Gladstone House

Gladstone House is a care home providing accommodation for people who require personal care and nursing care to up to 12 people, some of whom may be living with mental health issues and or a learning disability. At the time of our inspection there were 8 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The provider didn’t always give people care and support in a clean and well-maintained environment. We made a recommendation regarding infection prevention control measures in place and to review the service refurbishment plan.

Medicines were not always managed safely. The guidance for medicines taken ‘when required’ and documentation for these medicines were not always clear. The medicines policy in place stated homely remedies could be offered, and people told us these types of medicines were not available.

Staffs competencies to administer medicines was checked. Staff told us people were supported with administering their medicines in a way that promoted their independence. However, more development was needed in this area to build up people’s skills.

Care plans were improved for people to support their mental health, emotional well- being, personal care and dietary needs. Care plan monitoring records were improved to include tracking people’s progress.

The provider supported people to have the maximum possible choice, control and independence and they had control over their own lives. People were encouraged to plan ahead, set aspirations and work toward personal goals.

Fire drills were taking place regularly, issues with the fire doors being unsafe at our last inspection had been fully addressed.

Right care

The provider acted to protect people from poor care. The provider reported any concerns to the appropriate places. Staff had training on how to recognise and report abuse.

The provider had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff were recruited appropriately with the correct safety and suitability checks.

People were supported by person-centred practices; care plans were improved and included personalised plans with achievable goals and outcomes. People were encouraged to take positive risks. Risk assessments were in place.

Right culture

People were supported to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The quality assurance processes in place were improved and were more effective. People and those important to them, including advocates, were involved in planning their care.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 12 December 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made. However, the provider was still in breach of regulation.

This service has been in Special Measures since 12 December 2022. During this inspection the provider demonstrated improvements have been made. The provider is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected.

We carried out an unannounced comprehensive inspection of this service on 26 July and 1 August 2023. A breach of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make further improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from inadequate to requires Improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gladstone House on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to medicine management at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Gladstone House is a care home providing accommodation for people who require personal care and nursing care to up to 12 people, some of whom may be living with mental health issues and or a learning disability. At the time of our inspection there were 10 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

Care plans were not always in place for people to support them with their mental health, emotional well- being, finances, personal care needs or in some cases dietary needs. People who required support with managing their diet had not been provided with enough support to do this effectively to maintain their health. Care plans and monitoring records were not in place or not completed.

The service didn’t support people to have the maximum possible choice, control and independence be independent and they had control over their own lives. People were not encouraged to achieve their aspirations and goals.

The service didn’t give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. Regular fire drills were recorded as taking place however, there were some issues with the fire doors being unsafe or ineffective and health and safety procedures regarding potential hazardous materials were not followed correctly.

Medicines had not been managed, stored or administered safely. Insufficient records and systems to monitor medicines were in place. Staffs competencies to administer medicines was not always checked. People with their medicines in a way that promoted their independence and achieved the best possible health outcome. People were not supported to play an active role in maintaining their own health and wellbeing.

Right care

The service didn’t always act to protect people from poor care. The service didn’t always report concerns to the appropriate places . Staff had training on how to recognise and report abuse however, this wasn’t always practiced.

The service didn’t have enough appropriately skilled staff to meet people’s needs and keep them safe.

People were not supported by person centred practices; care plans did not contain personalised plans or outcomes for people with achievable goals.

People were not encouraged to take positive risks. Risk assessments were not followed, and some were not in place . Monitoring records had not been completed consistently and we could not be assured people were receiving appropriate care and support.

Right culture

People didn’t always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The quality assurance processes in place were not effective and failed to identify and address shortfalls in a timely manner.

People didn’t always receive good quality care, support and treatment because staff were not trained to meet their needs and wishes. Safe recruitment processes were not always followed

People and those important to them, including advocates, were not always involved in planning their care. The service didn’t enable people and those important to them to work with staff to develop the service.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 11 December 2019)

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being provided to people and infection prevention control. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider acknowledged the significant shortfalls found during this inspection. They took some action following the first day of inspection to begin to address some of the shortfalls found.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gladstone House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, assessing and managing risks, medicine management, infection control, nutrition, staffing, safe care and treatment, staff training and support and provider oversight and monitoring at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review, and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gladstone House is a residential care home providing accommodation and personal care for up to 12 younger adults with a mental health condition. At the time of the inspection there were 12 people using the service.

The service has three floors, two of which provide living accommodation for people. There is a communal lounge and dining area, with a smaller quiet room with access to outside space.

People’s experience of using this service and what we found

People told us they felt safe living at this service and had built trusting relationships with staff. Recruitment procedures ensured staff were suitable to work in a care setting. Staff had time to meet people’s needs and engage them in meaningful conversations. People’s medicines were managed safely. The providers quality assurance systems did not always highlight areas requiring improvement in relation to infection control and window safety. We made a recommendation about the governance and quality assurance systems in place.

Staff received training to support them in their role. The provider had scheduled refresher training to ensure staff knowledge and skills were maintained. Staff received informal day to day chats with the management team; supervisions and appraisals were scheduled to support them carry out their role effectively.

People had choice and control of their lives and the staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People accessed the community independently and were supported by a team of staff to engage in activities or explore interests they had chosen. People were encouraged to participate in the running of the home to further develop their life skills.

Care plans were person-centred and reflective of people’s current needs. Staff knew people well and could tell us about their support needs. People told us staff were, “Supportive, friendly and kind.”

The service demonstrated good outcomes for people. Staff told us people were at the heart of everything they considered. People, staff and relatives had opportunities to raise concerns, make suggestions to improve the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gladstone House on our website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published April 2017).

Why we inspected

This was a planned inspection based on the previous rating. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection this service was rated Good. At this inspection we found that the service remained Good.

There was a registered manager at this service who had been registered with the Care Quality Commission since June 2011 .

We found that the service was safe. There were sufficient staff on duty to meet the needs of people who used the service and they were trained in subjects which were reflective of their role and people's needs. They had been trained in safeguarding adults and were aware of reporting procedures.

Risks to people's health and safety had been identified and recorded. Premises safety was maintained through regular checks of services and equipment.

Medicines were managed safely and people who used the service had access to healthcare professionals when needed.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's nutritional needs were met.

People chose what activities they wished to take part in and led their lives as they chose.

Staff were kind and caring and showed respect to people.

Care plans were person centred and were reviewed regularly.

If people had any concerns or complaints there was a policy displayed telling them what action to take. No complaints had been made.

There was a clear management structure within the service. The organisational values reflected the way people were supported.

There was a quality monitoring system in place.

Further information is in the detailed findings below.

Care plans included information about mental and where necessary physical health. The care plan format had been improved recently with information being provided in a clear and concise way. This enabled staff to assist the individual in a personal way.

We saw that the environment was suitable for the people who lived there. People were able to lock their own room when they left it and this gave them a sense of safety.

We saw that employment checks were carried out on the staff before they started working at Gladstone House. This meant that staff were suitable to work with vulnerable people.

The manager carried out several audits of records kept, the environment and how people were. This meant that people received a service that met their needs.

Staff kept daily records for each person. These records contained detailed information about incidents people who used the service had been involved in. These incidents were not reflected in the reviews of the care plans. The daily notes also contained judgements rather than factual information.

People who used the service told us they helped with the domestic activities in the home. One person helped wash up, another set the tables and another took round the afternoon drinks. People told us that they took turns to help with these activities.

Staff told us they had mandatory training every year. Staff records also contained records of national vocational training (NVQ) that they had completed. There was no evidence that staff had received training about mental health issues other than challenging behaviour.

Staff told us that they had time to spend with people who used the service but this was not evidenced during the inspection. We saw that staff were busy with household tasks.