This inspection took place on the 14 and 15 January 2016 and was unannounced. We carried out an unannounced comprehensive inspection of this service on 9 December 2014 and found several regulatory breaches. Following the inspection, the provider wrote to us to say what they would do to meet these legal requirements. During this inspection we checked whether the provider had completed their action plan to address the concerns we had found. We found the provider had made the required improvements, however at this inspection we identified some other improvements were required.Glen Eldon is a care home registered to provide accommodation and personal care for nine adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living in the service some of whom had severe learning, communication, emotional and behavioural difficulties.
The home is located in a rural area five miles from the town of Alton. There is no public transport nearby. The home has a large living room, a dining room, a kitchen and three shared bathrooms. People were accommodated in single bedrooms.
The service did not have a registered manager in post as required for this location. The provider had informed us on 1 December 2015 that the service was being managed by a deputy manager from another of their locations. The provider has now successfully recruited to the post of manager and this person has submitted an application to become the registered manager. 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.
Our inspection of December 2014 found the arrangements to protect people if there was an emergency were not robust. At this inspection we found Improvements had been made. For example; people had personal evacuation plans in place that detailed information important to support them safely in an emergency. Information was available about people’s needs should they require an admission to hospital. Improvements had also been made to people’s care plans. People’s care plans including their risk assessments had been reviewed and updated to reflect their current and specific needs. People’s relatives were confident that people were cared for safely and staff knew how to manage the risks affecting people’s safety and welfare.
Improvements had been made to the governance system to ensure actions taken in response to health and safety risks were completed. Records showed that regular health and safety checks were carried out and action was taken to remedy any faults identified.
Improvements had been made to the organisation and accuracy of people’s care records. This had been achieved through a review of people’s care plans. Records showed the correct service user guide was included in people’s records which had been missing at the last inspection.
Appropriate arrangements were not in place to ensure people’s legal rights were always protected by proper implementation of the Mental Capacity Act 2005 (MCA). Where people lacked the capacity to consent to their care and treatment the required procedures had not always been followed, for example, in relation to the use of CCTV. Where people were unable to give their consent to decisions made on their behalf the provider had not assured themselves of the legal authority other people held to make such decisions.
Staff completed training to meet people’s specific needs to ensure they were cared for safely. An on-going training programme was in place so staff skills and knowledge were regularly refreshed. We were told Makaton was one of the communication methods used by all people living at Glen Eldon to some degree. Makaton is a language programme using signs and symbols to help people to communicate. However, not all staff had completed training in the use of Makaton. Use of Makaton by all staff would support people to maintain the communication skills they had developed. The operations manager told us the provider was sourcing this training.
People were supported by staff who understood the signs of abuse and how to report any concerns. Staff were aware of how people may communicate mistreatment when they could not do so verbally. Information and guidance on how to report safeguarding concerns was displayed within the home including the relevant contact details.
There were sufficient staff to meet people’s needs and care for them safely. There were three staff vacancies at the time of our inspection. These were being covered by existing staff wherever possible, the providers’ bank staff and the occasional use of agency staff. Staffing levels were calculated to meet people’s individually assessed needs to ensure they received the appropriate level of support.
People’s medicines were managed safely. Where people required emergency medicine to be taken as required staff understood how and when this should be administered. Procedures were in place and followed for the safe storage, ordering, administration, disposal and recording of people’s medicines.
New staff completed an induction to their role that included shadowing more experienced staff to get to know the needs and behaviours of the people they supported. This helped to ensure people received effective care when staff changes occurred. Staff were supported in their role through regular supervision, appraisal and on-going training. However, for staff in a leadership role access to further professional qualification training was limited. This could mean people were supported by staff who had not obtained further qualifications appropriate to any leadership role.
People’s nutritional needs were assessed and they received the appropriate support to manage risks from eating. People were supported to eat as independently as possible and to participate in choosing food. People’s dietary preferences were catered for.
People were supported to meet their healthcare needs by a range of healthcare professionals. Where healthcare treatment was required staff ensured people’s needs were met promptly. Records showed annual health checks were completed and important information about people’s healthcare needs was available and up to date.
The provider was consulting with people's relatives about relocating the service to new premises. Following feedback from people's relatives improvements were being made in order to maintain the current environment to a suitable standard.
People received kind and compassionate care from staff who were knowledgeable about people’s preferences and needs. People were supported to make decisions about their daily routines as much as they were able to. People’s privacy was respected in line with their assessed safety needs and staff knew how to provide dignified care.
Care plans were person-centred and included information about people’s preferences. This guided staff on how to provide appropriate care and support. People were supported in line with the guidance contained in their care plans.
People’s needs were reviewed monthly and their changed needs were communicated to all staff. People’s care plans were updated as required.
People engaged in a variety of activities to meet their needs and preferences. People were given the opportunity to try new activities and to choose an alternative if they did not want to do their planned activity. People’s relatives spoke positively about the activities provided by the home and the importance of this aspect of the service for their loved ones.
A complaints policy and procedures were in place. There had not been any formal complaints since our last inspection. People’s relatives told us they felt confident to raise their concerns with the manager and the provider.
The provider operated a quality assurance system to monitor the quality of the service people received. Actions were taken to resolve and improve the areas identified through this system and progress was checked by the operations manager and the provider’s quality and compliance team. This system was used to drive continuous improvements to the quality of the service people received.
A new manager had been appointed and people’s relatives were unable to comment on how well the service would be managed by them. However, they told us the manager had made a positive start through building relationships with people using the service, communicating with relatives and listening to them. The manager told us she was adequately supported by the provider in their new role.
People’s relatives and staff were asked for their feedback on the service and staff had recently been asked for their feedback at the time of our inspection. People were supported to contribute to service development through the advocacy of their relatives and by staff observation of people’s behaviours and responses.
People’s relatives told us the culture in the home had improved since our last inspection and was open and honest. Relatives told us there had been a willingness to improve by the provider and the leadership in the home over the past year had been strong and achieved positive results for people.
During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.