Glen Pat Homes

Glen Pat Homes is a residential care home providing personal care to seven people and a supported living service providing personal care and support to nine people.

The care home is in Winchmore Hill, North London and the supported living service is a building converted to nine flats in Chingford.

The care home and supported living service are for people who have a learning disability, autistic people and people who use mental health services. Some people also had a hearing impairment. In the supported living service, not everyone using the service receives support with personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

The care home had been short staffed. The registered manager increased the staffing levels immediately when this concern was raised to them.

People told us they felt safe at the service. They liked the staff and were satisfied with the support they received. The environment in the care home needed refurbishment and there was no suitable bathroom for one person who had a physical disability.

There were good infection prevention and control measures in place which protected people from risk of COVID-19. People had good support with their medicines. Staff were trained in recognising and responding to signs of abuse. Staff supported people with their health needs and to get health appointments. Staff were trained and supported to understand and meet people’s individual needs.

People were supported to have some 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.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care had become more person-centred since the previous inspection. The culture of the care home had changed from people doing all their leisure activities as a group to people going out individually with staff to places they chose. This was an improvement since the last inspection. People in the supported living service received care and support with a person centred approach which enabled them to become more independent and follow their individual interests. The service supported them to access specialist support where needed. The service supports people to learn skills of shopping, cleaning and cooking to enable more independence in their daily lives.

The governance of the service had improved with regular audits and checks and the introduction of an electronic record keeping system that helped the registered manager monitor the quality of care being provided.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 April 2020). There were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance of the service.

At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

The service remains rated requires improvement. There was a breach of regulation due to staffing levels in the care home. Please see the action we have told the provider to take at the end of this report.

We have also made two recommendations. One is to improve the environment in the care home and the other is to ensure best practice in use of PPE which supports communication for deaf people.

Why we inspected

This was a planned focussed inspection based on the previous rating. We had also received concerns that the provider was not providing the required number of staff to support people and this was addressed as part of the 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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Glen Pat Home on our website at www.cqc.org.uk

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Glen Pat Homes is a residential care home providing personal care to seven people at the time of the inspection and a supported living service providing personal care and support to nine people.

The care home is in Winchmore Hill, North London and the supported living service is a block of nine flats in East London.

The care home and supported living service are for people who have a learning disability or autistic spectrum condition and/or mental illness. Some people also had a hearing impairment. In the supported living service, not everyone using the service receives personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Risks to people’s health and safety were not always properly assessed and acted on. There was a lack of knowledge and guidance provided to staff about people’s serious health conditions and how these might impact on them. This left people at risk of their health needs not met due to a lack of clear information.

The service didn’t consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support in the care home as people went out as a group daily according to a timetable and there were limited opportunities for people to go out on their own to follow their interests with staff support. We have made a recommendation that the service follows best practice guidance in accordance with Registering the Right Support principles and person centred care planning.

People in the supported living service received care and support with a more person centred approach which enabled them to become more independent and follow their individual interests. The service supported them to access specialist support where they needed it and to follow their goals.

People said they were happy in the service and thought that the registered manager and staff were caring and supportive. People had good relationships with staff. Staff said they felt well supported in their work.

The environment was safe.

There was mixed feedback from relatives and professionals involved with people living at the service. The majority made positive comments about the home, staff and quality of care provided and said people were happy and settled, while some said they felt the service did not always follow best practices in person centred care in the care home.

The registered manager and provider showed a commitment to continuous improvement and acted on our concerns after the inspection.

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 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulations in relation to looking after people’s health, medicines and risks to their safety at this inspection. There was also a breach of regulation due to a lack of regular management audits to ensure any risks were addressed.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the previous inspection on 12 and 13 March 2015 the service was rated as good. We had made one recommendation regarding clarity of financial agreements where the service assisted people to manage their finances and this recommendation had been acted upon.

At this inspection we found the service remained Good.

There was a registered manager in place at the time of the inspection. 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.

People were kept safe from harm. The service had policies, procedures and guidance for staff about how to do this and staff we spoke with knew how to respond if anyone was at risk of harm. Risks to people were assessed and responded to. Anyone that required help to take their medicines received this help in a safe way and medicines were safely managed. The provider operated effective staff recruitment procedures to ensure that staff were safe to work with the people using the service.

The CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes and supported accommodation. Staff were knowledgeable regarding the Mental Capacity Act 2005 [MCA] and DoLS. Staff supported people 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 also supported this practice.

Staff were well trained and had completed an induction programme before starting at the service. Staff were also supported through supervision and appraisals.

People received on-going healthcare support from their local GP’s and the service maintained good links with health and social care professionals who were also involved with people’s care and support.

People’s dignity and privacy was maintained and staff knew how people preferred to be supported. Staff promoted people’s independence and encouraged people to do as much for themselves as possible. No unnecessary restrictions were placed on people and deprivation of liberty decisions were applied as required by law. People using the service were given information on how to make a complaint and people were supported to access advocacy services if this was required.

The registered manager, and provider, carried out regular audits of the service and used these as a means of maintaining high quality care. Any action that was required to maintain a good quality of the service provided was taken. There was open and transparent communication and people’s views about the service were obtained in the most appropriate way as well as the views of relatives and professionals that had contact with the service.

Further information is in the detailed findings below.

We spoke with three people who used the service. However, communications problems were experienced and we were not able to obtain confirmation regarding their views of the services provided. We spoke with three relatives of people who used the service and two health and social care professionals.

We observed that people who used the service were able to move about freely within the home and staff were constantly supervising and interacting with them. The fridge and freezer had been stocked with food. However, there was a lack of snacks. Nutrition assessments had been carried out. However, the recording of meals provided and eaten was not always completed. There was uncertainty as to whether special meals which met people's religious and cultural needs had been provided as there was a lack of supporting documentation. Significant weight loss recorded in a person's record had not been followed up.

The home had a record of maintenance and essential inspections of the electrical installation and boiler. However, the premises were poorly maintained and paintwork had peeled off in several parts of the building. Fire alarm tests had not always been carried out prior to the arrival of the new manager. Two bedroom windows did not have restrictors for the protection of people. The manager stated that arrangements will be made for them to be fitted.

Staff had been provided with training in infection control and disposable gloves and aprons were available for them. The home had a cleaning schedule which was checked by the manager. The registered provider may wish to note that curtains in two bedrooms were dirty and the wire netting over a kitchen window was dirty. Clinical waste bins were not available in the home.

Two relatives spoke well of staff and stated that staff were capable. The third relative expressed some concern regarding the services provided. Staff meetings had been arranged and guidance had been given to staff on improving the care provided to people. We however, noted that some staff were dissatisfied with their working arrangements and support received from management and other staff. Regular supervision and annual appraisals had not been carried out.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

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

Is the service safe?

We found that there were good arrangements for making sure that the home and the people who lived there were safe. Care was provided in an environment that was safe, accessible, clean and adequately maintained. We saw records that showed the service regularly checked facilities and equipment to ensure they were safe. This included annual checks of the gas and electrics appliances.

People’s health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We spoke with people who lived at the home. People told us they felt safe living at the home.

We saw that the home had appropriate safeguarding procedures in place. These were detailed and fit for purpose. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults. We spoke to staff and they demonstrated that they understood their role in safeguarding people and knew what action to take should it be necessary to do so.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

When people were referred to the service, details of their care needs, medical history, communications needs and likes and dislikes were detailed in the referral forms. The service carried out an assessment of people’s care needs and the care plans we saw met the needs identified in referral forms and assessments. We saw detailed, individualised plans for people in the records we read. One staff member told us “I know people well, care is delivered around their needs.” This meant the service was meeting the identified needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us from our observations and time spent talking with people, that staff were attentive, patient and caring with the people they were supporting. Staff treated people with respect and dignity. People commented that the staff were “good” and that staff were “caring and friendly.”

Is the service responsive?

There were suitable arrangements for making sure that people could express their views about the service. The records we read showed people were supported in promoting their independence and had regular opportunities to discuss and influence matters that were important to them during resident’s meetings. This included consultation about their views on things such as activities, meals and the home environment.

We found that care staff had regular meetings where they were able to discuss their training, development and welfare needs.

Is the service well-led

The staff we spoke with were aware of the aims and objectives of the service and had a good understanding of the quality assurance processes that were in place. We saw that people were regularly asked what they thought about the service and the registered manager took action to resolve any issues. We saw that the senior managers of the service regularly met to look at the performance of the service to identify areas for improvement.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form and interviews.References were taken up from their former employers. We saw that staff knew how to support people. The staff training matrix showed that staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene. Staff received appropriate professional development.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Relatives and professionals had also been consulted about how the service was performing. People's suggestions would be used as the basis to improve the care provided by the home.

We saw that the sitting-room had new furniture and a carpet. People had been involved in choosing the new furniture and carpet for the sitting-room. Staff told us that staffing had been increased at weekends. They said this meant they were able to support people to participate in activities over the weekend. Staff were available in sufficient numbers to meet people's needs.

We saw that staff knew how to support people. Staff had been trained in mandatory areas, such as manual handling, administration of medication and food hygiene. Staff said that they had been supervised and supported in their work with people. People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.