About the service:

Glenholme is a residential care home. The property is two houses joined together. There are dual facilities that includes two kitchens, two dining rooms and two lounges located in each adjoining property.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 18 people. Fourteen people were using the service at the time of our visit. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways, promotion of choice and control, independence and inclusion. For example, people were supported to be more independent, with opportunities to try new experiences and gain new skills.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People’s experience of using this service:

Quality monitoring systems were in place to drive improvements at the service. However, these were not always effective as they could be. For example, one person’s weights had not been monitored and checked to identify the person had been losing weight.

People using the service felt safe. Staff had received training to ensure they could recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to aid them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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 continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in a

This inspection took place on 5 May and was unannounced.

Glenholme provides residential care and support for up to 18 people with a learning disability. At the time of our inspection, 16 people were living in the home.

The service is required to have 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.

People were safe in the home. Staff had a good understanding of safeguarding and knew what constituted abuse. Staff knew how to keep people safe and reported any issues of concern appropriately. Risk assessments were clear and detailed and reviewed regularly. Staff acted in accordance with the guidance and protocols that were in place to help reduce the risks for people.

Medicines were administered, stored and managed safely and appropriately and people received their medicines on time and in the manner the prescriber intended.

Staffing levels were sufficient to meet people’s needs appropriately and the staff on duty had the skills and knowledge to support people effectively and meet their needs in a timely manner. Appropriate and safe recruitment practices were followed, to ensure staff were suitable to work with people in a care environment. Staff received support from the manager and quality assurance officer, which included supervisions and appraisals.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The manager and quality assurance officer ensured the service operated in accordance with the MCA and DoLS procedures. Staff also demonstrated a clear understanding of the MCA, DoLS, capacity and consent. People were able to make their own decisions and choices as much as possible.

People received enough food and drink to meet their individual needs and staff had a good understanding and knowledge of people’s dietary needs. Prompt referrals were made to healthcare professionals as needed and any advice or guidance given was followed appropriately by staff. There was also consistent monitoring and appropriate communication by staff, regarding people’s healthcare needs and any changes.

People were involved in planning and reviewing their own care and staff appropriately supported people, when necessary, to make informed choices for themselves. The staff were kind, caring and compassionate. People were treated with dignity and respect and their privacy was upheld. People were also supported to do as much for themselves as possible, in order to enhance and maintain their independence.

People pursued hobbies and activities of their choice, which helped enhance their overall wellbeing. Visitors were welcome without restrictions and people were supported to form and maintain personal relationships. People were listened to and any complaints were fully investigated and actions taken to improve the quality of care provided.

There were effective systems in place to monitor the quality of the service and these were used to develop the service further. Staff and people living in the home could be involved in making decisions on how the home was run.

Record keeping and management systems were in good order, with effective auditing and follow up procedures in place.

We conducted this inspection to establish the following about Glenholme: Was the service safe? Was it effective? Was it caring? Was it responsive and was it well-led?

Below is a summary of what we found. This summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from reviewing records.

If you want to see the evidence supporting our summary please read the full report. You should note that the manager named on this report was not employed by the service at the time of this inspection.

Is the service safe?

People we spoke with who lived at Glenholme told us that they felt safe and that staff treated them with respect and dignity. They told us that they knew who to speak to if they didn’t feel safe or were unhappy about something. They indicated that staff took great care to ensure that they felt secure in their home. A family member of one person we spoke with said "As a parent I have full confidence in Glenholme."

Staff also demonstrated during the inspection that safety of residents was of paramount importance, not just in the home but also outside. This was evidenced during the inspection by the manager following through on an incident that had occurred outside of the home.

Is the service effective?

There was a system of recording and managing incidents and complaints which was both supported and promoted by a recently appointed manager. Glenholme had also recently appointed to the role of quality assurance manager. All major aspects of the provision of care were undergoing a rigorous review to measure and ensure quality, safety and people’s satisfaction.

Is the service caring?

Glenholme operated an ‘open door’ policy to people living at the service, their families and staff. However it managed this against the needs of the individual as well as the needs of other people using the service, staff and the organisation as a whole. An example of this is allowing people to come and go but with agreed limits such as being back from having a drink with friends by an agreed time. The home supported people effectively by enabling people to become more involved in the day to day running of the home, which included cleaning, laundry and shopping. We also noted that people were encouraged to take part in training events such as fire safety and basic food hygiene. People were then rewarded with certificates which helped create a sense of belonging and involvement.

Was it responsive?

People’s care plans were reviewed regularly and we noted that care plans were assessed with the person and their family present where possible. People living at the service also took part in a yearly survey about life at Glenholme.

During our visit we noted the strength and depth of knowledge about people that the care staff had. Each staff member we spoke with had an individual knowledge of each person, for example, their likes, dislikes, dietary requirements and behavioural challenges. We noted that comments and thoughts were shared in the daily record book and shared across the management team as part of regular reviews. Where necessary they were also shared with the person, for example where behaviour may be deemed appropriate or inappropriate.

We found that the service took great care to both involve and respond to people living in the home. Examples of this were found in a recently initiated rolling programme of room decoration and refurbishment. There was also a full and individualised programme of activities available for people including adult education, entertainment activities and home contacts, supported by a note of likes/dislikes.

Was it well-led?

Recent staffing changes at Glenholme had resulted in a review of all activities, systems, policies and procedures. We were told this process would be ongoing throughout the year or until complete.

We spoke with people living at Glenholme, their relatives and members of staff. One person told us 'I'm okay here, they care for me." Another said "I like it here." Relatives we spoke with were very complimentary about the care and support their family members received. We were told that staff always welcomed them in to the home, made time to chat with them and were attentive and helpful if they had any concerns or queries. Another relative said the staff knew their family member well and were impressed that whenever they visited the home everything was calm.

A previous inspection in June 2012 had raised some issues and these were reviewed as part of this scheduled inspection. Substantial improvements had been made regarding care plans. They were now up to date and reviewed regularly. We were able to establish clear links between various medical records and it was easy to obtain an overview of people's health, care and support requirements.

Most of the premises related concerns had also been addressed and additional work had been carried out including the installation of a new boiler. However, some areas still needed attention, in particular some bathrooms. We were advised that this work would be progressed.

We found that systems were in place to assess and monitor the service provision and feedback was sought from people living at the home, their relatives and health care professionals.

We did not speak to people about their medicines on this occasion.

People using the service talked to us about the things they do and how well staff supported them. They said that they didn’t think there were enough staff to take them out at times. One person said that they can’t go on holiday this year as they were told it “was too much money”. They said that other years they had been away on holiday as a group. We talked about other activities they were involved with. One person said that they go out to the shops once a week but would like to go more often. Another person said that they go out to the “gateway club” where they play pool. Another said that staff were planning some day trips.

We talked about how people were involved in the day to day running of the home. One person told us that they did the hoovering four days a week and another service user did it on the other days. They said that they had been involved with cooking on special occasions and another person said that they helped with peeling vegetables sometimes. However, they said that they did not cook the main meals.

We found that people living in the home had access to all areas. People were in and out of the kitchen making drinks when they wanted to. Some people had their own food cupboards and one person had their own fridge. Bedrooms were very personalised and some people had been supported to buy bedding of their choice. Other people had been supported to have internet access and sky TV installed.

The people we spoke with gave lots of examples of activities they do outside the home. They told us about visits to the pub, to the adult education centre and regular contact with family and other members of the community.

During our visit we saw staff supporting people to go out. The service had a mini bus and staff took one person to visit their relatives for the day. Other people in the home were given the choice of going along for the ride. We also saw staff taking people to the adult education centre in the afternoon. People said they liked living in the home and felt safe. They said that if they had any concerns they would speak to the manager.

We observed staff to have a good relationship with people living in the home. They treated them with respect and involved them in decisions about them. People told us that they liked living in the home and felt safe. They said that if they had any concerns they would speak to the manager.

People said that they were involved in monthly meetings with the manager. They said that they were asked questions such as, where they would like to go on holiday and what meals they would like. However, they told us that they had not had a meeting for some time.