Glebe House

Glebe House is a residential care home which was providing personal care and treatment for injury, disease and disorder to 11 people at the time of our inspection. All people living at the service had mental health conditions. The service can support up to 12 people in one adapted building over two floors.

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

Medicines were not always managed safely. We found gaps in people’s medicine administration records. Protocols for staff to follow when people were prescribed to take medicines as and when required, were incorrect in one instance and missing in another. The provider had not realised there were concerns with medicines management as their quality assurance systems had not identified the issues we found.

Following the inspection, the provider sent us evidence to indicate they had made changes to improve medicines management.

People were kept safe. There were systems in place to help protect people from abuse. People’s risks were assessed and monitored. There were enough staff working at the service and recruitment processes were robust. Infection control practice sought to keep people safe from infection. Visitors were permitted as per infection control guidance. Incidents and accidents were recorded, and actions completed which showed the service learned lessons when things went wrong.

A positive person-centred culture was promoted. People and staff thought highly of the service management. The provider understood duty of candour and acted appropriately in this regard. Staff understood their roles. The registered manager fulfilled the service’s regulatory requirements. People and staff were able to be engaged and involved with decisions that affected the outcomes of the service. The service worked with other agencies to the benefit of people using the service.

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 on 27 March 2019.

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

Enforcement and Recommendations

We have identified a breach in relation to safe care and treatment at this inspection. We have also made a recommendation to follow best practice guidance around quality assurance.

The overall rating for this service has now changed from "Good" to "Requires Improvement."

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Glebe 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. Glebe House accommodates 12 people in one adapted building. At the time of our inspection 12 people were living there. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

¿ People told us they were happy with the care provided at Glebe House. One person said, “I’m happy with the service.”

¿ There were safeguarding procedures to keep people safe from abuse.

¿ People were risk assessed to keep them safe from harm.

¿ There were sufficient staff at the service. Suitable staff were recruited to work with people.

¿ Staff knew how to manage medicines safely.

¿ People’s needs were assessed before moving into the service.

¿ Staff were trained how to do their jobs and were supervised in their roles.

¿ People were supported to access health care professionals.

¿ 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.

¿ People told us staff were caring.

¿ People and their relatives were involved with their care and consented to their treatment.

¿ People’s privacy was respected and their independence promoted. However, we found some paperwork that should have been locked away. We have made a recommendation about this.

¿ People’s care plans recorded their needs so staff knew how to best work with them.

¿ People told us they knew how to make complaints.

¿ The service was not providing end of life care to people but stated they could.

¿ People were happy with the management of the service.

¿ The registered manager was supported in their role by a deputy manager and a regional manager.

¿ The service had links with other agencies to the benefit of people using the service.

¿ The provider used audits, spot checks and surveys to drive improvements in the service.

Rating at last inspection: This service was previously rated ‘Good’ at inspection in 2016.

Why we inspected: This was a planned inspection that was part of our inspection schedule.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. The next inspection will be planned for a future date based on our rating.

Glebe House provides accommodation and nursing care for up to 12 people who have mental health needs. At the time of the inspection, 11 people were using the service. People are accommodated in a purpose built house, in single rooms which have en-suite facilities. There was lift access to the first floor making it accessible to people.

The provider of the service is an organisation (The Avenues Group). The service had 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.

Staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. Medicines were managed and handled safely for people. Arrangements were in place to keep people safe in the event of an emergency.

People received their medicines safely and in line with their prescriptions. The service demonstrated good practice with regards to the administration, recording, auditing, storage and disposal of medicines

There were sufficient staff to meet people’s needs. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt well cared for. Risk assessments were in place about how to support people in a safe manner.

Staff undertook training and received supervision to support them to carry out their roles effectively. The registered manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed they had attended training in MCA and DoLS.

People’s needs were assessed before they moved in to the service . The care plans were person centred and tailored to meet their needs. Care plans were regularly reviewed to reflect people's changing needs. People were encouraged to develop and contribute to their care plans wherever possible.

People were supported to maintain good health and had access to health care services when it was needed. People received a nutritionally balanced diet to maintain their health and wellbeing.

The service had a clear management structure in place. People and staff told us they found the registered manager approachable and that they listened to them.

Any complaints were documented along with the actions taken. There was an effective system in place to monitor the quality of service provided.

The provider sought feedback about the care provided and monitored the service to ensure that care and treatment was provided in a safe and effective way to meet people’s needs.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

We spent time with people who used the service and observed how people were supported by the staff. We saw that staff treated people with respect and dignity. A person who used the service told us, 'It's a safe place.' In a customer survey another person had commented, 'It is safe here. I trust the staff.'

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were not any DoLs in place but staff were aware that on occasions decisions needed to be made in a person's best interest and that DoLS applications were required when people needed to be deprived of their liberty in some respect.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure

people's safety and welfare. People's individual files indicated risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

People were supported to receive the healthcare that they needed. In a customer survey one person had commented, 'Staff make sure I go to all my appointments.' Another stated, 'I tell the staff when I am worried about things and they help me.'

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences.

Is the service caring?

We saw that staff supported people in a respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do. One person who used the service said, 'The staff are very good. They speak to me in a proper way.' Another said, 'Staff are kind and they look after me.'

Is the service responsive?

Care staff were able to tell us about people's needs and how they supported and cared for them. The service was responsive to people's changing needs. For example some of the people who used the service now needed support with their personal care and mobility. Staff had been trained to carry out these duties. We saw that care plans were reviewed monthly and updated when needed. This meant that staff were made aware of people's current needs and how to meet these as safely as possible. A member of staff told us, 'We observe people closely and respond to individual needs and changing moods. For one person that means that a different staff will try to offer support if the first one is not successful.'

Is the service well led?

The service had a registered manager in place. Staff we spoke with felt that the home was well managed and that they received the support and guidance needed to carry out their duties and to meet people's needs.

The provider had a number of different quality assurance systems in place to enable them to effectively monitor the quality of care provided.