29 November 2021
During a routine inspection
Creative Support- The Glade is a residential care home providing personal care to eight people who were autistic, living with dementia or living with a learning disability, at the time of this inspection. The service can support up to eight people. People had their own personalised bedrooms and shared communal areas such as a kitchen, bathrooms, living rooms and a garden.
People’s experience of using this service and what we found
People were not always supported in line with their preferences, including social pastimes and interests. People were left for long periods of time without speaking to other people or staff increasing the risk of social isolation or boredom. Staff did not always describe people with dignity and respect and opportunities for people to be independent were being missed.
Risk assessments had been completed to guide staff how to support people safely, however these were not always followed in practice. There had been a large change in the staff team, and this had impacted on people’s lived experiences at the service.
Clinical waste bins were not stored appropriately which may lead to an infection control risk. Other infection control measures were effective in helping keep people safe.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation to the service around reviewing mental capacity assessments and best interest decisions to ensure they follow best practice guidance.
Audits were effective in picking up where improvements were needed in areas such as health and safety checks or medication. However, they had failed to pick up on areas for improvement we identified at this inspection. We were not assured that best practice guidance was being followed at the service in relation to Right Support, Right Care, Right Culture. Relatives gave us mixed feedback about how the registered manager and staff engaged with them.
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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.
People were at risk of social isolation due to staff not being able to drive vehicles and the location the service being far away from areas of interest and local amenities. Some people living at the service, visibly were not happy living with other people using the service. Opportunities for people to leave the service and take part in preferred past times was limited. Staff did not support people to take part in their preferred past times whilst they were at home.
Despite our findings people and relatives were happy with their care and support. One relative said, ‘‘I think The Glade is the perfect place for [family member] and I have no concerns that they are well cared for.’’
Staff were trained in safeguarding and knew how to keep people safe. Staff were recruited safely and there were enough staff to support people with their support needs. People were supported safely with their medicines. Health professionals supported people if this was needed and staff worked well with them. Staff supported people to eat and drink according to their support needs and their preferences.
People told us that staff were kind and compassionate and we observed people were relaxed whilst being supported by staff. Staff offered people choices in some aspects of their lives and communicated with people in ways that made sense to them. There was a complaints procedure that people had access to if they needed to use it. Plans had been discussed with people about the support they would like at the end of their life.
The registered manager and service director were passionate about supporting people. They were keen to put improvements in place following this inspection. People were positive about the management of the service and the way they were supported. Staff worked with health professionals and other services to help ensure good outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 29 April 2019 and this is the first inspection.
The last rating for the service under the previous provider was good (report published 15 August 2017). This service also had a focused infection prevention control (IPC) inspection completed and no issues were found (report published 13 March 2021).
Why we inspected
This was a planned inspection based on when the service registered with us.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
Enforcement
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.
We have identified breaches in relation to person centred care and good governance.
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 for 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.