Glebe Villa

Glebe Villa is a residential care home providing accommodation and personal care for up to seven people with a learning disability. At the time of this inspection there were six people in residence.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Improvements had been made to enable people to have maximum choice and control of their lives and how staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

At the last inspection the service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture. This had improved since the last inspection. Staff had received some training since the last inspection including the use of restraint and safeguarding. Further training was needed such as supporting people with learning disabilities and dementia.

Improvements had been made to the records kept in the home including incidents, accidents and the use of restraint. The use of restraint had significantly reduced since the last inspection with staff using a more person-centred approach.

People had access to health care professionals. Improvements had been made to the records relating to healthcare with everyone now having their own individual health record. This meant staff could easily monitor and review each person and people’s confidentiality was maintained.

Right Care

People and their relatives said they were happy with the care and support. People had personalised their bedrooms. People were now supported to go shopping, to the local hairdressers and other places of interest. People told us they were planning holidays for next year.

People were still not being protected by the provider's recruitment process because staff had not had the right checks completed in respect of a Disclosure and Barring Check. Assurances were provided that this would be completed immediately.

Right culture

Improvements had been made since the last inspection.

People were now being supported in a way that enabled them to have choice and control in their daily lives. The routine of the home seen at the last inspection that was potentially having a negative impact on people was being addressed. Activities people wanted to take part in, and the structure of the day was being reviewed. House meetings had been reintroduced so people could have influence on how they received support and the running of the home.

People's aspirations and goals were being explored to ensure they were living the life they wanted to. This work was still ongoing and needed to be embedded and sustained.

Improvements had been made to ensure the provider had oversight of the service with improved checks being put in place. This work was ongoing with a newly appointed operations manager.

Systems had been reintroduced to monitor and make improvements to the service. These needed to be fully embedded and sustained. Areas identified at the last inspection had been addressed in respect of safety, such as radiator covers and door guards.

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 (published 23 August 2022)

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 some improvements had been made and the provider was no longer in breach of regulations in respect of good governance, safeguarding, treating people with dignity and respect, staffing numbers and safe care and treatment. The provider remains in breach of regulations in relation to safe recruitment and staff training.

This service has been in Special Measures since 23 August 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.

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 and the warning notices that were served in respect of dignity and respect and good governance. This report only covers our findings in relation to the key questions safe, effective, caring 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 from inadequate to requires improvement. This is based on the findings at this inspection.

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 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 Glebe Villa on our website at www.cqc.org.uk.

Enforcement and Recommendations

The provider remains in breach of regulations found at the last inspection. These relate to the recruitment of staff, staff training and the provider's governance arrangements.

We have recommended the registered manager and the provider improve their knowledge and understanding of regulatory requirements to help them have a better understanding of managing and operating a care home and help drive improvements.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Glebe Villa is a residential care home providing accommodation and personal care for up to seven people with a learning disability. At the time of this inspection there were six people in residence.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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 and in their best interests; the policies and systems in the service did not support this practice. The service was not always able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.

Right Support

People’s needs had not been fully assessed before they had moved to Glebe Villa. Staff had not received training to support people with a diagnosis of mental health, or dementia. One person was being physically restrained when receiving personal care involving three staff, staff had not received training in the use of restraint. There was a lack of records detailing when and why the person needed this level of support or any debriefs for staff.

People had access to health care professionals, but records of appointments were poorly recorded. There was no individual record maintained as staff recorded all health information in one central book for everyone living at Glebe Villa.

Right Care

People and their relatives said they were happy with the care and support. People had personalised their bedrooms. People said they enjoyed attending the social groups and attended these at set times throughout the week.

People were not being protected by the provider’s recruitment process because not all checks had been completed before staff started working with people.

Staff were not always caring and spoke about people in front of others in a derogatory way. There were many examples where the structure of the home did not encourage people to have choice and control over their lives. People did not receive kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity.

Right culture

Not everyone was being supported in a way that enabled them to have choice and control in their daily lives. The routine of the home was potentially having a negative impact on people especially two people who were the most recent admissions to the home. People all ate and had drinks at the same time every day. Each person attended the same activities. People’s aspirations and goals were not explored to ensure they were living the life they wanted to.

There was a lack of oversight from provider and the registered manager regarding quality assurance within the service. Risks to people's health were not always identified. Risks relating to the environment had not been mitigated to keep people safe. The registered manager had not consistently submitted notifications to the Care Quality Commission or made referral to the local authority in respect of safeguarding concerns.

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 good (20 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about another home operated by the same registered provider. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring 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.

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 from good to inadequate based on the findings of this inspection.

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 Glebe Villa on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to ensuring people are safe in respect of safeguarding and the use of restraint, managing risks, staffing levels and training, people being treated in dignified and respectful manner, governance and the culture of the home.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

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.

We found the following examples of good practice.

We saw the communal areas of the home but did not go into any of the bedrooms. This was because we wanted to keep our movements in the home to a minimum, complying with the provider’s visitor’s policy.

The parts of the home we saw were clean and tidy. The care team maintained the cleanliness of the home but since the pandemic started had increased the frequency of cleaning. Three times a day they cleaned and sanitised the areas where people were in the home, paying attention to all touch-points. The registered manager monitored work practice and checked on cleanliness and staff compliance with wearing personal protective equipment (PPE).

Staff entered the home via the front door already wearing a face mask. A hand sanitising dispenser was sited on the wall in the hallway. GPs, community- based nurses or other allied health care professionals with a recent negative COVID-19 test also entered the home the same way. All visitors had to pre-book their visit, had to wear a facemask and complete the health questionnaire. They were not allowed to enter the home until a negative result from a lateral flow test was known.

The service had completed a visitor’s risk assessment, and this included the procedure for arranging visits, the infection prevention and control procedures that were in place, and the testing process. The risk assessment stated the safety of the people who lived in Glebe Villa was at the heart of their care.

Staff socially distanced from their colleagues and people as much as they were able. The furniture in the lounge area had been spaced apart as much as the room allowed. However, this room was being used more often now because people were not going out for social activities. The seven people have lived together for many years as a family.

To support people to maintain contact with family and friends, the care team assisted people to have telephone calls or video calls so they could keep in touch. Activities away from the home had been restricted since the beginning of the pandemic but people were assisted to go out for a walk during quieter times of the day.

The home does not have any vacancies and therefore will not be admitting any new people to their service. One person had spent a period of time in hospital but only returned home after negative COVID-19 test and then had to isolate in their bedroom for a 14 day period.

The care team had all completed their mandatory online infection prevention and control training. Additional training had been arranged on the correct procedures for donning and doffing PPE. The registered manager demonstrated to the care staff during team meetings these correct procedures. The care team were regularly tested for COVID-19: once a week with the full laboratory test (known as a PCR test) and twice a week with a lateral flow test. The people who live in Glebe Villa were tested each month however if were symptomatic they would be re-tested and isolated until test results known.

Those people registered with one GP practice had already received their first dose of the COVID-19 vaccine and the registered manager was in discussion with the seventh person’s GP practice. Most of the care team had also already received their first dose.

The service have been able to keep COVID-19 out of the home. The service had updated all their infection prevention and control policies and procedures. They have a COVID-19 management plan in place should there be any outbreak of infection with the aim of preventing further spread of infection. The registered manager and provider had regular contact with community health service, the local authority COVID team and kept abreast of any changes in policy provided by Public Health England, CQC and the Department of Health and Social Care.

Glebe Villa provides accommodation, for seven people. People who live at the home have a learning disability. There were six people living in the home at the time of the inspection. Glebe Villa was in a residential area of Bristol, close to shops and other local amenities.

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

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Requires Improvement. This was because some improvements were required to ensure the service was effective and well led. The registered manager was to seek support and training, about current legislation in respect to the Health and Social Care Act 2008 Regulations 2014. This was because the registered manager and the provider were still working with the previous legislation. Many of the policies and procedures required updating. The induction of new staff was not meeting the current standards as set down

by Skills for Care with staff completing the Care Certificate. Action had been taken to address these shortfalls and improvements made with the service now being rated overall as Good.

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. People were care for taking into consideration these principles.

People were supported to lead the life they wanted including accessing social activities based on their interests and hobbies. There was a relaxed and friendly atmosphere. People were treated with kindness by staff who knew them well.

Systems were in place to ensure people were safe including risk management, and safe recruitment processes. People received their medicines safely. Sufficient staff supported people and this had been kept under review.

People were protected from the risk of abuse because there were procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures.

People were involved in making decisions about their care. People had a care plan that clearly described how they wanted to be supported. The service was introducing a new electronic system of recording to capture how people were supported.

People had opportunities to take part in activities in both the home and the local community. Other health and social care professionals were involved in the care of the people living at Glebe Villa.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. Appropriate applications had been made in respect of deprivation of liberty safeguards.

People were provided with a safe, effective, caring and responsive service that was well led. The registered provider was aware of the importance of reviewing the quality of the service. This included seeking the views of the people they supported.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good. We found during this inspection, some improvements were required to ensure the service was effective and well led. The registered manager must seek support and training, about current legislation in respect to the Health and Social Care Act 2008 Regulations 2014. This was because the registered manager and the provider were still working with the previous legislation. Many of the policies and procedures required updating. The induction of new staff was not meeting the current standards as set down by Skills for Care with staff completing the Care Certificate.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Glebe Villa. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals.

The home continued to provide a caring service to people. People, or their representatives, were involved in making decisions about the care and support they received. Staff were knowledgeable about the people they supported. People were treated with kindness and there was a happy atmosphere in the home.

The service remained responsive to people's individual needs. Care and support was personalised to each person. People were assisted to take part in a variety of activities and trips out.

A relative and staff spoke positively about the commitment of the registered manager. They told us the registered manager was open and approachable. The registered manager and provider had monitoring systems in place. However, these would benefit from a review to ensure they are in line with the Health and Social Care Act 2008 Regulations 2014 and the key lines of enquiry. This would enable the provider to check whether people were receiving safe, effective, caring and responsive service, which was well led.

We found there were one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full copy of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people using the service, the staff supporting them and from looking at records.

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

Is the service safe

People told us they were 'happy' and they were 'safe'. People appeared relaxed and comfortable in the presence of staff. We saw that people were supported safely by staff in line with the risk assessments and individual capability while staff took them out for community activities.

The complaints procedure was accessible to people on the notice board and in the care files and was written in a picture format. This made it easier for the people who lived at the home to understand and to make a complaint in the way they knew how to. We saw from the records that there had been no complaints or incidents since the last inspection.

A safeguarding and whistle blowing policies and procedure were both in place. We were told that these policies and procedures would be followed if concerns were identified about a person's safety. This included contact details for reporting any suspected incidents of abuse and individual staff responsibilities. Staff training records confirmed that all staff had been trained in safeguarding vulnerable adults from abuse

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The home also had policies and procedures for mental capacity act, deprivation of liberty safeguards (DoLS). This was to ensure that people who were unable to make their own decisions were protected from harm or abuse. Records showed that three of five staff members have not had the training and the mental capacity act and DoLS. The manager told us that the online training for the three staff had been booked for 22 April 2014.

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Is the service effective?

People who used the service were encouraged to make choices in all aspects of their care, how they liked to spend their time and how they liked to be supported. This was documented in people's files.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans reflected their current needs.

Supervision processes were in place to enable staff to raise any future training needs and to discuss any concerns with the care of the people who used the service. This demonstrated that staff received support to provide care for the people who used the service.

The home had flexible routines to suit the needs of the people who used the service. People were involved with the running of the home and assisted with cooking meals, setting the tables at meals times and participating in the

house work rota.

Is the service caring?

People were supported by kind and attentive staff. During our inspection we observed that staff provided support and engaged with people positive way. For example we saw a member of staff explained to one person where they were going out for lunch and what time. People were relaxed and comfortable in the presence of staff and an individual told us they were "happy".

People's care plans indicated how they liked to be addressed and their preference for a male or female to assist them with their personal care. This demonstrated that people's privacy and dignity was respected.

Is the service responsive?

Individual's records had details of the other people involved in their care, for example their care coordinators, dentist and general practitioner. Any visits by or to healthcare professionals were recorded to show how the person's healthcare needs were being met.

People had a programme of activities which involved them participating in community activities. These included attending day centres, clubs and day trips. One person told us they had been on holiday to Blackpool with the other people from the home. The person told us 'I really enjoyed it and I am looking to going to Brighton in summer'.

Is the service well-led?

The service had a quality assurance system to make sure that people were provided with high quality care. The record we saw included surveys that enabled people to indicate how satisfied they were with the services provided. We saw that people were complementary about the home.

The home also had suggestion form for comments from families and representatives in relation to the home in general, services provided and care provided for the people who used the service. The comments we saw were all positive. Some of the comments included 'Glebe Villa is a very clean, friendly and welcoming home. The care given to our relative is of a high standard within the limits of what they will allow due to their illness'.

At our Inspection on the 5th July 2013 we found that the provider was not meeting this standard. We judged that the provider did not have suitable arrangement in place to ensure persons employed were appropriately supported to meet people's needs. This put people at risk of receiving unsafe or unsuitable care. The provider sent us information on how they had met this area of non compliance on 9 September 2013.

We reviewed the evidence sent to us by the provider and visited the home on 23 September 2013. We found that the home now demonstrated compliance in this area.

Although six people live at Glebe Villa, there were only three people present during our visit. We spoke with these people, the manager and a member of staff.

People were happy and relaxed during our visit. They told us staff always asked if they were ready to be assisted with their care needs. Records showed people were encouraged to be active and be part of the local community. People were able to engage in a wide range of activities.

We spoke with five relatives who all spoke positively about the support their relatives received. Comments included, 'I am happy with the way the staff look after my relative. The staff have the skills to look after them well." Another relative said 'staff are brilliant. My relative has developed a lot of skills since they have been at Glebe Villa because they have helped them'.

The provider did not have suitable arrangement in place to ensure persons employed were appropriately supported to meet people's needs. This put people at risk of receiving unsafe or unsuitable care.

We found systems were in place to ensure people were safeguarded from abuse.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

For this inspection we did not involve people using the service.