About the service Glebe Farm is a residential care home providing personal and nursing care to up to 9 people aged 18 and over. Four people were living at the home during our first two visits. A fifth person was admitted prior to our third visit.
Each person living at Glebe Farm has their own one-bedroom flat. There are three buildings surrounding an enclosed courtyard. Each building has three flats and some shared spaces. One flat has its own enclosed garden.
Although this is a new home, it is registered to support nine people, which is larger than current best practice. The provider worked closely with the local authority during the planning stages and designed and built a home to meet the needs of specific individuals who have very complex requirements.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service did not support people effectively in line with positive behaviour support principles. Staff were not suitably trained to support people using positive behaviour support.
People’s experience of using this service and what we found
The service did not consistently apply 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.
Staff had not always supported people to carry out activities that were meaningful to them. Support plans were not person-centred and did not give staff enough guidance to ensure that they knew how people wanted their needs met.
People were not always safe. There were not always enough staff deployed to support people, so people and staff were at risk of harm. The correct safeguarding procedures had not always been followed. Risk assessments were not always in place or did not contain personalised information staff needed to keep people safe. There was not an effective system in place to learn lessons from incidents or accidents.
Leadership of the service was poor. The provider had not ensured that quality assurance systems were robust enough to identify and rectify shortfalls. The management team had not always worked collaboratively with external health and social care professionals. People, relatives and others were not asked for their views about the service. Staff felt their views were not listened to.
There were not always enough staff with the right knowledge, skills and experience deployed to ensure that people’s holistic needs were met. Staff had not received suitable induction, training or support to ensure they were able to effectively meet people’s needs.
There was not a caring culture in the home. Relatives and external professionals told us that most staff were caring, kind and tried to do their best for the people they were supporting. We saw that most people were comfortable with the staff and enjoyed their company.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice. People’s choice of what they wanted to do was not always met.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 30 August 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns raised by a whistle-blower and by the local authority. The concerns were about staffing levels; staff training and competence; care planning; lack of activity; and poor management. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report. Some actions have already been taken by the provider to reduce risks. Following the inspection the provider told us that they had changed the management arrangements. Additional training for staff is planned.
Enforcement
We have identified breaches in relation to governance, safe care and treatment, staffing, person-centred care and notifications at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.