listening to what was going on and observed how staff interacted with people they were looking after. Staff understood people whose speech was not clear, and were patient with them. We saw positive and friendly interactions between people and staff, and staff treated them with respect.
Staff talked about their responsibility to safeguard the five individuals and demonstrated their awareness of the signs which may alert them to a potential abuse.
There had been difficulties in providing adequate staff numbers prior to our visit but the provider had already recruited new staff and was in the process of recruiting additional relief staff.
Some improvements had been made in the way the provider assessed and monitored the service. The measures they had in place were not fully implemented and the quality of the assessments was not consistent. We have asked the provider to take further action.