Glenfield

Glenfield is a residential care home providing personal care to up to 6 people. The service provides support to younger adults with a sensory impairment, physical disability, mental health needs and/or a learning disability or autistic spectrum disorder. At the time of our inspection there were 5 people using the service.

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

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.

Right Support: Overall the management of risks associated with people's care and support had improved. People had personalised strategies which provided guidance in the event they became distressed. However, care records did not reflect all staff fully understood or followed these strategies during incidents. Improvements had been made in the management of people's medicines. These had been reviewed to ensure prescribed medicines remained effective and appropriate.

We have made a recommendation that the provider ensures medicines are stored in accordance with National Institute for Care and Excellence (NICE) guidance.

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 this practice. People were supported by enough staff to meet their individual needs and to pursue hobbies and interests in their local community.

Right Care: Staff knew people well and used people's preferred communication methods effectively. Care plans had been updated to support staff to provide person-centred care. Staff had received additional training around people's health conditions and responses and interventions for people who experienced distress. The number and range of activities had increased since our last inspection, and people were going out more to places of interest.

Right Culture: Improvements had been made in provider oversight and governance systems. Our evidence identified that improvements needed more time to fully embed into working practices. The provider had learnt lessons from our previous inspection findings and been open about where things had gone wrong. A new manager had been appointed who was committed to supporting people to achieve the best possible outcomes from their care. Relatives and staff were positive about changes, including improved communication, consultation and encouraging innovation.

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

Rating at last inspection and update

The last rating for this service was inadequate (26 October 2022) and there were breaches of regulation. We served the provider a Warning Notice under Section 29 of the Health and Social Care Act 2008 and undertook additional enforcement action. The notice required the provider to become complaint with breaches relating to consent, safe care and treatment and governance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement

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.

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

Enforcement and recommendations

We have made a recommendation that the provider ensures medicines are stored in accordance with National Institute for Care and Excellence (NICE) guidance.

This service has been in Special Measures since 26 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Follow up

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.

Heathcotes (Glenfield) is a residential care home providing personal care to up to 6 people. The service provides support to younger adults with a sensory impairment, physical disability, mental health needs and/or a learning disability or autistic spectrum disorder. At the time of our inspection there were 6 people using the service.

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

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.

Right Support

The service did not give people care and support in a safe, clean or well-maintained environment that met their sensory needs. People’s risks associated with their health conditions were not met safely. Medicines systems and processes were unsafe. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People were supported to pursue some interests within the community when staff were available to accompany them. There were times when there were not enough staff available for people to go on outings.

Right Care

The service did not always have appropriately skilled and competent staff to meet people’s needs and keep them safe. People did not always receive care that was focused on their quality of life or followed best practice.

The staff knew individuals well and respected people’s rights and choices. Staff could identify people’s communication needs and explain these; however, they weren’t always well documented. Some care and support records contained out of date information, but staff were aware of the individuals needs.

Right Culture

The provider's quality assurance, governance systems and processes to monitor the quality and safety of the service failed to identify areas where improvements were required. This exposed people to the avoidable risk of harm and poor-quality care.

The staff knew and understood people well, however people’s wishes, needs and rights were not always at the centre of everything they did. People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

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 04 December 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s specific health care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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

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

Enforcement

We have identified breaches in relation to Deprivation of Liberty Safeguards (DoLS), risk management, infection control, medicines management, staff training and leadership and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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, if we do not propose to cancel the provider’s registration, 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.

The service is a detached house with garden. All bedrooms are single rooms with en-suite facilities. At the time of our inspection six people lived in the home.

The service was registered with the CQC prior to the CQC’s publication of ‘Registering the Right Support’ guidance for homes for people with learning disabilities and autism. However, the service provided at Heathcotes (Glenfield), was in-line with best practice identified in our publication.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. Six people lived at the home at the time of our inspection visit.

The service continued to be safe. Staff understood the risks to people’s health and wellbeing and took action to lessen each risk. There were enough staff on duty to meet people’s needs; and checks had been made on staff before working for the service to make sure they were safe to work with people. People received their medicines as prescribed. The home was clean and tidy and staff understood infection control practice. Premises were well-maintained.

The service continued to be effective. Staff received training to support them work effectively with people who lived at the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had access to different health and social care professionals when required, and good relationships had been formed between the service and those professionals. People received food they enjoyed, and were involved in menu planning.

The service continued to be caring. People received care from staff who were kind, treated them with dignity, and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. The service supported people to maintain and develop relationships with their family.

The service continued to be responsive. People’s needs were assessed and planned for with the involvement of the person. Care plans were very informative and helped staff understand the complexities of people’s care and support needs. People had opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure although no complaints had been made to the service since our last inspection. The provider worked to support people when they were near the end of their life.

The service continued to be well-led. The provider and registered manager worked hard to ensure a good quality of service was maintained. The registered manager provided good support to the staff group, and to people who lived at the home. Checks were made to ensure the service met its obligations to provide safe accommodation to people and to deliver care and support which met people’s individual needs.

The service provided accommodation for up to six people living with a learning disability and autistic spectrum disorder. There were six people using the service at the time of our inspection.

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 2008 and associated Regulations about how the service is run.

People felt safe at Heathcotes Glenfield. Staff understood and applied the provider’s policies and procedures to guide them on their responsibilities to keep people safe and to report any concerns they had regarding people’s safety.

There were enough staff on duty to keep people safe and meet their individual needs. The provider had a safe recruitment process to ensure that they employed staff who had the right skills and experience, and as far as possible were suited to supporting the people who use the service.

People received their medicines as prescribed. The provider had effective protocols for their safe management.

Staff had access to effective induction and training that equipped them with the skills they required to meet people’s needs.

People were not unlawfully deprived of their liberty. Staff sought people’s consent before they provided care and treatment. They supported people in accordance with the Mental Capacity Act 2005.

People nutritional needs were met. Staff provided the support people required to have timely access to health care services when they needed to.

Staff supported people in a caring and compassionate manner. They treated people with dignity and respect. They were knowledgeable about the needs of the people they supported and ensured that they were involved in decisions about their care where possible.

People’s care plans reflected their individual needs. Their care was provided in a person centred manner.

People had access to a variety of meaningful activities. They were supported to be part of the community.

The provider listened to feedback from people using the service, their relatives and staff and they acted on it.

Staff felt supported by the registered manager. They had easy access to the registered manager when they required guidance. The provider had effective procedures for monitoring and assessing the quality of service that people received.

Documents relating to the care and support people received contained detailed information about their preferred routines, likes, dislikes and specific needs. There was also information to explain how staff could communicate with people most effectively and we observed this in practice.

People were offered choices in relation to their food and drink. The provider had not completed any formal nutritional assessments to consider whether there were any specific risks associated with peoples' weight and diet.

Staff understood the potential risks to the safety and wellbeing of the people they supported and were clear that they would take action if they had any concerns about this.

There were a variety of communal spaces available to people and, overall, the home was clean, tidy and well maintained. Staff confirmed that any maintenance work was dealt with promptly.

There were sufficient numbers of staff available to provide the support people needed.

Information was available to explain how people could make complaints and opportunities to raise any concerns or complaints, if necessary.

We looked at support plans and these showed that people were assessed and plans were created to meet their needs in a way that maintained their safety. Staff told us that they were involved in maintaining plans and keeping them up to date.

People using the service were safeguarded from abuse by a staff group who understood their responsibilities and a manager who looked at ways of minimise risks for people using the service. We spoke with one person using the service and they told us they felt safe.

Medication records and storage were looked at and we saw that this was done in a thorough manner ensuring that people using the service were safe from risks associated with poor management of medication. Staff told us that only people who were trained and competent could administer medication.

We looked at recruitment procedures and saw that in some areas they were not robust enough to ensure that where a risk may be highlighted action was taken to minimise the risk. We discussed the issues with the manager who acknowledged the problem.

Records looked at during the inspection were up to date and fit for purpose ensuring that staff were able to do their job and people using the service were protected from risk.