Gloucestershire House - Care Home with Nursing Physical Disabilities

Gloucestershire House is a care home that provides nursing and residential care and support for up to 30 people. Care and support was provided to people living with learning and physical disabilities. Support is provided within one adapted building.

The service was developed and designed prior to Registering the Right Support and other best practice guidance being published. The provider was knowledgeable about the guidance and that it is in place to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. They were aware that its principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was bigger than most domestic style properties. It was registered for the support of up to 30 people. At the time of our inspection, 30 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated, as the service was community-based and enabled independence, inclusion and choice for the people living there. The service consisted of five separate lodges within the building, each of which housed six people and had its own name and set of care staff. Staff did not wear anything that suggested they were care staff when coming and going with people.

People's experience of using this service and what we found:

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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. The policies and systems in the service supported this practice. The service ensured that people were involved in decisions about their safety and empowered to take positive risks.

Feedback from people and relatives was overwhelmingly positive. There was consistent praise for the exceptional physical and emotional support provided by the staff at Gloucestershire House. Comments from relatives reflected the quality of the ongoing support for people to access meaningful activities in the home and community which promoted people’s independence and mental wellbeing.

People received highly effective and responsive support with their health and social care requirements and the safe administration of their medications. There was a strong, clear multi-disciplinary approach to meeting people’s care and support needs.

Staff demonstrated a culture of inclusivity and positivity that was evident throughout the service. Leaders constantly looked for ways to improve the service and ensure people received the outstanding support and care they deserved. Staff supported people to make decisions for themselves and engaged with people and their relatives about their wishes and preferences.

The service was a hub of activity with friendly staff providing care and support in a way people liked and enjoyed. Positive interactions took place between people, staff and each-other throughout our visit.

People had their privacy and dignity respected by staff, and there was a clear emphasis on independence.

The service's visions and values put people at the heart of the service. People were encouraged to comment on the quality of their support and their feedback was used to develop and enhance the service provided.

Gloucestershire House worked in partnership with health and social care professionals to ensure people’s care was well organised and met their expectations. People's care was regularly reviewed and was flexible. Staff responded to changes in people’s health and support needs to ensure people remained well supported and were happy.

Staff were skilled, motivated and knowledgeable. They had received appropriate training and support and were encouraged to develop their individual skills and interests.

The management team, staff and the provider understood the importance of the service within the local community and how family values and connections were vital to how people lived their lives. Community links were strong. People regularly accessed community based leisure activities and work based placements and were encouraged to engage with members of the public to raise the profile of the home and of those with disabilities.

Since our last inspection, under the leadership of the registered manager Gloucestershire House had continued to improve and had implemented some highly innovative support strategies. People clearly benefitted from a visibly person-centred culture that consistently delivered positive outcomes, reinforced by the provider's principles, values and expectations of staff.

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

Rating at last inspection:

The last rating for this service was Good (report published 5 July 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Gloucestershire House provided support to 36 people with physical disabilities, some of which had additional and associated complex needs. The environment had been adapted to suit the needs of those who lived with physical disabilities. The provider had refurbished and improved the building and facilities over a number of years and continued to do this.

There was an experienced and exceptionally committed registered manager in place. 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. They provided strong leadership to the staff who were also highly committed to improving people’s quality of life. People and staff were fully supported by equally committed volunteers. They supported people to take part in activities and work and to generally achieve their goals and aspirations. There were arrangements in place to monitor the service and a proactive approach was in place to continually strive to improve the services provided.

People told us they enjoyed living at Gloucestershire House, for example, one person said, “It’s my forever home.” They told us they felt safe and cared for. In particular people were listened to. They were supported to make independent decisions and were at the centre of planning and reviewing their care. Staff were exceptionally good at helping people to identify their goals and aspirations. They provided exceptionally personalised support to help them achieve these. The registered manager said, “I want people to live their lives fully.” For some people this had resulted in their lives generally and the quality of their lives altering dramatically. One person said, “My life has really changed beyond belief since I moved here."

People were supported to be independent. Staff were committed to helping people acquire the skills and the funding they needed to live in the wider community, if, this is what the person wanted to achieve. Otherwise the service provided a supportive long-term home for people.

People made choices and decisions about their care and support. They told us, "'Staff do what I ask, it's important to make our wishes known." They confirmed staff sought their consent before they supported them with their personal care.

People told us they discussed their care with key workers and that they had annual reviews to which they could invite their family and social workers. They said they had lots of opportunities to go out and about and enjoyed activities offered in the home such as the book club or hydrotherapy.

There was evidence of co-operation and communication with other health and social care professionals ensuring safe and co-ordinated care.

People told us they helped to choose the decor and fixtures and fittings for their new kitchens and dining rooms. The home was well maintained and pleasantly decorated and furnished. Adaptations to the environment and specialist equipment promoted people's independence.

People said that staffing levels had improved and this was confirmed by staff and the manager. People commented, "there are enough staff now, there wasn't before" and "there hasn't always been enough staff, but now it's better".

A robust quality assurance system was in place which promoted feedback from people, their relatives and staff.

We checked records relating to people's care and support and found that some risk assessments for pressure area care had not been completed correctly. People told us they felt safe at Gloucestershire House and we found that staff had received training to safeguard people from abuse. We looked at staff recruitment and found that required checks had been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as "fine" and 'pretty good'. We found that the service had an effective complaints system and complaints were recorded and responded to appropriately.