Gretton House

About the service

Gretton House is a residential care home providing care and support to 15 people at the time of inspection, most of whom live with Prader-Willi Syndrome, a rare and complex genetic condition. The service can support up to 20 people.

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

Right Support

Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

The service worked with people to plan for when they experienced periods of distress. An inhouse behaviour specialist supported people and staff develop strategies to manage and reduce distressed behaviours. These were recorded in positive behaviour support plans where needed.

People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community. People were supported to attend GP and other appointments independently or with support depending on their preferences and abilities. Staff supported people to make decisions following good practice in decision-making. Staff communicated with people in ways that met their needs.Staff supported people with their medicines in a way that promoted their independence and achieved the good health outcomes.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Recruitment was ongoing to fill vacancies. Staff received training and support appropriate to their roles.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability or Prader-Willi Syndrome may have. This meant people received compassionate and empowering care tailored to their needs.

Staff placed people’s wishes, needs and rights at the heart of everything they did. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so people received support based on transparency, respect and inclusivity.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Follow up

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.

We found the following examples of good practice.

¿ Safe arrangements were in place for visitors to the service including health professionals and relatives. This included temperature checks, risk questionnaire, hand sanitisation and wearing a mask. Plans were in place for a more permanent structure outside to facilitate family visits when it became safe to do so.

¿ Staff had received additional training in infection prevention and control and the use of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. There were sufficient stocks available and staff were seen to be wearing PPE appropriately.

¿ A variety of easy read and picture guides helped people understand about COVID-19 and the changes to their lives because of it. For example, guides supported people understand about testing, PPE and social distancing. This assisted in reducing heightened anxieties and keeping people safe.

¿ People were encouraged to socially distance in the service. A one-way system was in place for going upstairs via one staircase and downstairs via another, and everyone was encouraged to ‘keep to the left’ when walking around the corridors. Everyone entered the building through one door and exited through another. This all reduced the risk of infection spread.

¿ Enhanced cleaning schedules were in place including of high touch areas such as handrails, door handles and kitchen appliances. Domestic staff took responsibility for different zones and support staff also participated in some cleaning duties.

¿ The service did not use any agency workers and permanent staff did not work in any other care setting. This reduced the risk of infection spread between care services. Staff worked in four separate core teams which also reduced the risk of cross infection within the staff team.

¿ The contingency plan was a practical working document which was regularly updated when anything changed. This meant the service were well-placed to deal with any emergency as they had robust and well thought out back up plans in place.

Further information is in the detailed findings below.

Gretton House is a residential care home providing personal and nursing care for up to 20 younger people with a diagnosis of learning disability, autism or mental health concerns, 16 people had a primary need of Prader- Willi syndrome. PWS is a rare genetic condition that causes a wide range of physical symptoms, learning difficulties and behavioural problems. At the time of our inspection 18 people were using the service.

The service was based in a large house which is a listed building. This is larger than current best practice guidance.

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

We made a recommendation regarding mental capacity assessments.

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; however the current policies and systems in the service did not support this practice.

People told us they were supported by kind staff who knew them well. Staff had received appropriate training and understood how to raise any safeguarding concerns they may have.

People’s needs were detailed in their care plans and risk assessments. Staff supported people in a person-centred way as all the information regarding communication, choices, routines and likes and dislikes was documented.

People told us the food was good and some people helped in the kitchen preparing meals. Staff knew what support people needed with their nutrition and hydration and supported them to meet these needs. Referrals were made to external health professional as required.

People were supported to engage in activities that were relevant to them, including games, reading, craft, shopping, employment and accessing the community.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

Staff felt supported by the registered manager and received regular supervisions. The registered manager was accessible to everyone and was open to suggestions and feedback.

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

Rating at last inspection

The last rating for this service was Good (published 9 June 2017).

Follow up

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, in March 2015, the service was rated Good. At this inspection we found that the service remained Good.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People continued to receive safe care. There were enough staff to provide care and support to people to meet their needs and appropriate recruitment procedures were followed. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff were provided with a thorough induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions. People were supported to maintain good health and nutrition.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People had personalised plans of care in place to enable staff to provide consistent support in line with people’s preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the home. People, their relatives and staff told us that they had confidence in the manager’s ability to provide high quality managerial oversight and leadership to the home.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement. People were supported to have choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We spoke with four relatives who confirmed that the service was very good. One relative said: 'I am very happy with the home. They (the staff) have been wonderful'.

This was a largely a positive inspection. Everyone we spoke with said that care that staff supplied was good. All the standards we inspected, except one, were compliant.

They were issues that needed to be dealt with. Premises issues need improvement to ensure that any issues are quickly attended to, particularly those that potentially affect the health and safety of people.

There were a small number of suggestions: to have a snoozelum, and to have a small gym or gym equipment so people can more easily access this type of exercise.

The expert by experience spoke with nine people who lived in the home at the time of the inspection. They said that they were satisfied with the care that they received.

A person told us that staff; 'are friendly and try and help you'.

We spoke with six relatives. They all told us that the care staff provided was of a very high standard.

One relative said; 'this home is done so much for my son. He has come on leaps and bounds'.

We received a small number of comments of concern: trips out between people and their key workers were often cancelled due to lack of staff or transport. (The manager later wrote to us stating that staff were directed to order taxis if the home's cars were unavailable). Also, that activities in the afternoon seemed to comprise of having a short walk to a coffee shop, rather than having a variety of activities offered to people.

This was a positive inspection. People living in the home and their relatives said that they were satisfied with the care supplied by staff. The essential standards we inspected were met.