This inspection took place on the 2 October 2018 and was unannounced, which meant the staff and provider did not know we would be visiting.

Glebe Villa provides accommodation, for seven people. People who live at the home have a learning disability. There were six people living in the home at the time of the inspection. Glebe Villa was in a residential area of Bristol, close to shops and other local amenities.

People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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.

At the last inspection, the service was rated Requires Improvement. This was because some improvements were required to ensure the service was effective and well led. The registered manager was to seek support and training, about current legislation in respect to the Health and Social Care Act 2008 Regulations 2014. This was because the registered manager and the provider were still working with the previous legislation. Many of the policies and procedures required updating. The induction of new staff was not meeting the current standards as set down

by Skills for Care with staff completing the Care Certificate. Action had been taken to address these shortfalls and improvements made with the service now being rated overall as Good.

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. People were care for taking into consideration these principles.

People were supported to lead the life they wanted including accessing social activities based on their interests and hobbies. There was a relaxed and friendly atmosphere. People were treated with kindness by staff who knew them well.

Systems were in place to ensure people were safe including risk management, and safe recruitment processes. People received their medicines safely. Sufficient staff supported people and this had been kept under review.

People were protected from the risk of abuse because there were procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures.

People were involved in making decisions about their care. People had a care plan that clearly described how they wanted to be supported. The service was introducing a new electronic system of recording to capture how people were supported.

People had opportunities to take part in activities in both the home and the local community. Other health and social care professionals were involved in the care of the people living at Glebe Villa.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. Appropriate applications had been made in respect of deprivation of liberty safeguards.

People were provided with a safe, effective, caring and responsive service that was well led. The registered provider was aware of the importance of reviewing the quality of the service. This included seeking the views of the people they supported.

Glebe Villa provides accommodation, for seven people. People who live at the home have a learning disability. There were six people living in the home at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspection took place on the 6 September 2017.

There was a registered manager in post. 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.

At the last inspection, the service was rated Good. We found during this inspection, some improvements were required to ensure the service was effective and well led. The registered manager must seek support and training, about current legislation in respect to the Health and Social Care Act 2008 Regulations 2014. This was because the registered manager and the provider were still working with the previous legislation. Many of the policies and procedures required updating. The induction of new staff was not meeting the current standards as set down by Skills for Care with staff completing the Care Certificate.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Glebe Villa. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals.

The home continued to provide a caring service to people. People, or their representatives, were involved in making decisions about the care and support they received. Staff were knowledgeable about the people they supported. People were treated with kindness and there was a happy atmosphere in the home.

The service remained responsive to people's individual needs. Care and support was personalised to each person. People were assisted to take part in a variety of activities and trips out.

A relative and staff spoke positively about the commitment of the registered manager. They told us the registered manager was open and approachable. The registered manager and provider had monitoring systems in place. However, these would benefit from a review to ensure they are in line with the Health and Social Care Act 2008 Regulations 2014 and the key lines of enquiry. This would enable the provider to check whether people were receiving safe, effective, caring and responsive service, which was well led.

We found there were one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full copy of this report.

This inspection took place on 31 March 2015 and was unannounced. Glebe Villa provides accommodation and personal care to seven people with learning disabilities.

There were six people living in the home on the day of our inspection. At our last inspection on 15 April 2014 there were no breaches of the legal requirements identified.

There was a registered manager in post at the time of our visit. 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 and associated Regulations about how the service is run.

People told us that they were well supported in their living environment and felt safe and happy. One person told us “I feel safe here. They treat us well here”.

People were supported to make choices around the care they received and were involved in discussions and decisions about their preferences. A relative told us “staff always try their best to give people choice of what they want to do within their limits. People were registered with a doctor, dentist and an optician to ensure their health was monitored.

Systems were in place to ensure staff learnt from events such as accidents and incidents, complaints, whistleblowing and investigations. This reduced the risks to people and helped to keep people safe. A recruitment policy was in place to help ensure people employed were of good character. People’s medicines were administered and handled safely. These ensured that people who lived in the home were safe.

People were cared for in a clean, hygienic environment. People received their medicines when they needed them. Staff understood their roles and responsibilities and they were provided with the guidance, training and equipment they needed for this.

People’s care was planned and delivered in a way that was intended to ensure their safety and welfare. Care plans detailed their health needs and the care interventions that staff needed to follow, to ensure these were safely met.

Each person had their own weekly activity planner in their support plan. People told us they liked how they spent their time during the week and how staff needed to support them. Staff told us the staffing levels were safe and met the needs of the people who used the service.

Staff were aware of and followed the Mental Capacity Act 2005 to make sure people were supported to make decision about their care. Staff were able to describe how they assessed their capacity to make these decisions about day to day care. People’s care records had details of the types of decisions they were able to make and the circumstances under which decisions were made in their best interests.

The provider’s written procedures supported staff to report any concerns about people’s safety and welfare. For example, changes in people’s medical conditions and accidents and incidents, including the suspected or witnessed abuse of any person using the service.

The provider carried out regular quality monitoring visits to check that people’s care needs were being safely met. They also checked that people who lived in the home were protected against the risks of unsafe premises. There were proper maintenance arrangements, risk assessments and contingency plans and procedures in place to ensure people’s safety. These included known possible emergencies, such as a fire.

We carried out an inspection at Glebe Villa to help us to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people using the service, the staff supporting them and from looking at records.

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

Is the service safe

People told us they were “happy” and they were “safe”. People appeared relaxed and comfortable in the presence of staff. We saw that people were supported safely by staff in line with the risk assessments and individual capability while staff took them out for community activities.

The complaints procedure was accessible to people on the notice board and in the care files and was written in a picture format. This made it easier for the people who lived at the home to understand and to make a complaint in the way they knew how to. We saw from the records that there had been no complaints or incidents since the last inspection.

A safeguarding and whistle blowing policies and procedure were both in place. We were told that these policies and procedures would be followed if concerns were identified about a person's safety. This included contact details for reporting any suspected incidents of abuse and individual staff responsibilities. Staff training records confirmed that all staff had been trained in safeguarding vulnerable adults from abuse

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The home also had policies and procedures for mental capacity act, deprivation of liberty safeguards (DoLS). This was to ensure that people who were unable to make their own decisions were protected from harm or abuse. Records showed that three of five staff members have not had the training and the mental capacity act and DoLS. The manager told us that the online training for the three staff had been booked for 22 April 2014.

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Is the service effective?

People who used the service were encouraged to make choices in all aspects of their care, how they liked to spend their time and how they liked to be supported. This was documented in people's files.

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans reflected their current needs.

Supervision processes were in place to enable staff to raise any future training needs and to discuss any concerns with the care of the people who used the service. This demonstrated that staff received support to provide care for the people who used the service.

The home had flexible routines to suit the needs of the people who used the service. People were involved with the running of the home and assisted with cooking meals, setting the tables at meals times and participating in the

house work rota.

Is the service caring?

People were supported by kind and attentive staff. During our inspection we observed that staff provided support and engaged with people positive way. For example we saw a member of staff explained to one person where they were going out for lunch and what time. People were relaxed and comfortable in the presence of staff and an individual told us they were "happy".

People's care plans indicated how they liked to be addressed and their preference for a male or female to assist them with their personal care. This demonstrated that people's privacy and dignity was respected.

Is the service responsive?

Individual's records had details of the other people involved in their care, for example their care coordinators, dentist and general practitioner. Any visits by or to healthcare professionals were recorded to show how the person's healthcare needs were being met.

People had a programme of activities which involved them participating in community activities. These included attending day centres, clubs and day trips. One person told us they had been on holiday to Blackpool with the other people from the home. The person told us “I really enjoyed it and I am looking to going to Brighton in summer”.

Is the service well-led?

The service had a quality assurance system to make sure that people were provided with high quality care. The record we saw included surveys that enabled people to indicate how satisfied they were with the services provided. We saw that people were complementary about the home.

The home also had suggestion form for comments from families and representatives in relation to the home in general, services provided and care provided for the people who used the service. The comments we saw were all positive. Some of the comments included “Glebe Villa is a very clean, friendly and welcoming home. The care given to our relative is of a high standard within the limits of what they will allow due to their illness”.

We did not speak to people who used the service. This was a follow up inspection to check on one compliance action following a previous inspection.

At our Inspection on the 5th July 2013 we found that the provider was not meeting this standard. We judged that the provider did not have suitable arrangement in place to ensure persons employed were appropriately supported to meet people’s needs. This put people at risk of receiving unsafe or unsuitable care. The provider sent us information on how they had met this area of non compliance on 9 September 2013.

We reviewed the evidence sent to us by the provider and visited the home on 23 September 2013. We found that the home now demonstrated compliance in this area.

We used a number of different methods to help us understand the experiences of people using the service. These included observing how people were supported, spending time with people and talking with them.

Although six people live at Glebe Villa, there were only three people present during our visit. We spoke with these people, the manager and a member of staff.

People were happy and relaxed during our visit. They told us staff always asked if they were ready to be assisted with their care needs. Records showed people were encouraged to be active and be part of the local community. People were able to engage in a wide range of activities.

We spoke with five relatives who all spoke positively about the support their relatives received. Comments included, “I am happy with the way the staff look after my relative. The staff have the skills to look after them well." Another relative said “staff are brilliant. My relative has developed a lot of skills since they have been at Glebe Villa because they have helped them”.

The provider did not have suitable arrangement in place to ensure persons employed were appropriately supported to meet people’s needs. This put people at risk of receiving unsafe or unsuitable care.

We found systems were in place to ensure people were safeguarded from abuse.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

In June 2012 we carried out an inspection of Glebe Villa Care Home and found the service needed to make improvements to achieve compliance. Following the inspection the provider told us about the changes they intended to make. This inspection was carried out to check the improvements had been made.

For this inspection we did not involve people using the service.

The people who used the service at Glebe Villa had dementia and a learning disability and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we used SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spend their time, the type of support they got and whether they had positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with relatives and other health professionals.

People told us they liked living in Glebe Villa. They told us that the staff were supportive and caring. .People told us that they were given the choice to participate in activities or decline. One person said “I am very happy here. I prefer to stay in my room and watch television. I do paintings too and I like it.”

People told us that staff enabled them to be part of the community. For example, staff accompanied them on shopping trips.

People said that staff respected them and would ask their permission before making any decision for them. People said that staff would ask them first before giving their information to an outsider.

People said that they were able to choose when to rise and retire and when to have a bath or shower.

People said that they felt safe living in the home. People said they were involved with the running of the home and would complain to the manager if they were not happy with any of the services provided for them. Two people said “We are always involved in what is going on here. Another person said “Staff support me with anything I ask them to do for me but I am independent”.

We observed a staff member interacting with people in an inclusive way. For example the staff member asked the person to join other people in their conversation in the lounge so they didn’t feel isolated.

We observed staff offering people choices about how they wanted to spend their time and what food and drink they wanted.

We observed people accessing the kitchen area without restrictions. Staff we spoke with told us that people were supported to do things that they were able to do. For example, making a drink for themselves and other people.

During our visit we observed people going out to Day centres for the day’s activities. We were concerned that a senior member of staff used inappropriate language when a person using the service wanted to go out as well. This showed lack of respect and concerned us that this use of language could be seen as acceptable by other staff working in the home.