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Inspection carried out on 4 July 2018

During a routine inspection

The inspection took place on 4 July 2018 and was unannounced.

The Glen is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care service had been developed and designed in line with the values that underpin the 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 the service can live as ordinary a life as any citizen. At the time of inspection there were six people living at the service.

The registered manager was not present on the day of the inspection. 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 for The Glen oversaw several services and a service manager was responsible for the day to day running of the individual service. The locality manager for The Glen was present during the inspection.

At the last inspection, we rated The Glen as ‘Good.’ Since that inspection, some elements of The Glen have remained good, while other areas have become outstanding. The provider had made some changes and improvements to the environment to help support communication and to help people feel more relaxed. Staff had developed and built on the good support previously provided, they had worked with healthcare professionals to increase people’s quality of life.

The Glen accommodates up to nine people. People living at The Glen had some complex health needs. Staff had to use creative ways to support people to live the lives they chose. Staff were determined to provide people with the best possible opportunities in life. Staff linked people to specialist health professionals who updated them on the latest research and supported people with the latest treatments.

People were given support to live a more active and meaningful life. It was clear that staff were very caring and committed to supporting people to live fulfilled lives. Staff shared the provider’s vision, that ‘everyone is unique, every day is special.’ Staff tried to make every day special by trying to ensure people had a good day every day. People smiled and laughed with staff and staff responded to people and colleagues with kindness and respect. Staff felt supported, included and valued by the whole management team, one stated “I would never do anything else .”

Staff worked innovatively with people, their families, friends and health professionals to overcome challenges, big or small. The staff team had an excellent working relationship with a range of professionals. These professionals told us how staff always valued their suggestions and created action plans to implement them. Relatives echoed this, praising the “amazing” relationship they had with staff had with people and praised the support staff provided to their loved ones.

Staff supported people to increase their skills, including cooking, cleaning and budgeting to enable them to live more independently. People had developed skills and grown in confidence and some had moved on to live more independently. The provider had adapted the premises to accommodate and adjust to people’s changing needs. Noise was a particular issue for some people so the provider had adapted the premises to reduce the amount of noise. This had led to one person becoming less upset and anxious.

Since the last inspection, the manager had worked with speech and language therapists to introduce assistive technologies. These technologies enabled people to explain their wishes and preferences more clearly. A tablet

Inspection carried out on 22/12/2015

During a routine inspection

This unannounced inspection took place on 22 December 2015.

The service is registered to provide accommodation and personal care for up to nine people with different learning disabilities. People may also have behaviours that challenge and complex communication needs. Accommodation is situated over three floors: there is a communal lounge on the ground floor, a dining room and kitchen. Bedrooms are located on all three floors. There is a spacious garden at the rear of the property. Parking is available at both the front and rear of the property. At the time of the inspection nine people were living at the service.

This service had a registered manager in post. A registered manager is a person who is 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.

Potential risks to people were assessed and recorded. There was full guidance on how to safely manage risks in each person’s care and support plans so that people received the interventions they needed to keep them as safe as possible. The assessments identified people’s specific needs, and measures were in place to reduce the risks, without restricting peoples’ activities or their lifestyles.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns, both within the organisation and to the local authority safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the managers or senior staff, who would take the appropriate action.

Accidents and incidents were reviewed and action was taken to reduce the risk of them happening again. Each person had a personal evacuation plan in the event of an emergency, such as fire or flood. Health and safety checks on the equipment and the environment were carried out regularly to make sure the premises were safe. Staff told us that there was a plan to redecorate a number of areas within the service in the new year, which included each person’s bed rooms and communal areas. Routine maintenance was carried out on a regular basis.

Some people living at the service needed one to one staffing support and there were appropriate levels of staff on duty and deployed throughout the service to meet people’s needs. Additional staff were on duty throughout the day to ensure that people were supported to enjoy activities of their choice. There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. People were supported by trained staff who had appropriate skills and knowledge to provide the care people needed. Staff received regular one to one supervision from their line manager, together with an annual appraisal, to discuss their training and development needs. New staff were given a detailed induction, and completed a probationary period to make sure they were suitable to work with people. The on-going training programme ensured that staff had the right skills, knowledge and competencies to carry out their roles

There had been no recent admissions to the service, but when people did first come to live at the service they had a detailed assessment, which identified the care and support they needed.

Care and support plans were designed around people’s individual interests and needs. These were written in a way people could understand, and included pictures and photos.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff demonstrated good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), including people’s right to make informed decisions independently, but where necessary to act in someone’s best interests. Mental capacity assessments had been carried out to determine people’s level of capacity to make decisions in their day to day lives and for more complex decisions when needed. DoLS authorisations were in place for people who needed constant supervision because of their disabilities. Guidelines were being followed by staff to ensure there were no unnecessary restrictions to people’s lifestyles.

Staff supported people with their health care needs and when it was necessary, health care professionals were involved to make sure people remained as healthy as possible. People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs and ensure well-being. Medicines were managed safely and stored securely, and people’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

There was a strong emphasis on person centred care and care plans covered people’s preferred daily routines and lifestyle. The plans were reviewed on a regular basis so that staff had the current guidance to meet people’s changing needs. The manager of care ensured that staff had a full understanding of people’s support needs and they had the skills and knowledge to meet them. Staff skills and knowledge were monitored to make sure they knew people well and how to support them in a way that suited them best. We observed that staff were flexible and adapted as required to meet people’s preferences and choices.

People were treated with kindness and compassion. Interactions between staff and people using the service were positive and staff had developed good relationships with people. People were treated with dignity and respect to enable them to take part in activities and events to enrich their lifestyle. We observed that people’s privacy was respected and this was clearly recorded in their care plans. People or their relative /representative had been involved in writing their care plans.

Feedback about the service had been sought from people, their relatives, staff and other stakeholders about the service. Their opinions were analysed to promote and drive improvements within the service. Staff told us that the service was well led and that the management team were very supportive.

Comprehensive quality monitoring was in place, with detailed checks regularly undertaken to identify any shortfalls so that appropriate action could be implemented and the service could be continuously improved. There was a culture of openness and inclusion within the service.

People’s care and support plan recorded when people were happy or sad, and what staff should look for if people were not presenting their usual behaviour. There were systems in place to investigate and respond to people’s complaints. The complaints procedure was also in an easy read picture format to ensure that people could be supported to understand the process.

Inspection carried out on 10 December 2013

During a routine inspection

There were 9 people living at The Glen when we inspected. We spent time with the people and observed interactions between the people and the staff.

We found that people were supported to give consent and were involved in the decisions about the care and support they received. People indicated that they were happy with the support they were receiving.

Staff were observed asking people for their consent before any care took place and their wishes were respected. People were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond patiently and in a caring way.

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and wellbeing.

We saw that there were systems in place to make sure people who used the service received their medicines regularly and safely.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

We saw that people and relatives were asked their views on the standard of service being provided. There were procedures in place for people to complain. We saw that staff knew when people were unhappy about something from the way they communicated their body language and facial expressions.

Inspection carried out on 4 October 2012

During a routine inspection

Some of the people living in the home were unable to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Some people using the service expressed that they were happy. They were participating in activities which they were enjoying.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw staff responded in a caring and positive way.

We saw that people were able to access all of the areas of the home. We observed people having their breakfast or getting up when they wished.

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