Archived: OSJCT Glebe House

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good overall.

Why the service is rated Good:

People remained safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. Risk assessments were carried out and promoted positive risk taking which enable people to live their lives as they chose. People received their medicines safely. However, medicine records were not always accurate. The registered manager took immediate action to rectify this concern.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

The service continued to provide support in a caring way. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity. People were involved in decisions about their care needs and the support they required to meet those needs.

People had access to information about their care and staff supported people in their preferred method of communication. Staff also provided people with emotional support.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The service was led by a registered manager who promoted a service that put people at the forefront of all the service did. There was a positive culture that valued people, relatives and staff and promoted a caring ethos.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care and support and promote a positive culture that was person-centred, open, inclusive and empowering which achieved good outcomes for people. The registered manager was supported by the area manager and provider.

We considered our inspection findings to answer the questions we always ask:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found.

Is the service safe?

The service was safe because care and treatment was delivered in a way that was intended to ensure people's safety. Care plans identified risks to people's health and safety and risk assessment were put in place accordingly. For example we saw risk assessments in place for pressure sores and for mobility, dexterity and falls risks.

There were arrangements in place to deal with foreseeable emergencies. The provider told us that the service had a contingency plan in place. People had individual evacuation plans in place and a fire pack was checked daily. The registered manager and area manager were available on call.

Is the service effective?

The service was effective. We spoke with people about the care and support they received. One person said 'it's wonderful, that's the only thing I will say', another person said, 'It's alright' and one person told us they were getting on very well.

People were able to express their views and were involved in making decision about their care. Care plans showed that people were involved in decision about their care. For example; we saw in one care plan that the person was had expressed that they were not ready to discuss their advance care planning, and in another that the person doesn't like to wear trousers. We heard and saw people being offered a choice from the menu at lunch time.

Is the service caring?

We found the service to be caring. During our visit we conducted a short observational framework (SOFI) which is one of the tools we use to capture the experiences of people who use the service who may not be able to express this for themselves. We observed five people over lunch time in the dining room. The interactions with care workers were positive. Care workers were attentive and caring and spoke to people with warmth and respect. People were also offered a choice of food and encouraged with their meals.

People's privacy and dignity was respected. We observed care workers knock on people's doors before entering their rooms, whether people's doors were open or not. Care workers bent down to speak with people where appropriate and made eye contact. One person said 'they make sure no one is around, and there are no doors open or anything when doing personal care'; another person told us that care workers were polite. We heard one care worker ask a resident who was shortly to have their lunch if they would like an apron to help keep their clothes clean while having their lunch.

Is the service responsive?

The service was responsive to people's needs. People were able to express their views and were involved in making decision about their care. Care plans showed that people were involved in decision about their care. For example; we saw in one care plan that the person was had expressed that they were not ready to discuss their advance care planning, and in another that the person doesn't like to wear trousers. We heard and saw people being offered a choice from the menu at lunch time.

People's views and experiences were taken into account in the way the service was provided. We saw from the home's action plan that the provider had carried out a survey of people who used the service and their relatives. One of the outcomes of this had been that the manager was to have quarterly meetings with the residents and relatives, which each head of department was to attend. We saw that one had taken place in January and saw minutes produced from the meeting held in April. This meant that people's views were acted upon.

Is the service well led?

The service was well led. The home had a new manager in post since January 2014 who was working to ensure that people, relatives and staff views were sought and used to inform service development and improvement. The manager was responsible for and oversaw the home's ongoing action plan. This was used as a tool to monitor and review actions to be addressed for the service as a whole, which had been identified from the quality monitoring systems in place.

There were systems in place to regularly assess, and monitor the quality of the services provided. The manager and the quality assurance manager outlined the range of quality monitoring assurance systems in place. We saw that these included a range of health and safety audits, such as monthly infection control audits, monthly medication and care plan audits. The organisation compiled a six monthly quality risk profile of the home based on results from the homes quality monitoring systems in place, organisational audits, and external monitoring from the local authority. There was an internal organisational medication audit being carried out on the day of our inspection, the results of which informed the homes quality risk profile.

We found people had good care plans in place which enabled staff to support them in the way they wanted to be supported. One person told us 'they always tell me what they are going to do, the staff here are really good'. A relative told us' the staff here are pretty good and some staff are exceptional they know how to care for mum'.

We found that equipment in the home was safe and suitable. A visiting professional told us 'I have never seen any poor manual handling in the home; they work hard to ensure they have the right equipment for each person'.

Staff were trained and supported to deliver good care. One member of staff told us' the training here is consistent'. A visiting professional told us 'the staff here are really good, they are well trained and know what is going on, things have really improved'.

We found improvements in record keeping and care records. We found that records were kept securely. A visiting professional we spoke with told us 'there has been a huge change here and records have improved, care plans are all up to date and notes are easy to access and clear, working here now is brilliant'.

People were generally happy with the way they were looked after. They said they felt safe, were well looked after and the staff were kind and polite. The visitor we spoke with said that the staff always kept them informed of what was happening and reported any changes in their relative's health or welfare. They said they were informed of GP visits.

People received the care and support they needed because assessment and care planning arrangements took account of each person's needs, choices and preferences. They did not tell us about the numbers of staff who were on duty but did say "the staff were all kind and helpful', 'that carer is the best carer in the home', 'the staff know what I like and they look after me wonderfully' and 'the staff are always very busy and have so much to do. Some of us need a lot of help'.

People were made aware of the complaints procedure and given a Service User Guide. This contained a copy of the procedure.

We found that some of the care records we looked at were not accurately maintained. People may not receive the care and support they needed because of poor documentation. This would impact upon their health and welfare. We have asked the provider to make improvements and will follow up that this happens.