Glebe House

Glebe House is an independent healthcare service providing rehabilitation therapies and support to up to 11 younger people. Accommodation and support with eating, drinking and education for all 11 people is provided under OFSTED registration and regulation.

For Glebe House's Care Quality Commission registration, the service supports younger people who may live with a learning disability, autistic spectrum disorder, or mental health needs. At the time of our inspection all 11 people were being supported with rehabilitation and therapies. These included work experience, music and art as well as learning to drive and theatrical performances.

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

Sufficient staff were recruited safely and deployed in a way which kept people safe. Staff implemented their knowledge of hygiene and safeguarding systems well. Risks were identified and managed. One person told us, "I keep my self clean. Staff wash their hands before giving me my [medicines]." Sufficient staff supported people with their rehabilitation. Lessons were learned when things did not go quite so well.

People's assessed needs were met by staff with appropriate skills and whose induction, supervision and training was kept up-to-date. The provider worked well with professionals involved in people's care, we found people benefitted from this. People prepared their own meals and drank enough. Staff enabled people to access healthcare and support services. 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 support this practice.

People's care was kind, dignified and staff were thoughtful about how they did this. Staff respected people's privacy and upheld their confidentiality. People who needed support from an advocate were given this. People had a say in developing their care and how it was provided. People used advocacy support, and this helped them to have actions in relation to their views about their care.

People's care was person centred and based on what mattered and what was important to them. People's lives were transformed to enable them to achieve their dreams, which some relatives and professionals??? did not previously think were possible. One person said that the difference to their life had been, "Tremendous". Relatives praised the service for its achievement which one relative told us had been, “A struggle but [staff never gave up. It is incredible what they have done.” Systems and procedures were in place to support people with end of life care and in an emergency situation.

The registered manager was aware of their responsibilities and made improvements when needed. The registered manager had fostered an open and honest staff team culture, staff felt supported. People, relatives and staff had a say in how the service was run. Quality assurance, audits and governance were effective in identifying and driving improvements. The provider worked well with others to provide people with joined up care.

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 requires improvement (published 2 January 2019) and there were two 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous inspection 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.

The service is also registered and inspected by OFSTED for younger people receiving educational support. People's accommodation is provided as part of their educational needs.

This announced inspection took place between 4 and 10 January 2019. At the time of our inspection there were 12 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 our inspection in May 2016 the service was rated as ‘Good’. At this inspection the rating for Safe and Well-led had deteriorated to ‘Requires Improvement’. This is the first time the service has been rated as ‘Requires Improvement’.

Staff were trained in how to pro-actively recognise and report abuse and incidents related to people's safety. They set up and maintained clearly documented evidence of incidents and how they were dealt with. However, the service failed to report safeguarding incidents and allegations to the local authority and the Commission. The providers policy failed to inform staff of the correct reporting procedures and to whom.

The information and guidance for people's medicines was not always detailed and medicines were not always stored safely. This put people at risk of harm.

The provider's policies did not always provide accurate information to staff for responding to incidents. Audits and quality assurance procedures were not always effective in identifying improvements that were needed. Communication with others involved in people’s care was not always done promptly and this prevented input into people’s care and respond swiftly to people’s changing needs.

Staff promoted good hygiene and clean environment standards. Staff and people adhered to good infection prevention and control procedures.

The service remained effective. Skilled and knowledgeable staff supported people with their care and treatment needs. Staff received training and support according to people's needs. 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 systems in the service supported this practice. People were supported to eat and drink sufficiently. Staff supported people to access health care services or enabled this.

The service remained caring. People were cared for and treated with kindness and compassion. People had a say in how much they wanted to be involved in their care. People's treatment and care plans were detailed and gave staff the information they needed. People who needed advocacy support were supported to access this. People's privacy and dignity was respected and promoted.

The service remained responsive to people's needs. People received treatment and care that was person centred. People used technology to access services involved in their care. People's concerns were acted on before they became a complaint.

The registered manager fostered a positive, open and honest staff team culture. People, relatives and advocates had a say in how the service was run. The registered manager and staff team worked well with other stakeholders involved in people's care and treatment.

We found one breach of the Care Quality Commission (Registration Regulations) 2009 and one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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 that they felt safe living at the service. Staff were very knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medicine as prescribed.

There were sufficient numbers of suitably qualified staff employed at the service. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the service were employed following satisfactory recruitment checks had been completed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. We found that the registered manager and the staff were knowledgeable about MCA and were aware of who to contact when necessary

Staff respected and maintained people’s privacy at all times. People were provided with support tailored to meet their individual needs and were able to receive attentive and reassuring input from staff. This meant that people’s dignity was respected and that their support needs were met in a timely manner.

People’s assessed support needs were planned and met by staff who had a good understanding of how and when to assist and support people whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to support people in the right way.

People were supported to attend appointments with health care professionals when required, including their GP and any hospital appointments. Risk assessments were in place to ensure that people could be safely supported at all times. People were provided with sufficient amounts of food and drinks and they were involved in cooking and preparing a range of meals.

People’s support was provided by staff in a caring, kind and compassionate way. People were involved in a wide range of educational sessions, work experience projects and interests and were supported by staff in a way which involved them to learn new skills and remain active.

The service had a complaints procedure which was made available to people and their relatives to use and all staff were aware of the procedure. We saw that staff took prompt action to address people’s concerns .People had regular opportunities to raise their concerns through individual and group meetings facilitated by staff. Advocacy services were available to people.

There was an open culture within the service and people were able to comfortably talk with the staff and raise any issues with them. People were provided with several ways that they could comment on the quality of their care and discuss day to day issues and concerns. This included regular contact with the registered manager, clinical and support staff. People were given the opportunity to be involved in the daily running of the service and to discuss events and issues affecting them.