The inspection took place on 10 May 2018 and was unannounced. 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.
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