Glenister Gardens provides care and support to adults with a learning disability and autistic people living in a 'supported living' setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this assessment looked at people's personal care and support. The service can accommodate up to 12 people in their own flats, located in the same building with communal areas. At the time of the inspection 11 people were being supported by the service. The assessment was carried out on site by 2 inspectors and a nurse specialist advisor. After the assessment, an Expert by Experience contacted families for feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. We met with 2 people during the assessment and spoke with 1 person on the phone after the assessment. We also spoke with 6 relatives and a social care professional. We received feedback from the local authority quality monitoring team and safeguarding authority. We did not assess all quality statements at this assessment. For those areas we did not assess, we used the ratings awarded at the last inspection to calculate the overall rating. We identified some areas, such as medicines management, where improvements were needed. The Head of Learning Disabilities took immediate action to make some of the improvements and sent us evidence of this action. We will continue to monitor information we receive about the service, which will help inform us when to next assess them. At the time of our assessment, there was not a registered manager in post. The provider had recruited a new manager internally who was in post and had applied to CQC to become the registered manager for the service. We spoke with the management team and 3 care workers during the assessment. We also looked at a range of records.
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Glenister Gardens provides care and support to adults with a learning disability and autistic people living in a 'supported living' setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this assessment looked at people's personal care and support. The service can accommodate up to 12 people in their own flats, located in the same building with communal areas. At the time of the inspection 11 people were being supported by the service. The assessment was carried out on site by 2 inspectors and a nurse specialist advisor. After the assessment, an Expert by Experience contacted families for feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. We met with 2 people during the assessment and spoke with 1 person on the phone after the assessment. We also spoke with 6 relatives and a social care professional. We received feedback from the local authority quality monitoring team and safeguarding authority. We did not assess all quality statements at this assessment. For those areas we did not assess, we used the ratings awarded at the last inspection to calculate the overall rating. We identified some areas, such as medicines management, where improvements were needed. The Head of Disabilities manager took immediate action to make some of the improvements and sent us evidence of this action. We will continue to monitor information we receive about the service, which will help inform us when to next assess them. At the time of our assessment, there was not a registered manager in post. The provider had recruited a new manager internally who was in post and had applied to CQC to become the registered manager for the service. We spoke with the management team and 3 care workers during the assessment. We also looked at a range of records.
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CCS Homecare Services Ltd at Glenister Gardens was rated Requires Improvement overall following a July 2023 inspection, with breaches of Regulations 12 and 17 identified in relation to unsafe medicines management, unmitigated risks, and ineffective governance systems. Caring and Responsive domains remained Good, reflecting kind, personalised support and strong community engagement, but significant failings in consent/MCA compliance, risk assessment accessibility and medicines safety underpinned the downgraded ratings.
Concerns (13)
criticalMedication management: “We identified out of date medicines, some dating back to 2014, and used gloves in the bag. There was no itemised log or checks of what was in the bag.”
criticalMedication management: “Another person required their medicines to be crushed and administered covertly, but the provider did not have a best interest decision to support this.”
criticalMedication management: “The temperature recorded on the day of the inspection was 11°C, which could impact of the efficacy of the insulin.”
criticalCare planning: “One person's risk assessment recorded they should be supported to eat a 'soft and bite-sized diet'. We observed they were given an orange segment, which caused them difficulty with swallowing.”
criticalCare planning: “When we asked to show us risk assessments that included swallowing, asthma and epilepsy risk assessments, the provider told us these documents had been archived.”
criticalConsent / capacity: “We found the provider was not always working within the principles of the MCA. Best interest decisions for people who did not have the mental capacity to make specific decisions were archived.”
criticalConsent / capacity: “One person used restrictive equipment such as bedrails but we did not see consent for their use or a best interest decision regarding their use.”
criticalGovernance: “Medicines checks were not effective as they had not identified the concerns we found with the management of medicines, including out of date medicines, incorrect temperatures.”
moderateGovernance: “A number of documents could not be provided on the day of the inspection and had to be sent days later. Not all risk assessments were accessible on the day.”
moderateIncident learning: “It was not always clear what action had been taken to reduce the risks of the incident reoccurring. Team meeting minutes did not include any of the specific incidents.”
moderateInfection control: “In a toilet, we found a bucket with two soiled mops. Although colour coded for different areas, they had been placed in the same bucket, risk of cross contamination.”
moderateRecord keeping: “Risk assessments were not always dated to indicate when they had been completed and therefore it was not clear if they were up to date.”
minorRecord keeping: “The records for one person we looked at did not match the cash amount or reconcile with the receipts total.”
Strengths
· Staff were kind, considerate and engaging; people's diverse needs including language preferences were acknowledged and met.
· Sufficient staffing levels maintained with greatly reduced reliance on agency staff and safe recruitment procedures followed.
· People were supported to access community activities, healthcare appointments and maintain family relationships.
· Support plans were personalised, including communication profiles, food preferences and individual ways of working.
· Staff felt well supported by the registered manager and reported an open, approachable culture.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law