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Glen Pat Homes Requires improvement

Reports


Inspection carried out on 13 February 2020

During a routine inspection

About the service

Glen Pat Homes is a residential care home providing personal care to seven people at the time of the inspection and a supported living service providing personal care and support to nine people.

The care home is in Winchmore Hill, North London and the supported living service is a block of nine flats in East London.

The care home and supported living service are for people who have a learning disability or autistic spectrum condition and/or mental illness. Some people also had a hearing impairment. In the supported living service, not everyone using the service receives personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Risks to people’s health and safety were not always properly assessed and acted on. There was a lack of knowledge and guidance provided to staff about people’s serious health conditions and how these might impact on them. This left people at risk of their health needs not met due to a lack of clear information.

The service didn’t consistently apply 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 did not fully reflect the principles and values of Registering the Right Support in the care home as people went out as a group daily according to a timetable and there were limited opportunities for people to go out on their own to follow their interests with staff support. We have made a recommendation that the service follows best practice guidance in accordance with Registering the Right Support principles and person centred care planning.

People in the supported living service received care and support with a more person centred approach which enabled them to become more independent and follow their individual interests. The service supported them to access specialist support where they needed it and to follow their goals.

People said they were happy in the service and thought that the registered manager and staff were caring and supportive. People had good relationships with staff. Staff said they felt well supported in their work.

The environment was safe.

There was mixed feedback from relatives and professionals involved with people living at the service. The majority made positive comments about the home, staff and quality of care provided and said people were happy and settled, while some said they felt the service did not always follow best practices in person centred care in the care home.

The registered manager and provider showed a commitment to continuous improvement and acted on our concerns after the inspection.

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 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulations in relation to looking after people’s health, medicines and risks to their safety at this inspection. There was also a breach of regulation due to a lack of regular management audits to ensure any risks were addressed.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 3 July 2017

During a routine inspection

Glen Pat Homes is a care service which has been registered to provide both accommodation and personal care for a maximum of seven people who have a learning disability in a care home setting. The service is also registered to provide personal care to people in their own homes at a supported living scheme. At this inspection there were seven people living in the care home and nine people receiving personal care in their own homes at the supported living scheme.

At the previous inspection on 12 and 13 March 2015 the service was rated as good. We had made one recommendation regarding clarity of financial agreements where the service assisted people to manage their finances and this recommendation had been acted upon.

At this inspection we found the service remained Good.

There was a registered manager in place at the time of the inspection. 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 were kept safe from harm. The service had policies, procedures and guidance for staff about how to do this and staff we spoke with knew how to respond if anyone was at risk of harm. Risks to people were assessed and responded to. Anyone that required help to take their medicines received this help in a safe way and medicines were safely managed. The provider operated effective staff recruitment procedures to ensure that staff were safe to work with the people using the service.

The CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes and supported accommodation. Staff were knowledgeable regarding the Mental Capacity Act 2005 [MCA] and DoLS. Staff supported people 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 also supported this practice.

Staff were well trained and had completed an induction programme before starting at the service. Staff were also supported through supervision and appraisals.

People received on-going healthcare support from their local GP’s and the service maintained good links with health and social care professionals who were also involved with people’s care and support.

People’s dignity and privacy was maintained and staff knew how people preferred to be supported. Staff promoted people’s independence and encouraged people to do as much for themselves as possible. No unnecessary restrictions were placed on people and deprivation of liberty decisions were applied as required by law. People using the service were given information on how to make a complaint and people were supported to access advocacy services if this was required.

The registered manager, and provider, carried out regular audits of the service and used these as a means of maintaining high quality care. Any action that was required to maintain a good quality of the service provided was taken. There was open and transparent communication and people’s views about the service were obtained in the most appropriate way as well as the views of relatives and professionals that had contact with the service.

Further information is in the detailed findings below.

Inspection carried out on 12 and 13 March 2015

During a routine inspection

This inspection took place on 12 and 13 March 2015 and was unannounced. Glen Pat Homes is a care service which has been registered to provide both accommodation and personal care to a maximum of seven people who have learning disabilities in their care home at10 Elm Park Road, Winchmore Hill, London, N21 2HN and also personal care to people in their own homes. At this inspection there were 5 people living in their care home. There were 2 people receiving personal care in their own homes.

At our last inspection on 29 and 30 September 2014 the service did not meet Regulations 12, 14, 15 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found that these regulations had been met.

The home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

We spoke with four people who used the service. However, people using the service had complex needs and were not able to share all their experiences of using the service with us. People gave us short replies, they nodded and smiled in response when we spoke with them. We also gathered evidence of people’s experiences of the service by observing their interaction with staff. We spoke with four relatives of people who used the service and received feedback from four health and social care professionals. We spoke with five care staff, the deputy manager and the nominated individual who is also a director of the company and who regularly visits the home to discuss progress and check on the welfare of people and staff. The registered manager was on holiday when we visited.

We saw staff going about their duties in a calm and orderly manner. They interacted well and in a friendly manner with people. Staff checked to ensure that people were safe and their needs were met. Staff treated people with respect and dignity.

People received care which met their needs. They had been carefully assessed and detailed care plans were prepared with the involvement of people and their representatives. Their physical and mental health needs were closely monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs. There were suitable arrangements for the recording, storage, administration and disposal of medicines in the home.

Staff had been carefully recruited and provided with essential training to enable them to care effectively for people. They demonstrated a good understanding of the needs of people. Regular supervision and annual appraisals had been carried out.

The service had a safeguarding and whistleblowing policies. Staff had received training and knew how to recognise and report any concerns or allegation of abuse. People informed us that they felt safe in the home. However, we found that there was no written agreement with people, their representatives or commissioners of services for certain items of expenditure charged to people who used the service. This is needed for the protection of people’s finances. We have made a recommendation regarding the protection of people’s finances.

Staff had assessed people’s preferences and their daily routine and arrangements were in place to ensure that these were responded to. The home had weekly residents’ meetings where people were encouraged to express their views about the service and make suggestions regarding their weekly schedule. People could participate in a range of activities they liked and these included shopping, going to the gymnasium and doing household tasks.

The CQC monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes and supported accommodation. The nominated individual and deputy manager were knowledgeable regarding the Mental Capacity Act 2005 (MCA) and the DoLS. The deputy manager and the nominated individual were aware of the procedure to follow if people’s freedom needed to be restricted to ensure their safety.

The service had a positive culture. The quality of the care provided had been monitored. Regular checks and audits of various aspects of the care provided in the home had been carried out by the registered manager and the nominated individual. There was evidence that relatives had been consulted and kept informed of progress via weekly telephone calls. No satisfaction survey had been carried out in the past twelve months. These are needed to ensure that the quality of the care provided was closely monitored. The nominated individual stated that a satisfaction survey would be carried out soon after the registered manager returned from his holidays.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Inspection carried out on 29, 30 September 2014

During an inspection looking at part of the service

One inspector carried out this responsive inspection. The purpose of this inspection was to check whether people living in the care home at 10 Elm Park Road were protected against the risks of inadequate nutrition and dehydration following a complaint received by us regarding the quality of food for people who used the service. We also checked on concerns expressed regarding the maintenance of the premises and the management and support provided for staff.

We spoke with three people who used the service. However, communications problems were experienced and we were not able to obtain confirmation regarding their views of the services provided. We spoke with three relatives of people who used the service and two health and social care professionals.

We observed that people who used the service were able to move about freely within the home and staff were constantly supervising and interacting with them. The fridge and freezer had been stocked with food. However, there was a lack of snacks. Nutrition assessments had been carried out. However, the recording of meals provided and eaten was not always completed. There was uncertainty as to whether special meals which met people�s religious and cultural needs had been provided as there was a lack of supporting documentation. Significant weight loss recorded in a person�s record had not been followed up.

The home had a record of maintenance and essential inspections of the electrical installation and boiler. However, the premises were poorly maintained and paintwork had peeled off in several parts of the building. Fire alarm tests had not always been carried out prior to the arrival of the new manager. Two bedroom windows did not have restrictors for the protection of people. The manager stated that arrangements will be made for them to be fitted.

Staff had been provided with training in infection control and disposable gloves and aprons were available for them. The home had a cleaning schedule which was checked by the manager. The registered provider may wish to note that curtains in two bedrooms were dirty and the wire netting over a kitchen window was dirty. Clinical waste bins were not available in the home.

Two relatives spoke well of staff and stated that staff were capable. The third relative expressed some concern regarding the services provided. Staff meetings had been arranged and guidance had been given to staff on improving the care provided to people. We however, noted that some staff were dissatisfied with their working arrangements and support received from management and other staff. Regular supervision and annual appraisals had not been carried out.

Inspection carried out on 12 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that there were good arrangements for making sure that the home and the people who lived there were safe. Care was provided in an environment that was safe, accessible, clean and adequately maintained. We saw records that showed the service regularly checked facilities and equipment to ensure they were safe. This included annual checks of the gas and electrics appliances.

People�s health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We checked people�s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We spoke with people who lived at the home. People told us they felt safe living at the home.

We saw that the home had appropriate safeguarding procedures in place. These were detailed and fit for purpose. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults. We spoke to staff and they demonstrated that they understood their role in safeguarding people and knew what action to take should it be necessary to do so.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

When people were referred to the service, details of their care needs, medical history, communications needs and likes and dislikes were detailed in the referral forms. The service carried out an assessment of people�s care needs and the care plans we saw met the needs identified in referral forms and assessments. We saw detailed, individualised plans for people in the records we read. One staff member told us �I know people well, care is delivered around their needs.� This meant the service was meeting the identified needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us from our observations and time spent talking with people, that staff were attentive, patient and caring with the people they were supporting. Staff treated people with respect and dignity. People commented that the staff were �good� and that staff were �caring and friendly.�

Is the service responsive?

There were suitable arrangements for making sure that people could express their views about the service. The records we read showed people were supported in promoting their independence and had regular opportunities to discuss and influence matters that were important to them during resident�s meetings. This included consultation about their views on things such as activities, meals and the home environment.

We found that care staff had regular meetings where they were able to discuss their training, development and welfare needs.

Is the service well-led

The staff we spoke with were aware of the aims and objectives of the service and had a good understanding of the quality assurance processes that were in place. We saw that people were regularly asked what they thought about the service and the registered manager took action to resolve any issues. We saw that the senior managers of the service regularly met to look at the performance of the service to identify areas for improvement.

Inspection carried out on 17 June 2013

During a routine inspection

We saw that staff understood the needs of people who use the services. People received the care and support they needed. We talked to staff and looked at the storage and record keeping of medication. Staff were able to explain how they administered medication to people safely. Appropriate arrangements were in place in relation to the recording of medicines.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form and interviews.References were taken up from their former employers. We saw that staff knew how to support people. The staff training matrix showed that staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene. Staff received appropriate professional development.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Relatives and professionals had also been consulted about how the service was performing. People�s suggestions would be used as the basis to improve the care provided by the home.

Inspection carried out on 12 November 2012

During a routine inspection

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with them, by using pictures, sign language and symbols. We saw that staff understood people�s needs. People were treated respectfully and spoken to in an appropriate manner. They could share their concerns with the staff.

We saw that the sitting-room had new furniture and a carpet. People had been involved in choosing the new furniture and carpet for the sitting-room. Staff told us that staffing had been increased at weekends. They said this meant they were able to support people to participate in activities over the weekend. Staff were available in sufficient numbers to meet people's needs.

We saw that staff knew how to support people. Staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene. Staff said that they had been supervised and supported in their work with people. People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.

Inspection carried out on 26 September 2011

During an inspection in response to concerns

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with them. People were treated well by staff. We saw that staff understood their needs. Staff spoke to people in a manner that showed respect. Staff made sure that people were safe. We saw that staff understood peoples� needs. Staff knew how to support them.

We saw that the carpet in the sitting room was worn and stained. The furniture was also worn. The television was to small given the size of the sitting room. This made it difficult for people to see the television when sitting at the end of the room. We looked at the en suite facilities in a number of bedrooms. We found that the paintwork was chipped and worn. The flooring was not smooth and could present a trip risk in some of the en suite toilets.

Reports under our old system of regulation (including those from before CQC was created)