West House - 3&4 Glebe Lane

Updated 20 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 9 January 2019 and was unannounced. The inspection was carried out by an adult social care inspector.

People in the home were living with a learning disability. The care service has been developed and designed in line with the values that underpin the 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 can live as ordinary a life as any citizen.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least annually to give some key information about the service, what the service does well and improvements they plan to make. This was received in a timely manner and in good detail. We also reviewed the information we held about the service, such as notifications we had received from the registered provider. A notification is information about important events which the service is required to send us by law. We also spoke with social workers, health care practitioners and commissioners of care during our regular contact with them. We planned the inspection using this information.

The lead inspector spent time with all of the seven people in the home on the day. The team spent time talking with people and the staff. We also spent time in shared areas simply observing the life of the home. We met an officer of the organisation who was meeting with the people who lived in the house.

We read four care plans in depth and looked at daily notes related to these care plans. We looked at charts and other records of things like food and fluids taken. We saw moving and handling plans and risk assessments for other interventions. We also looked at records of medicines and checked on the stored medicines kept in the home.

We met the registered manager, the senior support worker and six care staff. We talked with them in small groups or individually and observed their practice. We looked at four staff files which included recruitment, induction, training and development records. We checked on the details of the supervision and appraisal notes on these files. We saw rosters for the four weeks prior to our visit.

We had access to records relating to maintenance and to health and safety. We checked on food and fire safety records and we had discussions about some of the registered provider's policies and procedures. We saw records related to quality monitoring. We routinely received copies of quality reports throughout the year.

We walked around all areas of the home and checked on infection control measures, health and safety, catering and housekeeping arrangements.

We received information related to staffing issues and quality audits during and after the inspection. We also had contact with the operations manager before and after the inspection in relation to staffing issues and to the plans for future activities.

Updated 20 February 2019

This was an unannounced inspection that took place on 9 November 2018. The service was last inspected in 2016 where there were no breaches in regulation seen and the home was rated as Good. We found at this inspection that the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

3 & 4 Glebe Lane 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.

The care service has been developed and designed in line with the values that underpin the 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 can live as ordinary a life as any citizen.

The care home can accommodate up to eight people in a bungalow and a small house that are next to each other but have separate adapted facilities. there were seven people living in the home when we visited. People in the service were living with a learning disability and, in some instances, with a physical disability and complex health needs. The home does not provide nursing care.

The home had a suitably qualified and experienced registered manager who had a background in social care and in management. 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 team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well. Good arrangements were in place to ensure that new members of staff had been appropriately vetted and that they were the right kind of people to work with vulnerable adults. Accident and incident management was of a good standard.

The registered manager kept staffing rosters under review as people's needs changed. We judged that the service employed enough support staff by day to meet people's needs. Staffing levels at night were being changed to meet people's needs.

We made a recommendation about continuing to review staffing at night.

Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles.

People had reviews of their medicines on a regular basis. Medicines were stored safely. We noted that some, but not all, staff did not always sign the records in a timely manner but this was being addressed by the provider under their quality monitoring, supervision and disciplinary processes.

People in the home saw their GP and health specialists whenever necessary. The staff team had good working relationships with local GP surgeries, community nursing services and specialist health care professionals.

Good assessments of need were in place, and the staff team reviewed the delivery of care for effectiveness. They worked with health and social care professionals to ensure that assessment and review of support needed was suitable and up to date.

People told us they were satisfied with the food provided and we saw suitably prepared meals being served. Good nutritional planning was in place. Special diets and support needed to take enough nutrition and hydration were in place.

The home is situated in a quiet residential cul-de-sac and consists of a four bedroom house and a four bedroom bungalow. The bungalow is adapted to accommodate up to 4 people who have complex physical needs. Both buildings were clean, homely and suitable for diverse needs. There were suitable adaptations and equipment in place.

Where possible people were consulted about their preferences and choices. Where people lacked capacity advocates were used or, if appropriate, relatives were involved in decision making. We saw records of 'best interest' meetings held where people were unable to make their own decisions.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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 who lived in the home told us that the staff were caring. We also observed kind and patient support being provided. Staff supported people in a respectful way. They made sure that confidentiality, privacy and dignity were maintained.

Risk assessments and care plans provided detailed guidance for staff in the home. Some of the people in the service were aware of their care plans and had influenced the content. The management team had ensured the plans reflected the person-centred care that was being delivered. The registered manager was reviewing the format of care planning to simplify the process.

Staff could access specialists if people needed communication tools like sign language or braille but no one in the service used specialised ways of communication.

Staff encouraged people to follow their own interests and hobbies. We saw evidence of regular activities and outings.

The service had a comprehensive quality monitoring system in place and people were asked their views, where possible, in a number of different ways. Quality assurance was used to support future planning.

We had evidence to show that the registered manager and the operations manager were able to deal with concerns or complaints appropriately .

Records were well organised, easy to access and stored securely. Staff were being reminded about the importance of signing when they recorded interactions.