We inspected the home on 7 November 2018. The inspection was unannounced. Glebe 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. The service accommodates up to 24 people.

On the day of our inspection 24 people were living in the home.

At our last inspection on 20 May 2016 we rated the home as ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and ongoing 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.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks in relation to people’s daily life were assessed and planned for. There were enough staff to ensure people received care and support when they needed it and safe staff recruitment procedures were in place and used. Medicines were managed safely and people received their medicines as prescribed. People lived in a clean and hygienic environment and were given appropriate support to manage their lifestyles and behaviours in the least restrictive way.

People continued to receive an effective service. Staff had the knowledge and skills to provide safe and appropriate care and support for people which included meeting their nutritional needs. Staff worked well with external health care professionals and people were supported to access health services when required. 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 home supported this practice. The principles of the Mental Capacity Act 2005 (MCA) were followed.

People had developed positive relationships with the staff who supported them. Staff understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. They promoted people’s privacy, dignity and independence.

People continued to receive a responsive service. People were involved with assessing and planning for their care needs and regularly reviewing their progress. They were supported to pursue their interests and hobbies, and social activities were offered. There was a complaints procedure in place and people knew how to use the procedures when required.

The home continued to be well led. The culture within the home was open, transparent and person-centred. People were encouraged to give their views on how the home was run and there were systems in place to monitor and improve the quality of the service provided.

Glebe House is situated in the market town of Caistor in Lincolnshire. The home is registered to provide care and support for up to 24 adults living with mental health and communication difficulties.

We inspected the home on 12 April 2016. There were 22 people living in the home when we carried out our inspection.

At the time of our inspection the home had an established registered manager. A registered manager is a person who has registered with the 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.

Staff ensured people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care which respected their rights.

Staff were recruited through the provider using a range of checks to ensure they were suitable to work with vulnerable people. Staff had received training and support to deliver a good quality of care to people. An active training programme was in place to support staff to maintain and further develop their skills.

The registered manager was well known to everyone who used the service and provided staff with strong, values-led leadership. Staff worked together in a friendly and supportive way. They were proud to work at the home and felt supported to by the registered manager and provider.

There were enough staff on duty to give each person the individual support they needed. Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People had been helped to avoid the risk of accidents and medicines were managed safely.

People were supported by staff to be able to access a range of external social and health and care professionals when they required any additional specialist support.

People were fully involved in planning their care and had been consulted about their individual preferences, interests and hobbies. Staff encouraged people to retain an active presence in their local community and to maintain personal interests and hobbies. Staff supported people to carry out meaningful activities on a flexible and planned basis in order to further develop their interests and hobbies.

People could freely express their views, opinions and any concerns. The provider, registered manager and staff listened to what people had to say and took action to resolve issues or concerns when they were raised with them. Clear systems were also in place for handling and resolving any formal complaints. The provider and registered manager reviewed and reflected on concerns or any untoward incidents and took any additional actions needed to keep developing and improving practices for the future.

People, their families and visiting health and social care professionals were invited to comment on the quality of the services provided. The provider was committed to the continuous improvement of the service and maintained a range of auditing and monitoring systems to ensure the care provided continually reflected people’s needs and preferences.

We looked at four people’s care records which included their care plans, risk assessments and health plans. These were clear, person-centred, detailed and provided up to date information on how their diverse needs should be met.

One member of staff told us the home promoted health and well being as much as possible. We saw in people’s care plans there were leaflets about special tests, diabetes and dental health, all written in accessible formats using simple text and pictures.

We looked at the menus and saw they offered a wide range of hot and cold meals. We were present whilst lunch was taken. We saw appetising food was served.

We reviewed the home’s safeguarding policies and procedures. The deputy manager told us all staff attended safeguarding awareness training. We reviewed the staff training records and the training programme, which confirmed what we had been told.

We looked around the home and observed a good overall standard of cleanliness. We saw people’s rooms were clean and communal areas were clean and tidy. The home was free from mal odour.

We asked one member of staff for their opinion on the staffing levels, they said, “There are enough staff, it’s a good number and we seem to be well staffed overall.” One person who lived at the home said, “There’s always staff around if I needed any help.”

We observed staff were attentive to people’s needs. People who lived at the home were at ease with the members of staff.

We spoke with four people who used the service. They told us they were well looked after and staff were caring. One person told us, "I love it here, I really do" and another person said, “I’ve made lots of friends.” We found care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. One person told us they were moving out soon to live locally with support from staff.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found staff had a good understanding of people's medication needs.

We saw people received individualised care and support, from staff that were knowledgeable about their needs, wishes and preferences. Throughout our inspection we observed good interactions and found people who used the service were relaxed and happy in the care of the staff.

The people we spoke with told us that Glebe House was a nice place to live and they praised the staff, who they said were helpful. One person who was returning from a visit to the local shops told us, “You get everything you need in the way of support here.”

People told us that they were asked for their views about the running of the home by the manager and staff and that they felt confident taking any concerns to staff members or the manager direct if needed.

People also said they felt safe living at the home and raised no concerns about the way they were cared for. They told us they felt comfortable speaking to any of the staff about any additional worries or issues they might have.

There was a programme of activities available in the home and people told us about things they had done and had planned. One person said, “There are things going on but I like to do my own activities and they have helped me to do these.”