Glover House

Glover House is a residential care home for eight younger adults and people who need support due to having learning adaptive needs/autism. It can also accommodate people who have physical and/sensory adaptive needs.

At the time of this inspection there were three people living in the service. All of these people had complex needs for support and one person used an individual form of sign-assisted language to express themselves.

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 live in 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 adaptive needs/or autism to live meaningful lives that include control, choice, and independence.

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

People's experience of using the service:

People and their relatives were positive about the service. A person said, “I’m good here and I’m happy here.” A relative said, "I think the staff at Glover House are excellent and so I never have to worry about my family member.”

People were safeguarded from the risk of abuse.

People received safe care, treatment and support in line with national guidance from support staff who had the knowledge and skills they needed.

There were enough support staff on duty and safe recruitment practices were in place.

People were supported to use medicines safely.

Lessons had been learnt when things had gone wrong.

People had been helped to receive medical attention when necessary.

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.

Some parts of the accommodation had not been well maintained.

Support staff were courteous and polite.

Confidential information was kept private.

People received person-centred care and they were supported to pursue their hobbies and interests.

There were robust arrangements to manage complaints.

There were arrangements to treat people with compassion at the end of their lives and to enable them to have a pain-free death.

People had been consulted about the development of the service and quality checks had been completed.

Good team work was promoted and regulatory requirements had been met.

Why we inspected:

This was a planned inspection based on the previous rating. At the inspection in May 2018 we found a breach of regulations. This was because one person had not been supported to use one of their medicines in a safe way. At this inspection in June 2019 we found that people were being supported to take medicines safely. This meant that the breach of regulations had been addressed.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

Glover House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Glover House is registered to accommodate care and support for up to eight people. At the time of the inspection there were two people at the service.

The service did not have a registered manager in post. A registered manager is a person who is 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.

The registered manager had left in March 2017. A new manager had been appointed and had started working at the service on 8 May 2018, two days before the inspection. They planned to register with the CQC as soon as possible.

At our last inspection in November 2017, the service was rated 'Inadequate’ in all domains. We asked the registered person to take action. We imposed a condition on the provider’s registration requiring them to undertake monthly audits of the service and send a monthly written report to the CQC regarding their findings.

The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made.

At our last inspection we found that the care service had not been developed and designed in line with the values that underpin 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 should live as ordinary a life as any citizen and this was not happening.

People with learning disabilities and autism living at Glover House were now beginning to get the support they needed to live as ordinary a life as any citizen. People were receiving the support they needed to have choice and control of their lives. People were being supported by staff in the least restrictive way possible; the policies and systems in the service were changing to an empowering, inclusive culture. Restrictions had been reviewed. Doors were now unlocked so people could access all areas of the service freely and when they wanted to. People could go into the garden when they wanted to.

On the whole people’s medicines were managed safely. People did receive their medicines when they needed them. However, during the inspection it was identified that a change in a person’s medicines had not been followed up in a timely manner and the amount of the medicine to be given was not accurate according to the prescriber’s instructions. This was identified before the person received an incorrect dose and immediate action was taken to resolve the issue.

The culture of staff was changing and staff were doing daily activities with people and not for them. Staff expectations of people’s potential ability had changed. People were getting more opportunities to achieve and develop. Staff had received extra training and had regular supervisions and this had impacted positively in equipping them for their roles.

At the previous inspection it was identified that people, and others, were at risk of harm as staff did not support them to manage their behaviours safely. At this inspection improvements had been made. Physical intervention had been assessed but would only be used as the last resort. Since the last inspection staff had not used any restrictive physical intervention as it had not been needed.

Some people had one to one or two to one support. Staff no longer invaded people’s personal space nor did they place themselves in doorways so people could not go in and out as they pleased. Staff now interacted with people a meaningful way, they sat on the floor with them doing puzzles, looking at pictures and choosing music. Risks were safely managed. People were supported and empowered to take risks and staff made sure that risks were minimised by having strategies and measures in place to allow people to develop and promote their independence. Staff now recognised, concerns or incidents or near misses. When things went wrong lessons were learnt.

Accidents and incidents were recorded and staff looked at ways to try and prevent their reoccurrence. The amount of accidents and incidents had reduced significantly since the last inspection. However, when some behavioural incidences had occurred they had not been fully analysed to look for trends and patterns and ways of reducing them. The new manager addressed this during the inspection.

At the last inspection the registered manager had not reported incidents to relevant authorities so they could be followed up or investigated. They had not informed the local safe guarding team of incidents of abuse. At this inspection no incidents had occurred that required reporting. Staff had received extra training in this area and now knew when to report to the relevant authorities. Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The deputy manager had submitted notifications in an appropriate and timely manner and in line with guidance

No new people had moved to Glover House since the last inspection. There were procedures in place to assess people before they moved to the service. Each person had a care plan. The new manager had plans to involve people more in planning their care. Care and support now reflected current evidence-based guidance, standards and best practice. Personal goals and aspirations had been identified but were not yet recorded in care plans to ensure people and staff knew what they were and could work towards them consistently. The principles of person centred care were now being used and staff had more understanding about what this meant. End of life care plans were being developed and this had been identified as a shortfall in the provider’s audits. Staff were working on these with input from relatives.

Staff had recently received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. They had a more in depth understanding about this legislation. Decisions were now made on people's behalf considering the least restrictive option. Best interest meetings were taking place when it was necessary.

Staff sought advice when people were unwell. People had the food and drink they liked and were now involved in food shopping and food preparation. Activities had improved and expanded. Peoples everyday life skills were developing including cooking, cleaning and shopping.

There was a complaints procedure and action had been taken to resolve complaints. People were supported to air their views and opinions. The complaints procedure was in a format that people could understand. People were more involved in developing the service. People, relatives and staff had recently been asked their opinions about the service using surveys. These had not yet been analysed.

There were enough staff available to support people Their skills and knowledge was improving to make sure people received the support and care that they needed. There were recruitment procedures in place and staff were recruited safely.

The building was fitted with fire detection and alarm systems. Regular checks were carried out on the fire alarms and other fire equipment to make sure it was working. The staff carried out regular environmental and health and safety checks to ensure that the environment was safe. The service was clean and well maintained. Staff understood about infection control and how to keep the risks of infection to a minimum.

The governance arrangements including the checks and audits had improved since the last inspection. Regular audits and checks were undertaken and if any shortfalls were identified then action was taken. The culture of the staff was changing. Staff were more positive and realised that people could do a lot more than they had previously expected. The provider now had oversight and input into what was happening at the service. They took timely action when shortfalls were identified. There had been improvements with developing relationships with other agencies like social services and specialist services that supported people with learning disabilities to improve their lives and achieve.

The provider had made the new manager fully aware of the shortfalls that had been identified previously. The new manger was enthusiastic and keen to take on their responsibilities to make sure improvements continued and were sustained. They had innovative ideas and plans about what they would do to make sure people received good care and support and live their lives to their full potential.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating at the service and on their website.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. The condition on the registration will remain. We will continue to monitor Glover House to check that improvements continue and are sustained.

We found one new breac

Glover House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Glover House is registered to accommodate care and support for up to eight people. At the time of the inspection there were three people at the service.

The service had a registered manager in post. A registered manager is a person who is 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.

The service had not 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 living at Glover House were not supported to live as ordinary a life as any citizen. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support an empowering, inclusive culture. Doors were kept locked so people could only access lounges and toilets and could not go outside into the garden freely. These restrictions had not been reviewed to check they were still needed.

There was a culture of staff being in control and staff ‘did for’ people rather than with them. Staff had low expectations of people’s potential to achieve and develop. Staff had received training and had supervisions but this had not been effective in equipping them for their roles.

People, and others, were at risk of harm as staff did not support them to manage their behaviours safely. Staff used restrictive physical intervention that had not been agreed to by people and those involved in their care. Physical intervention had not been assessed as necessary or as a last resort. Some people had one to one or two to one support and staff were in close proximity to people at all times. For most of the time staff did not engage or interact with people in a meaningful way they just followed them around. We did observe some meaningful interactions when staff sat with people and involved them in jigsaw puzzles or games. Risks were being managed by controlling and containing people rather than by empowering them. Staff did not recognise, concerns or incidents or near misses. When things went wrong lessons had not been learnt.

Accidents and incidents were not analysed to look for trends or ways of reducing them. There had been incidents when people had been harmed or were placed at risk of harm. The registered manager had not reported all of these incidents to relevant authorities so they could be followed up or investigated. They had not informed the local safe guarding team of incidents of abuse. Services that provide health and social care to people are required to inform CQC of important events that

happen in the service. CQC check that appropriate action had been taken. The registered manager had not submitted notifications in an appropriate and timely manner and in line with guidance

People’s needs were assessed before they moved into the service and each person had a care plan. Care plans were written for people and not with them or their family /representatives. Care and support did not always reflect current evidence-based guidance, standards and best practice. Personal goals and aspirations were not identified, recorded and supported; the principles of person centred care were not used and not understood. People did not have end of life plans in place.

Some staff lacked understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Decisions had been made on people's behalf without considering the least restrictive option and there was no record of any best interest meetings regarding these decisions.

Staff sought advice when people were unwell. People had the food and drink they liked but were not involved in food shopping or food preparation. Activities on offer were limited and staff did not have the skills to develop people’s everyday life skills including cooking, cleaning and shopping. People’s medicines were managed safely.

There was a complaints procedure and action had been taken to resolve complaints. However, people were not supported to air their views and opinions. The complaints procedure was not in a format that people could understand. People were not involved in developing the service. Relatives and staff had been asked their opinions about the service but no analysis or action had been taken as a result.

There were enough staff but they lacked the skills required to give good support. there were recruitment procedures in place. The building was fitted with fire detection and alarm systems. Regular checks were carried out on the fire alarms and other fire equipment to make sure it was working. The staff carried out regular environmental and health and safety checks to ensure that the environment was safe. The service was clean and well maintained. Staff understood about infection control and how to keep the risks of infection to a minimum.

The governance arrangements including the checks and audits had not picked up the range of issues found at the inspection. The culture of staff being in control had not been identified and so it continued. There was a lack of oversight of staff practice, incidents and accidents, staff were not observed and given feedback. Audits carried out some time ago had unmet actions.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating at the service and on their website

After the inspection the provider told us that they had employed a consultant to give them advice and that they had started to research providers of Positive Behaviour Support and Active Support training for staff.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of the report.

The service had a newly appointed registered manager in post. They had previously been the deputy manager of the service and had registered with The Commission in July 2016. 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 2008 and associated Regulations about how the service is run.

Some of the language used in people’s records was not dignified or respectful. The registered manager had identified this as an area which needed to improve and had booked some staff on to a report writing course.

Staffing was sufficient and flexible to meet people’s needs; staff had time to respond to people’s needs in an unrushed way. People were protected by the service using safe and robust recruitment processes.

There were safe processes for storing, administering and returning medicines. Medicines were administered by trained staff who were competency checked by the registered manager. Medicines were regularly audited to maintain good oversight.

Accidents and incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment.

The service was good at responding to people who needed help to manage their health needs. People were supported to access outside professionals and the service was adaptable when a person’s needs changed.

Staff received supervision and appraisal to support the development of their role and attended staff meetings to share knowledge and information.

Staff had appropriate training and experience to support people with their individual needs and demonstrated a good understanding of people.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make their own decisions and the Mental Capacity Act (MCA) 2005. The service ensured people’s rights were protected by meeting the requirements of the Act.

Staff demonstrated caring attitudes towards people and showed concern for people’s welfare. When people required to be supported with their anxieties staff did this in a patient and compassionate manner.

People had care plans which were detailed and informative. Care plans gave clear descriptive information which was easy to understand. Robust guidance was available for staff to follow to help support people manage their behaviours.

People were supported to take part in activities which were suitable for their individual needs and had the opportunity to discuss activities they wished to undertake in the future.

Staff said they felt well supported by the registered manger and were able to talk to them at any time. There were good processes in place to ensure people’s daily needs were met and important appointments or events were not missed.

People were encouraged to express their views and provide feedback so the service could continuously improve.

The provider strived to continually improve the service to improve the lives of the people. Quarterly internal audits were conducted by a senior manager to identify areas which were in need of improvement.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that the company had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, in order to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). One person had had a Deprivation of Liberty Safeguard authorisation put in place; and an application had been made on behalf of another person. This meant that vulnerable people were being protected and safeguarded.

We found that people's care plans included risk assessments, which were specific to the people concerned. The risk assessments showed that the staff had assessed all aspects of risk to people living in the home, and suitable action was in place to minimise the risks concerned.

We inspected medication management and found that robust procedures were in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as managing challenging behaviour and autism awareness. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

Is the service effective?

People living in the home had suitably detailed care plans which covered all aspects of their care and treatment. The people or their representatives had been fully involved in all aspects of their care planning so that the plans expressed their individual needs and goals for development.

We found that people living in the home were appropriately supported by health and social care professionals. This meant that people’s needs and wishes were planned for and developed in accordance with their individual progress.

Is the service caring?

We saw that staff were aware of people’s specific communication needs and knew how to interact with them. Some people had non-verbal communication, but staff were able to demonstrate that they understood what people were indicating with their individual signing skills. We saw that people smiled or showed agreement or disagreement with things that staff were saying to them.

We found that the staff treated people with respect and dignity and gave people time to express themselves in their own way. We asked one person with verbal communication skills if they liked living in the home, and if they thought that the staff looked after them well, and they responded “Yes, yes!” in reply to the questions.

The staff made provision for people to share their views about the home through individual key worker meetings with staff every week. We saw that action was taken in response to these meetings. This showed that the service sought to obtain people’s views and respond to them appropriately.

Is the service responsive?

We found that people were able to carry out activities in relation to their own interests and abilities. The activities were flexible according to their moods and behaviour each day, so that they fitted in appropriately with what people wanted and the support that they needed.

We saw that staff were constantly looking for new opportunities to suggest to people in the home, so that they could broaden their range of activities or work experience. Some people were being supported to develop skills which might enable them to move into more independent living in the future. This showed that the service responded to people’s individual development.

The service had documents which were provided in a suitable framework for each person. This included pictures, photographs and “widget” format, as well as plans and procedures in writing. We saw that the complaints procedure was provided in different formats so that people could show if they were unhappy or upset with any aspects of their care or treatment.

Is the service well-led?

The company and the manager had systems in place to provide ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, fire safety, staff training needs and medication management.

Staff said that they worked well together as a team and were supported by the management structure. We saw that they interacted well with each other as well as with the people living in the home. The manager and deputy manager provided daily support working alongside support staff, and on-call support when they were not on duty. This meant that support staff always had access to management staff to help them with any difficult situations or decision-making processes.

We saw that staff had individual support meetings with the manager or deputy each month, as well as monthly staff meetings.This meant that there were processes in place to support staff to share their views and concerns, and to identify any training needs.

These actions showed that there were reliable systems in place to provide oversight for the service, and effective leading by the management.

We saw that people's needs were reflected in their care plans and they and their representatives had been consulted about their preferences for how they liked to be supported and the things they liked to do.

We observed good interactions between people and staff and that staff provided a flexible and responsive approach towards people and the activities they were offered and chose to take part in each day.

Staff demonstrated they knew how to keep people safe and how to avoid any risks to their safety.

The provider had systems in place to check on the quality of the service provided at the home. These included asking people and their representatives, other professionals for their views.

People were able to make choices about their lives and things that were important to them. They chose when to get up and go to bed, what to do and what to eat and staff respected their choices.

People had been asked how they liked their care and support to be provided and were supported to learn and maintain independence skills. They chose how to spend their time at home and in the community. People helped with household tasks and to keep their rooms clean and tidy. A person said 'Staff help me with my money and to clean my room and bathroom'.

People were provided with opportunities to experience activities at home and in the community. They were engaged in activities they enjoyed during the inspection. One person said 'I like shopping, there are good shops in Ashford'.

People's health needs were met and the service worked with health and social care professionals when it needed to.

People's rooms were personalised, they had chosen the colour schemes and rooms reflected people's personalities.

Staff understood people's needs and had the training they needed for their roles. People were comfortable in the presence of staff and happy to approach them to ask about anything. A person told us 'Staff are ok '.

The provider made regular checks of the service to make sure it was safe for people.