About the service:

Glenholme is a respite service which provides a mix of planned and emergency short breaks for people with learning disabilities. The service had ten respite beds, three short stay beds and one emergency placement. The service had 30 people who used the service during the year. At the time of the inspection there were five people in the service.

People’s experience of using this service:

People felt safe and relatives were happy with staff. Staff knew how to report potential abuse and to take immediate action to protect people. Risk was considered for all aspects of care but not all risk assessments were current. The acting manager agreed to check all risk assessments for relevance and accuracy.

Staffing levels were sufficient to meet people’s needs promptly. There were robust medication procedures in place and staff could explain the processes well. The home was clean and although in the middle of some building improvements, was checked regularly to ensure the environment was safe for people.

Staff were supported with regular supervision and had up to date training. Staff had a good understanding of complex needs and were able to respond well. They demonstrated through discussion and observation a sound understanding of seeking people’s consent, and how to support people if they lacked capacity to make specific decisions. The service had appropriate Deprivation of Liberty Safeguard authorisations in place but needed to review any conditions more clearly to ensure compliance.

People received support with nutrition and hydration as required, and external health and social care services worked closely with the service to ensure optimum support for people. Communication between such services was appropriate and detailed, and staff took a holistic view of people’s needs.

People were happy with care staff and their attitude, describing them as friendly, kind and patient. Staff clearly knew people well, and documentation showed people’s choices and preferences were noted. We found positive examples of promoting independence and respecting sexuality. Privacy and dignity was respected and evident in all interactions between staff and people using the service.

Some relatives felt there was a lack of activities for people, but the service did well to balance people’s differing needs and requirements. Care was delivered in a person-centred manner and reflected in the records we saw.

The service had not received any complaints but everyone we spoke with knew who to contact and staff felt able to raise any issues. We received much positive feedback from people using the service, their relatives and professionals.

Due to the lack of registered manager the audits were brief, however all aspects of care were reviewed. The acting manager agreed to ensure any actions taken were logged and recorded as completed.

Rating at last inspection:

Good (Report published 12 July 2016).

Why we inspected:

This was a planned inspection in conjunction with our inspection schedule.

Follow up:

The service will continue to be monitored in line with our inspection programme, and if information of concern is raised, this will be investigated.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 22 June 2016 and was unannounced.

The last inspection of this service took place in January 2014. The service was found to be compliant with all of the legal requirements inspected at that time.

St Anne's Glenholme is a respite service which can provide short stay and respite accommodation for up to 14 people at any one time. At the time of inspection there were nine people living at the home.

There was a registered manager in position. 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.

From our observations and speaking with visitors and social care professionals we concluded people were safe living at the service. Risk assessments and safeguarding procedures were in place and up to date. We saw evidence of consent and best interests meetings where appropriate.

There was a robust system for monitoring and detailing accidents and incidents with lessons learned and action plans in place where required.

Medicines were generally managed safely although some improvements were required in the layout and auditing of the Medicines Administration Records (MARs) in order to comply with current guidelines. Management of 'as required' (PRN) processes needed to be more robust. However, from observing immediate systems changes being implemented during the inspection, we felt confident these improvements would be made.

Staffing levels were good and responsive to the needs of the people living at the service. A robust and safe recruitment process was in place and staff training was up to date, with service specific training available.

The premises were clean, comfortable and well maintained. Any issues were reported in a timely manner.

People's dietary requirements were being met and the service offered a varied rolling menu which people enjoyed.

People had access to a wide range of health care professionals and there was appropriate equipment in place to assist with people's care needs.

During our inspection we observed many positive interactions between staff and people that use the service. People appeared happy and the atmosphere in the service was calm and relaxed.

Staff knowledge about people living at the service was excellent and their approach was kind, caring and respectful of people's privacy and dignity.

Care files were detailed and person centred and we saw evidence care plans were put into practice by staff. Care files were reviewed regularly.

Varied, person specific activities were offered, with people choosing what activities they wanted to pursue, with a number supporting and promoting people's independence.

The service had a robust complaints procedure in place although no official complaints had been made since July 2015.

People we spoke with praised the staff and management team. The registered manager was approachable, well respected and was a visible presence in the service. Morale in the service was good and staff told us they felt supported.

Service audits were in place and up to date and there was regular support from the provider to ensure quality of service.

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. Each person had their own room which was furnished and decorated in a pleasant way. People did not decorate their rooms to reflect their own tastes because people only stayed for short periods of time.

We spoke to three people who were staying for short periods of time in the home. One person said “I get up and go to bed when I want” another person said “I got up at four this morning and the staff were very nice and gave me a cup of tea”.

People we spoke with who used the service understood the care and treatment choices available to them and were involved in making decisions about their care and treatment.

Records were well laid out, easy to follow, legible and comprehensive. Each record contained information on assessments being carried out across areas such as personal care, daily living activities, thinking and memory and mental health. We saw that risk assessments had been carried out and that all had been reviewed and were up to date.

We saw that healthcare professional were involved in the care of people. We spoke to one district nurse who said “It’s very good here. Staff are very good and communicate very well”.

We spoke to three members of staff who said they were familiar with safeguarding procedures. We spoke to one senior carer who described a recent safeguarding incident and how he had responded to it.

When asked what constituted abuse one staff member said “It can be something like not providing support to people or not giving them their medication or neglecting them”. All of the staff said that they discussed safeguarding at staff meetings. We saw minutes from staff meetings that demonstrated that staff had discussed safeguarding at each meeting.

We looked at two staff records which demonstrated that effective recruitment and selection procedures were in place. We saw that a checklist was in place that demonstrated that staff had two satisfactory references, that gaps in employment had been checked and that a Criminal Records Bureau (CRB) had been completed. All of the original documentation was held by the HR department.

We asked how the provider monitored the quality of the care delivered. We spent time observing the care and interaction between staff and people who used the service. We spoke with staff and the manager about the care and wellbeing of people who used the service. We also gathered evidence of people’s experiences by talking to people who used the service, by reviewing care records and quality assurance documentation.

Due to the complex needs of people using the service at the time of our inspection, we were only able to talk with two people who used the service.; they told us they received good care at St Annes, Glenholme. We observed how staff interacted with people using the service and it was evident they knew them well and the different ways people communicated.

We looked at two sets of care records which provided a detailed description of the person's physical, mental and social care needs. The deputy manager explained how they kept up to date with people's care needs and told us they liaised with people's family/carers, social workers and health care professionals involved in their care.

Staff told us they had access to lots of training and were able to develop their skills. They told us they received frequent supervision and were able to discuss any concerns with the manager.

We looked around the home and saw it was clean and regular maintenance checks were carried out to enure people were protected from unsafe or inappropriate facilities. They home had also been recently re-decorated.

We talked to people when they returned from their activities at the end of the day and we looked at the comments people made in the satisfaction surveys sent by the service.

One person told us they liked spending time at Glenholme, they said "I've got friends here". Another person said they liked the staff and got on well with them. People said there were plenty of activities to get involved in.

According to the surveys people were happy with the food and they said they enjoyed the activities on offer; some people made suggestions about additional activities they would like to take part in. Everyone said they felt safe when being supported by staff.

One relative we talked to said they couldn’t fault the service provided. They said the service was flexible and told us how staff had responded at a time when they particularly needed support in exceptional circumstances that it was not possible to plan for.