Glebe House

We found the following examples of good practice.

The provider had an up to date visiting policy in place to ensure that visiting was safe for people living at the service and their families. The home had recently opened to visitors following an outbreak of Covid-19 and had safe practices in place for their arrival, for example visitors were encouraged to sanitise their hands, have their temperature taken, wear personal protective equipment (PPE) and complete a lateral flow test for Covid-19. Visits were by appointment only, the time and duration of visits were spaced to allow for cleaning.

People who were admitted to the home or from hospital were isolated in accordance with government guidance. People with symptoms of Covid-19 and those that had received a positive test were isolated in single occupancy rooms and where possible in one area of the home. The provider promoted a whole home isolation approach, once one person had tested positive all residents were isolated to robustly track and test those that may have come into contact with the positive person, to reduce the risk of potential transmission.

Staff understood the importance of using personal protective equipment (PPE), they had received training and were confident in their knowledge of PPE and how to dispose of it safely. Staff were observed wearing correct PPE and promoting hand hygiene, and the registered manager had developed a Covid-19 handover sheet which staff could carry to remind them of good IPC practice.

The premises were clean and hygienic and there were daily cleaning schedules in place for rooms and communal spaces. There were extra cleaning schedules in place for the cleaning of high touch areas and staff were confident in their roles and responsibilities relating to these tasks. Cleaning schedules are reviewed daily by the supervisor to ensure schedules had been met and any concerns are brought to the management's attention.

The provider had a range of policies relating to Covid-19 and infection control practices. Policies were up to date and showed amendments made to reflect changes in government guidance or the care homes individual circumstances.

Glebe House is situated in Southbourne, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Glebe House accommodates 40 people across separate units, each of which have separate bedrooms with ensuite shower facilities, a communal dining room and lounge. There were also gardens for people to use and a hairdressing room. The home provides accommodation for older people, a small number of whom are living with dementia. At the time of the inspection there were 39 people living at the home. The home 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 2008 and associated Regulations about how the service is run.

At the last inspection the home was rated as Good. At this inspection we found the home remained Good.

People continued to be safe. Risks to their safety had been identified and lessened. People were supported by sufficient staff who had the appropriate skills to meet their needs. One person told us, “If I call for help, normally they come quickly, but if it’s an emergency they come running”.

People were protected from abuse. Staff knew the signs that might indicate a person was experiencing harm and knew what to do if they had concerns about people’s safety. One person told us, “I’m safe. It’s a lovely place”.

People’s needs were assessed and met. Their health was promoted and people were encouraged and able to maintain their health and well-being. Timely responses and referrals had been made when people were unwell. People received their medicines to maintain their health and told us that they trusted staff to meet their needs when they were unwell. Staff worked in a coordinated way with external healthcare professionals.

The home was clean. Infection control measures ensured that people were protected from the spread of infection and cross contamination was minimised.

People were complimentary about the food and told us that staff respected their right to choose what they had to eat and drink. People had sufficient amounts to eat and drink. One person told us, “The meals are very good, reasonable choice”.

People had access to an environment that met their needs. People had their own rooms if they preferred to spend time alone. Communal areas such as lounges, dining rooms and gardens enabled people to spend time with others to meet their social needs.

People were actively involved in discussions and decisions about their care. Regular care plan reviews as well as residents’ and relatives’ meetings enabled people to voice their opinions and make suggestions. People could raise questions and concerns. These were respected, listened to and welcomed. One person told us, “I do feel party to discussions about my care”.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and procedures at the home supported this practice.

Care was person-centred and focused on people’s needs and preferences. People told us that they were fond of the staff and that they were well-cared for. Positive and compassionate interactions were observed and people were treated with kindness. Staff were sensitive to people’s needs and supported people in a way that maintained their dignity and privacy. People received dignified and appropriate care at the end of their lives.

Feedback about how the home was managed was positive. The registered manager worked in partnership with others. People, relatives and staff were complimentary about the leadership. They told us that it was well-organised and that they were involved in the running of the home. One person told us, “I know the manager and I feel I can approach her”.

Quality assurance processes provided the registered manager and other external managers with a way of monitoring the systems and processes within the home to ensure that these were effective.

Further information is in the detailed findings below.

There was a registered manager in post. 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.

People told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received all essential training and there were opportunities for them to study for additional qualifications. All staff training was up-to-date with refresher course booked for people. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways – verbally, through physical gestures or body language. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s preferences and likes and dislikes were documented so that staff knew how people wished to be supported. Some people went out into the community independently while others required staff support. There were a variety of activities and outings on offer which people could choose to do. Complaints were dealt with in line with the provider’s policy.

People could express their views and discuss any issues or concerns with their keyworker, who co-ordinated all aspects of their care. The culture of the service was homely and family-orientated. Regular audits measured the quality of the care and service provided.

We considered six outcomes during this inspection. These being

Outcome 2 Consent to care and treatment

Outcome 4 Care and welfare of people who use services

Outcome 8 Cleanliness and infection control

Outcome 14 Supporting workers

Outcome 16 Assessing and monitoring the quality of the service

Outcome 21 Records

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

We spoke with 12 of the 36 people at the home. They all told us they were happy with the service they received. People said they felt safe. They said they had consistent care staff who knew what support they required. We also spoke with six relatives who were visiting the home. They were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people's safety or welfare.

Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment identified in people's care plans was in place to reduce risks and keep people safe. This included equipment such as pressure reducing mattresses, bed rails and moving and handling equipment. Staff told us they had received training to use equipment and we observed this being used correctly in communal areas. Systems were in use to ensure the home was clean and infection control concerns appropriately managed.

We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

Staff were knowledgeable about people's care needs and how to meet them. Staff told us about the care they were providing for specific people which matched information in each person's care plan. Staff had received training to ensure they had the skills necessary to care for people. The registered manager and staff were aware of who to contact for specialist advice and when this may be required. We saw records of when specialists such as community psychiatric nurses and dieticians had been consulted. We spoke with one external health professional who said the home met people's needs well. They said they were 'contacted promptly and appropriately' by the home and their 'guidance was followed'.

We spoke with people and visitors, all of whom were positive about the service provided. Visitors said their relative's health needs were met and they were kept informed when medical professionals had attended. One person told us they were being supported to increase their mobility. We saw they were encouraged to walk as far as they could to the dining room before being assisted in their wheelchair. This showed the care was effective.

Is the service caring?

People were supported by kind and attentive staff. People said they were treated with respect and dignity by all staff. People also told us the staff were very kind and gentle. One person told us 'the carers are lovely people'. Another person said 'The staff are all wonderful, and the quality of care is excellent'. A third person told us 'I like it here'. We spoke with six visitors. One commented 'the staff have been so patient', another said they 'had no concerns about anything'. Similar comments were made by the other visitors.

Staff said they had time to meet people's identified needs and could provide care at times people wanted it. Staff were able to talk about the individual preferences and were aware of peoples life histories. For example, one staff commented a person had worked in the theatre and this was seen in their care plan. Staff were aware of people's rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. Discussions with the registered manager showed they were aware of how to get advice and support when required. We saw staff organised an emergency dental appointment for a person during the inspection. Transport and a staff escort were also arranged. This showed the home was able to respond to people's urgent healthcare needs. Following the inspection in February 2014 we made a compliance action as the care plans lacked sufficient individual detail. An action plan was produced and on this inspection we found care plans had all been rewritten and provided appropriate individual detail.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. Staff were aware of the action they should take in an emergency such as when the fire alarms were sounding.

Is the service well-led?

There was a clear management structure with the registered manager being supported by a deputy manager. This meant key management tasks were completed by people with the correct skills to undertake them. One relative said 'the manager is always around and I can talk to him'. There were procedures in place to monitor the quality of service provided with audits, such as for care plans and infection control, being completed. There were regular meetings for people living at the service where issues such as the environment and activities were discussed. Staff meetings were also held enabling staff to raise issues and be kept informed about the service.

Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. All records requested were available and well maintained. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the management team. Staff stated they could rely on the registered manager for support at all times.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 35 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. People were given choices about the food they would like to eat. Staff responded to people's requests.

People told us they were satisfied with the service they received. One person said, 'It's like a five star hotel.' People said they were looked after well and were aware they had a care plan, although two people said they had not seen a copy of their care plan.

We saw each person's needs were assessed and there were care plans of how to meet those needs. We noted that care plans for specific care needs had not been reviewed and updated when they needed to be.

The home provided a range of activities including activities in the community. People had opportunities to maintain and develop their independence.

People's nutritional needs were assessed and people were supported so they had adequate food and fluid. We saw there was choice of meals and that food portions were ample.

We saw people received their medicines and that medicines were handled appropriately although we noted there was a lack of clarity about how the home supported someone with their medicines.

The home had adequate number of staff to meet people's needs. People said staff were responsive when they asked for help.

Comments included. “It’s lovely, my family visit, everybody is so kind and friendly, food is excellent and my room is cleaned every day. I can’t fault it.”

For each person living in the home there was a detailed plan of care in place that included people’s individual needs and wishes. The plans also detailed physical and emotional healthcare needs.

In order to meet individual needs, the home’s staff worked with a variety of healthcare professionals including district nurses and mental health teams.

People were protected from risk of abuse or harm by there being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

Comments from people living in the home included. “I am looked after beautifully, the staff are wonderful and there are lots of activities.”

A relative said. “I am informed if my mum is poorly at all, the manager and staff are very good indeed and the atmosphere is relaxed but professional.”

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review. Records showed us that people using the service, families and professionals involved in people’s care were consulted.