Archived: Gulliver House

Gulliver House is the base for supported living and outreach services for people living with enduring mental health issues. Gulliver House itself has nine bedrooms for people who need support to help them recover or stabilise. There were seven people living in these tenancies at Gulliver House when we inspected. The service also provides outreach support to people in the local community. At the time of our inspection nine people were being supported in the wider community.

This service provides care and support to people living in one 'supported living' setting [Gulliver House], so that they can live in their own home as independently as possible. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Gulliver House receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

The staff and people who use the service told us the registered manager was very approachable and people trusted her ability and her integrity. The service had an open and inclusive culture where people were consulted and where staff views were respected.

Staff had received training on ensuring people were kept free from harm and abuse. The staff team understood how to report any safeguarding matters and the registered manager responded to any risks. Turning Point had a confidential phone line for staff to report any concerns.

Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed, action taken to reduce risks and consideration of the issues under a 'lessons learned' approach.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. There had been a temporary increase in night staff to meet the assessed needs of people in the service.

Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.

Medicines were appropriately managed. People had their medicines reviewed by specialist nurses, psychiatrists and by local GP's. Self-medication was encouraged as people moved through their recovery plan.

Staff were trained in infection control and supported people in their own environment.

Induction, training and supervision had helped to develop the staff team. Staff received training around principles of care in relation to people living with complex mental health conditions. They also received induction and on-going training in a wide range of subjects. Restraint had not been used in this service.

Consent was sought for interactions. Even when people were in the service under an order related to the Mental Health Act they were still consulted about preferences.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to get good health care support from local GPs, specialist community mental health nurses and psychiatrists. Staff supported people to get help with physical health problems. Staff worked with people to support and encourage them to visit relevant health care providers.

Staff supported people to shop, budget and prepare food. Healthy eating was covered in group work and staff encouraged people to cook as much as possible.

Staff displayed a caring and respectful attitude and were also able to support people who were suffering from the symptoms of mental ill health. People told us the staff were caring and that they understood their needs. Independent and specialised advocacy could be sourced for individuals as people in the service were under the care of mental health professionals. People were supported to use services like Citizens Advice Bureau.

Each person had been assessed by a psychiatrist and we saw full assessment of need on file from social workers and other specialists. The staff team continued the assessment process once the person started to use the service. Detailed care and support plans were in place, along with contingency plans for any mental health crisis. Many of the people in the service had written their own assessment of need and parts of their care plans.

People were encouraged to do their own household chores and to manage their own affairs. They were supported by staff to manage their lives. People in Gulliver House attended regular group sessions as part of their recovery. People were encouraged to go out and to engage, where possible, with sport, learning and social events in the wider community.

Complaint procedures were in place. There had been no complaints received about the service.

Turning Point had a suitable quality monitoring system used in all their services. This service used the quality assurance system to good effect. This was evident in internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.

Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.

The inspection was carried out by an adult social care inspector. This was the first inspection of this service which was registered in April 2015.

Gulliver House provides personal care and support for up to 9 people who are recovering from mental ill health. People live in one property which is located in the centre of Whitehaven and within walking distance of all the amenities of the town. The property is a listed Georgian House. The service does not take people who have complex physical disabilities as the property cannot be adapted due to the listing.

The accommodation consists of nine single bedrooms - some of which have ensuite toilet facilities. The house has a shared bathroom and a shared shower room. There is a kitchen where people can prepare meals. There is a shared lounge area. People can live in this supported living environment for up to two years.

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

We spoke with people in the service and they were generally satisfied with the arrangements in place for support. They told us that the staff team treated them well and encouraged them in their recovery.

People told us that they felt safe in the property and that staff protected them from any potential abuse or harm. They told us that no one on the staff team was abusive or impolite. Staff could talk about safeguarding people from abuse. The manager and the deputy understood how to make safeguarding referrals and were training support workers so that they could do this. There was information about local safeguarding strategies available for staff and people who used the service.

Turning Point had a dedicated 'whistleblowing' line so that staff and people who used the service could contact the organisation if they felt concerned about anything in the service.

Turning Point took responsibility for the building and worked with the landlord Impact Housing. The property was safe and secure and people had keys to the front door and to their rooms. No one had a tenancy agreement but lived in Gulliver House under a license.

Accidents and incident management was done correctly and the management team were aware of their responsibilities while working with vulnerable people.

We looked at rosters and saw that there were two staff on duty by day and night. This was appropriate to the needs of the people using the service.

We checked on recruitment and disciplinary matters. These were being managed appropriately. The manager had good levels of support from the organisation's human resources department.

We checked on medicines management and we discussed some minor improvements. We judged that medicines were managed appropriately.

Staff and service users were aware of good infection control practices and the home was clean and hygienic on the day of our visit.

The original staff team had received comprehensive training prior to the service opening. Anyone recruited after this had completed induction and further training was planned for them. We met knowledgeable and skilled staff who were keen to develop in their role. All of the staff were registered to complete a foundation course in working with people who were living with mental health problems.

We saw good records of supervision and appraisal. Staff told us that they used these meetings to reflect on their practice and that they could ask for training and support. They said that they had a good relationship with the manager and that communication was good in the service.

Staff had received training on the Mental Capacity Act and the Mental Health Act and they could apply this learning to their work.

We had evidence to show that people were asked for consent when support was needed. Staff understood that sometimes people in the service would have constraints on their freedom if they were subject to mental health legislation. There were some rules related to the terms of the licence agreement.

People were encouraged to shop and cook for themselves and were expected to attend healthy eating groups. One person had been helped to access the dietician for advice.

People in the service saw their psychiatrist and other members of the mental health team. They were registered with local GPs and went to the optician, dentist and chiropodist when necessary.

People lived in a comfortable and suitable house that met their short term needs.

We met staff who were able to approach people in the service in a suitable way. They had been trained in equality and diversity and they respected people's preferred lifestyles. People told us that staff treated them appropriately and with dignity and respect. People trusted that the staff used information about them in a confidential way.

Care plans showed that the focus of the service was to encourage people to become independent after ill health. Good person centred plans were in place. People were involved in the creation of their recovery plans.

People were encouraged to be part of the community in order to improve the social isolation that mental health problems may bring. Staff helped people on the day to access the local gym, to shop and to use the amenities of the town. One person was in education and others were planning to look for voluntary work. There were some joint activities on offer but people were encouraged to develop their own interests.

The manager was developing the culture of the home. Staff understood the vision and values of the organisation. Turning Point had strong values and staff were aware of these.

The manager's application to register with the Care Quality Commission was underway.

We saw evidence before, during and after the visit to show that quality monitoring was of a good standard and that changes were made when people felt the service needed to improve.

We had evidence to show that there was good joint working with the local GP practices, social workers and the mental health team.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We judged that the staff team had done their best to keep people as safe as possible given that the environment was not suitable for the people who were living in the home. We saw that each person had been assessed and that the staff team and the local mental health team were working on plans for relocation. There was also a plan to upgrade the environment in place.

Is the service effective?

The service continued to work effectively with people who had long standing problems with their mental health. The relocation process took into account the difficulties people might have with change.

Is the service caring?

We saw caring interactions on the day of our visit. We learned that staff would continue to support people in a planned way once they moved to other accommodation.

Is the service responsive?

We saw that each person had been given the opportunity to talk about their needs and wishes. Two of the seven people in residence were unhappy about proposed changes but the other five people accepted that they needed to live somewhere that would meet their physical health needs.

One person said:

"I understand that this house isn't the best place for me as I get older and I am looking forward to moving nearer to my family".

Is the service well-led?

We judged that the registered manager, the operations manager and the organisation had worked with people who lived in the home, the local mental health team and the commissioners of the care to develop a plan for the home. We had evidence to show that the management had an empathy for people who lived at Coates Lane but that they had balanced risk and need and had put together a detailed plan for the future.

This planning meant that current residents would be supported to move on, the building would be upgraded and that plans were in place to change the way the home functioned. We saw well thought through plans to develop a rehabilitation service for people with mental health needs. We saw that the management had realised that the building was unsuitable for long term care and the planning had been completed with all of the people in the home and with relevant agencies. We spoke to staff who said they felt sad in one way but they knew that long term the management had taken the right decision.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw that the staff team understood how to protect vulnerable people and suitable training was in place. We looked at recruitment and staff development and we saw that the management team ensured that only suitable staff worked in the service.

People told us:

"I feel quite safe here...it is fine night or day."

"I can talk to staff if anything is worrying me."

We saw evidence to show that the manager of the service had looked at people's dependency levels and was aware that there was potential risk to people because the building was not suitably adapted to meet the needs of people with mobility issues. We made a compliance action about this because the environment was potentially unsafe for some people.

Is the service effective?

People in the service were helped and supported by the way care and treatment were managed. The written plans of care were of a high standard. Staff kept to the plans and helped people to have positive outcomes. Medicines were reviewed and managed effectively so that people's mental and physical health needs were met appropriately.

We had evidence to show that staffing levels had not been as good as they could be. We asked the provider to make sure that they reviewed the systems around retaining new staff.

Is the service caring?

We saw caring and respectful care and support being given during our visit. Staff impressed us with their understanding and commitment to giving high levels of support to people with enduring mental health issues who were also having problems with their physical well being.

People in the home told us that the staff were "grand", "really nice" and they told us that they felt well supported and that the whole team had their welfare at heart.

Is the service responsive?

We spoke to people who were able to ask for what they wanted. They told us that the staff team responded to their needs. We saw people talking about what kind of food they wanted, about holidays they were planning and about making choices about their care and treatment. We looked at files and saw that the care plans were reflective of this kind of responsive care.

Is the service well-led?

The service had an experienced and qualified manager who knew and understood the needs of people in the service.

The home had a good quality monitoring system in place. Staff were given suitable levels of training and development.

"It is grand here....no complaints."

We saw suitable care plans on file and we checked with people who told us they were getting good levels of care and support.

They told us that the food was 'fine' and that they were being encouraged to eat healthily.

We spoke to people about how well protected they felt from harm and abuse. No one had any concerns and the staff were trained and aware of their responsibilities in protecting vulnerable people.

People who lived in the home were involved in recruitment and selection of new staff. The company good policies and procedures to make sure the right people were taken on to care for vulnerable adults.

We looked at staffing levels and saw that these had been adjusted to make sure there were always enough staff on duty to give people appropriate levels of care and attention.

During our visit we saw plenty of evidence to show that the registered manager and the company monitored the quality of the care and services provided. Any issues that arose were dealt with quickly and to the satisfaction of people in the service. One person told us:

"I have nothing to complain about. I never feel anxious anymore."

People told us they were well cared for:

"I get help to go to the doctor or to see my psychiatrist. The staff are quite good and they give me help when I need it".

"I get support and I go out and go on holiday".

We looked at how people were helped with good nutrition and hydration. People were fairly non-committal about the food provided:

"It is Ok I suppose".

"It's fine...I eat it"

We found that the menu was not balanced and some people needed more help and support to get the right nutrition to help them be as well as possible.

We checked on medicines kept on behalf of people. We found these to be managed appropriately.

We spoke to staff and people in the home about staffing levels:

"We have some new staff and I have to get used to them..."

"We can be stretched a bit when there is only one of us on duty".

The rosters showed that there were suitable levels of staffing on duty.

We looked at records kept about people and about the operation of the service. These were suitable and reasonably well maintained.