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Gloucestershire House - Care Home with Nursing Physical Disabilities Outstanding

Reports


Inspection carried out on 13 December 2019

During a routine inspection

About the service:

Gloucestershire House is a care home that provides nursing and residential care and support for up to 30 people. Care and support was provided to people living with learning and physical disabilities. Support is provided within one adapted building.

The service was developed and designed prior to Registering the Right Support and other best practice guidance being published. The provider was knowledgeable about the guidance and that it is in place to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. They were aware that its principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was bigger than most domestic style properties. It was registered for the support of up to 30 people. At the time of our inspection, 30 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated, as the service was community-based and enabled independence, inclusion and choice for the people living there. The service consisted of five separate lodges within the building, each of which housed six people and had its own name and set of care staff. Staff did not wear anything that suggested they were care staff when coming and going with people.

People's experience of using this service and what we found:

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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. The service ensured that people were involved in decisions about their safety and empowered to take positive risks.

Feedback from people and relatives was overwhelmingly positive. There was consistent praise for the exceptional physical and emotional support provided by the staff at Gloucestershire House. Comments from relatives reflected the quality of the ongoing support for people to access meaningful activities in the home and community which promoted people’s independence and mental wellbeing.

People received highly effective and responsive support with their health and social care requirements and the safe administration of their medications. There was a strong, clear multi-disciplinary approach to meeting people’s care and support needs.

Staff demonstrated a culture of inclusivity and positivity that was evident throughout the service. Leaders constantly looked for ways to improve the service and ensure people received the outstanding support and care they deserved. Staff supported people to make decisions for themselves and engaged with people and their relatives about their wishes and preferences.

The service was a hub of activity with friendly staff providing care and support in a way people liked and enjoyed. Positive interactions took place between people, staff and each-other throughout our visit.

People had their privacy and dignity respected by staff, and there was a clear emphasis on independence.

The service's visions and values put people at the heart of the service. People were encouraged to comment on the quality of their support and their feedback was used to develop and enhance the service provided.

Gloucestershire House worked in partnership with health and social care professionals to ensure people’s care was well organised and met their expectations. People's care was regularly reviewed and was flexible. Staff responded to changes in people’s health and support needs to ensure people remained well su

Inspection carried out on 6 April 2017

During a routine inspection

This inspection took place on 6 and 7 April 2017 and was unannounced.

Gloucestershire House provided support to 36 people with physical disabilities, some of which had additional and associated complex needs. The environment had been adapted to suit the needs of those who lived with physical disabilities. The provider had refurbished and improved the building and facilities over a number of years and continued to do this.

There was an experienced and exceptionally committed registered manager in place. 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. They provided strong leadership to the staff who were also highly committed to improving people’s quality of life. People and staff were fully supported by equally committed volunteers. They supported people to take part in activities and work and to generally achieve their goals and aspirations. There were arrangements in place to monitor the service and a proactive approach was in place to continually strive to improve the services provided.

People told us they enjoyed living at Gloucestershire House, for example, one person said, “It’s my forever home.” They told us they felt safe and cared for. In particular people were listened to. They were supported to make independent decisions and were at the centre of planning and reviewing their care. Staff were exceptionally good at helping people to identify their goals and aspirations. They provided exceptionally personalised support to help them achieve these. The registered manager said, “I want people to live their lives fully.” For some people this had resulted in their lives generally and the quality of their lives altering dramatically. One person said, “My life has really changed beyond belief since I moved here."

People were supported to be independent. Staff were committed to helping people acquire the skills and the funding they needed to live in the wider community, if, this is what the person wanted to achieve. Otherwise the service provided a supportive long-term home for people.

Inspection carried out on 23 October 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

The inspection was unannounced.  There were no breaches of legal requirements from our last inspection that we needed to follow up. 

Gloucestershire House is a modern 36 bedroomed home near to Cheltenham town centre.  The home is suitable for mostly young adults with a range of physical disabilities.  The home comprises of five inter-linked lodges each with their own lounge/kitchenette area plus a further six bungalows for the more independent person.  At the time of our inspection there were 35 people living at Gloucestershire House.

There was a registered manager in post at the service.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The registered manager and staff team had received safeguarding adults training and understood their role and responsibilities to protect people from harm.  Information was available to them on what to do if they needed to raise safeguarding concerns with other agencies.  Any risks in respect of people’s daily lives or their specific health needs were assessed and appropriately managed.  Plans were in place to reduce or eliminate those risks. Staffing numbers on each shift were sufficient to ensure that each person was kept safe and their care needs were met.  Medicines were well managed and people were supported to manage these themselves where they were able.

Staff  were provided with regular training and opportunities to develop their skills further.  Staff had the knowledge and skills they needed to meet people’s individual care needs.  People were provided with sufficient food and drink, or dietary supplements to meet their requirements.  Where people were at risk of poor nutrition or hydration, measures were in place to monitor how this was going.  Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

Staff and people who lived in the home had positive and caring relationships.  People were involved in making decisions about how they wanted to be looked after and how they spent their time.  People’s privacy and dignity was maintained at all times.

People’s individual needs were met because everyone was looked after in a person-centred way.  They were encouraged to have a say and to express their views and opinions about their care, the way the home was run and activities that took place.  Staff listened to what they had to say and acted upon any concerns to improve the service they provided.

The registered manager provided good leadership and had a committed staff team who provided the best possible service to each person who lived there.  The quality of service provision and care was continually monitored and where shortfalls were identified actions were taken to address the issues.

Inspection carried out on 31 July and 1 August 2013

During a routine inspection

We spoke with 14 people living at the home and with eight members of staff. People told us, "this is the best place you are ever going to get" and "I love it here, I am very blessed".

People made choices and decisions about their care and support. They told us, "�Staff do what I ask, it�s important to make our wishes known." They confirmed staff sought their consent before they supported them with their personal care.

People told us they discussed their care with key workers and that they had annual reviews to which they could invite their family and social workers. They said they had lots of opportunities to go out and about and enjoyed activities offered in the home such as the book club or hydrotherapy.

There was evidence of co-operation and communication with other health and social care professionals ensuring safe and co-ordinated care.

People told us they helped to choose the decor and fixtures and fittings for their new kitchens and dining rooms. The home was well maintained and pleasantly decorated and furnished. Adaptations to the environment and specialist equipment promoted people's independence.

People said that staffing levels had improved and this was confirmed by staff and the manager. People commented, "there are enough staff now, there wasn't before" and "there hasn't always been enough staff, but now it's better".

A robust quality assurance system was in place which promoted feedback from people, their relatives and staff.

Inspection carried out on 20 March 2013

During a routine inspection

We spoke to four people who were using the service and asked them about the care and support they received. They told us how their privacy and dignity were respected and how they received enough help to meet their needs.

We checked records relating to people�s care and support and found that some risk assessments for pressure area care had not been completed correctly. People told us they felt safe at Gloucestershire House and we found that staff had received training to safeguard people from abuse. We looked at staff recruitment and found that required checks had been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as "fine" and �pretty good�. We found that the service had an effective complaints system and complaints were recorded and responded to appropriately.

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