Glenthorne Court

Glenthorne Court is a residential care home providing personal care to seven people at the time of the inspection. The service specialises in care provision for younger and older adults with a learning disability or mental health issues.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. The service can support up to eight people all living in their own flats in one large adapted building. There were also communal areas including a large lounge and rear garden. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design. There were deliberately no identifying signs outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People’s medicines were ordered, stored and disposed of safely. Medicine records were completed correctly. People were encouraged to take positive risks and risk assessments were in place to minimise the risk of avoidable harm.

People were supported by well trained staff. Staff supported people to eat and drink enough to keep them healthy. When people required access to health care this was arranged to ensure the best outcome for the person’s wellbeing. The service had recently been renovated and decorated and there were now improved lounge areas for people to use.

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.

Care was delivered with dignity and respect. People liked the staff who supported them and were happy with the care and support they received.

People’s support plans contained detailed information to ensure their individual needs and preferences had been considered. They were reviewed regularly to reflect any changes. People were involved in a variety of activities that reflected their own hobbies and interests. They went out individually whenever they wished to and regular group outings were also arranged. There was a procedure in place for addressing complaints and this was correctly followed.

An effective system of checks and audits was in place. People and staff were regularly consulted about the quality of the service.

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.

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 requires improvement (published June 2018). 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 rating.

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.

Glenthorne Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides support and accommodation for up to eight people living with a mental health condition and / or learning disability. The service is based in a house which has been adapted into eight individual flats over three floors with a small communal area on one floor. The building was located in a residential area of Norton within its own grounds. It had on-site parking and was close to local amenities. At the time of our inspection there were eight people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our previous inspection in July 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach of Regulation 12 Safe care and treatment, as risks to the health and safety of people, the building and outside areas were identified during inspection. Water temperatures were outside of safe limits which increased the risk of injury from scalds. Staff had failed to report these risks and ensure appropriate action was taken. There was also a breach of Regulation 17 Good governance. This related to record keeping, a lack of meetings for people using the service and quality assurance processes which had not identified the concerns with the premises or records which we identified during inspection.

Following the inspection we issued requirement notices for these two breaches. The provider sent us an action plan detailing how they would become compliant with the regulations. At this inspection we found the provider had made improvements in some areas. The building was secure, the grounds were safe and repairs identified as required had been undertaken. There was however a continued breach of Regulation 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk assessments, water temperatures and medicines management. You can see what action we asked the provider to take at the back of the full version of this report.

Since the last inspection some improvements had been made in auditing processes. Care plans were regularly reviewed. Care plan records were comprehensive and did not have the gaps in them we identified at the last inspection. Meetings for people had not previously been taking place, however during this inspection we found that they were taking place regularly. Minutes of staff meetings that were missing at the last inspection were made available to us on this inspection. There was however a continued breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the governance arrangements in place had not identified the issues we found during this inspection with medicine recordings and risk assessment. You can see what action we asked the provider to take at the back of the full version of this report.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Policies and procedures were in place to protect people from harm such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

People and relatives told us there were suitable numbers of staff on duty to ensure people’s needs were met. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with people.

The environment was maintained however some areas required redecoration. Records showed that maintenance and equipment checks were undertaken to help ensure the environment was safe. During the inspection we identified a risk to people in regards to hot water temperatures. Emergency contingency plans were in place. Infection control practices were followed.

General risk assessments and care plans were in place and had been reviewed regularly however we saw that not all risks to individuals had been recorded.

Staff received training to be able to carry out their role including in areas such as health and safety, food safety and people movement. Staff had regular supervision and annual appraisals. Staff felt they were well supported by the registered manager.

Medicines were administered safely however we saw that there were some omissions in medication records. People had access to a range of healthcare such as GPs, hospital departments and dentists. People’s nutritional needs were met.

The registered manager told us that lessons were learnt when they reviewed accidents and incidents to determine any themes or trends.

Independence was actively promoted. 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.

Care was planned and delivered in way that responded to people’s assessed needs and preferences. People were supported by a regular team of staff who were knowledgeable about their likes, dislikes and preferences. Interactions between people and staff showed that staff knew the people they were supporting very well.

Staff members were kind and caring towards those who used the service. People’s privacy, dignity and independence were respected. The policies and practices of the home helped to ensure that everyone was treated equally. Staff encouraged people to access to a range of activities and to maintain personal relationships. Visitors were made welcome. The service had good links with the local community.

Staff were very positive about the registered manager. They confirmed they felt supported and were able to raise concerns. We observed that the registered manager was visible in the service and found people and staff interacted with them in an open manner. Provider audits covered areas such as premises, complaints, and recordings. The registered manager audited a range of areas however the issues we identified in regards to risk assessment and medicines recordings during this inspection were not identified through these processes.

A clear complaints process was in place. Meetings for staff and people using the service were held regularly. This enabled people to be involved in decisions about how the service was run. The service worked with a range of health and social care professionals to ensure individual needs were being met.

Glenthorne Court is registered to provide support and accommodation for up to eight people living with a mental health condition and / or learning disability. The service is a house which has been adapted into eight individual flats over three floors with a small communal area on one floor. The service was located in a residential area of Norton within its own grounds and had on-site parking. The service was located close to local amenities and a short distance from local amenities.

At the time of inspection there were four people using the service who were supported by a deputy manager and five care staff.

The registered manager had been registered with the Commission since November 2015, however they were not based at the service. They told us they visited the service each week. 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.

During inspection we identified a number of risks to the safety of people and staff. These included risks to the security of the building, hazards to personal safety, rubbish and failure to carry out repairs needed to one person’s flat in a timely manner. Water temperatures were noted to be outside of safe temperature limits. Staff had failed to report and act upon these risks. Health and safety audits had not highlighted any of these risks.

Care plans were in place however lacked the detail needed. Care plans were also in place where no care needs had been identified. Care plan reviews did not show if people had been involved in them or what they had said.

There were gaps in care records and records relating to the day running of the service. This meant information needed was not always available. These gaps had not been identified within quality assurance checks by the registered manager and registered provider.

Quality assurance processes required improvement. The concerns which we had identified during inspection had not been identified during quality assurance checks. No quality assurance checks had been carried out in relation to care plans or records.

No meetings for people had been carried out since the service opened. This meant we could not be sure if appropriate information was shared with people. Staff meetings were carried out each month, however minutes were not available for all meetings.

The registered manager had failed to notify the Commission about an incident at the service where contact with police was made. The deputy manager told us this was because of confusion about when notifications needed to be made.

Staff told us they enjoyed working at the service and felt supported by the deputy manager who was based at the service. A registered manager was in post, however not based at the service but staff felt able to approach them if needed. Staff told us the registered manager did visit the service.

The registered manager was responsible for providing information about safeguarding, accidents and incidents and outcomes of audits with the registered provider regularly.

No complaints had been made at the service, however everyone we spoke with told us they knew how to make a complaint and felt confident that this would be taken seriously.

People told us they received their medicines when they needed them. Some people were given assistance with their medicines and some people managed their own medicines. Records were in place to support this. Staff had received training in medicines; however no competency checks had been carried out.

Topical creams intended for use as ‘homely remedies’ did not contain dates of opening. We asked the deputy manager to take action to ensure that topical creams are only used by the same person and not for communal use. Also, ‘As and when’ medicine protocols were not in place for everyone who needed them.

Staff spoken to during inspection understood the procedures which they needed to follow to raise a safeguarding alert if they felt a person using the service was at risk of abuse. All staff told us they wouldn’t hesitate to whistle blow [tell someone] if they needed to.

Risk assessments were in place for the day to day running of the service. People had risk assessments in place specific to their individual needs. Risk assessments had been reviewed, however had not always been signed by the people and staff involved in them.

Thorough recruitment procedures were in place and all appropriate documentation was in place to support this. Staff only started working at the service when they had obtained two check references and a disclosure and barring services check.

People and staff told us there were enough staff on duty to provide care and support. People told us staff were always available when they needed them.

Staff participated in mandatory training such as fire safety, infection prevention and control and health and safety. Some staff had also participated in person specific training such as autism, epilepsy and diabetes. Not all training was up to date for all staff; we asked the deputy manager to take action to address this.

Staff received regular supervision and told us they felt supported in their roles. We identified that pre-populated supervision records were in place which provided little evidence of the discussions which had taken place or the actions which had arisen.

Staff supported people to make healthy choices in their diet and assisted people to plan menus and shop for food. We found support was flexible to meet people’s changing needs. Staff understood the action they needed to follow if people became at risk of dehydration or malnutrition.

People had regular involvement with the health and social care professionals in their care. The service maintained good links with these professionals.

No-one using the service was subject to a deprivation of liberties safeguard; however staff understood the procedure which they needed to follow if they suspected a person may not be able to make their own decisions.

People told us they were happy living at the service and felt cared for by staff. People told us staff were always there for them when they needed assistance.

People told us they were involved in making decisions about their own care, however this was not always clear from the care records.

Privacy and dignity was respected and maintained. People told us staff knocked on their doors and waited until they answered them. Staff told us they ensure identification badges were not visible when they went into the community with people to make sure their privacy was protected.

People were supported to access the local community and to keep in contact with the people important to them.

We found two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and records. You can see what action we told the provider to take at the back of the full version of this report.