This inspection took place on the 17 and 18 December 2018 and was unannounced.

During our previous inspection on 13 and 14 March 2018, we identified the provider had breached Regulations 9, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people did not have satisfactory rehabilitation and physiotherapy programmes in place. The provider had not dealt with complaints effectively. The provider's quality assurance process had not picked up on areas that needed improving. Staff were not always supported effectively.

We asked the provider to take action to address these issues and at this inspection, we checked whether the provider had made improvements. At this inspection we found the provider had made and sustained the required improvements in relation to the breaches in Regulations 9, 16 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There had been some improvements in relation to the Breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, however we found that further improvements were needed in this area and therefore there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we also identified new breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Glenside Farnborough provides residential accommodation and rehabilitation services for up to 22 people with people with a brain injury, neurological condition or both. At the time of the inspection 20 people were using the service.

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. The service did not have a registered manager at the time of inspection, but the provider had put in place a manager who was currently ‘stepping’ in to the role and planned to apply to become the registered manager.

The provider did not have effective recruitment processes in place to make sure the staff they employed were suitable to work in a care setting. Medicines were not always managed safely and staff did not all have regular competency checks. Health and safety checks were not consistently completed. Quality monitoring systems were not effective in identifying areas for improvement.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Risk assessments were in place and actions documented to minimise risks to people.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence. Infection control measures were in place to manage the risk of infection.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet people’s individual complex needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People reported they were treated in a kind and caring manner by staff. People were supporte

We inspected Glenside on 13 March and 14 March 2018. The inspection was unannounced. Glenside Farnborough provides residential accommodation and rehabilitation services for up to 22 people with brain injury and / or neurological conditions. At the time of the inspection 21 people were using the service.

At the last inspection, in November 2015, the service was rated Good. At this inspection we rated the service as Requires Improvement. Glenside Farnborough is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a 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.

The service had a satisfactory approach to safeguarding. For example there was a suitable policy and procedure in place and staff received appropriate training. Where there had been safeguarding concerns, these were reported appropriately, and any recommendations had been implemented.

A risk assessment process was in place. Risk assessments were comprehensive and reviewed regularly. Other records were comprehensive, accurate and up to date.

Health and safety procedures were satisfactory. Equipment was regularly checked and was judged as safe.

Staff received training about behaviours of people which could challenge the service. There were however concerns about how management had responded to some incidents, where staff had felt threatened and did not feel safe.

Some concerns were expressed about staffing levels, and the ability for staff to subsequently provide satisfactory activities and rehabilitation within the current staffing levels provided.

Staff recruitment, training, supervision and appraisal systems were effective, and suitable records were maintained. However records of staff induction could be improved. We have recommended new staff, who have not worked in the health and social care sector previously, undertake the Care Certificate.

Medicines procedures were to a good standard. People received the correct medicines on time. Suitable records were kept. The service was very clean, and there was a good standard of infection control precautions in place.

Assessment processes were comprehensive to enable decisions about whether people were suitable to move into the service. Care plans were also comprehensive and regularly reviewed. People had some involvement in the care planning process. The service had a suitable approach to assessing people’s mental capacity. Documentation about mental capacity was comprehensive.

People had a choice of meals, and were positive about the food they were provided with. We were concerned about some aspects of the support provided; for example whether food was prepared appropriately for those who were at risk of choking.

People’s healthcare needs were met by external professionals. However there were concerns about whether satisfactory physiotherapy was provided by the service. This meant that people’s rehabilitation was currently not effective as it should be. The registered provider said this would be improved, but people said there had been a problem for some time.

Staff were seen as caring, respectful and supportive. Some people felt frustrated by what they saw as too many rules at the service, and the inability for staff to escort them out of the home if they were unable to go out on their own. People were involved in decision making however, and staff were observed as friendly and attentive.

We had significant concerns about the provision of activities. Although there were records to demonstrate some activi

We found that policies were in place and staff had been trained regarding the need for people’s consent to care and treatment and the protection of their rights. One member of staff told us, “We have very good processes to make sure that people consent to their care. They are very vulnerable and we want to do what’s best for them and what makes them happy”.

People who used the service and their relatives told us that they were happy with the care and support provided at Glenside. One person told us, “I think it’s the same for everyone, but we plan my week so that there’s a mixture of treatment, work and fun to help me improve. Now I’m here it’s easier for my family to visit too”.

We found that the service monitored people’s well- being and provided regular nutritious meals and drink in line with people’s needs and preferences. Food and drink was also available on request at any time. One person told us, “The food here is brilliant. The chef can make anything”.

We found that there were sufficient suitably trained staff with a balance of skills and experience to meet the needs of people who used the service and to enhance their lives.

The service provided formal and informal opportunities for people, their relatives and staff to provide feedback on the care provided at Glenside. We saw evidence that the management team was responsive and keen to improve standards where possible.

At the time of our inspection eight people were living in the service. Our inspection was facilitated by a senior member of staff. This service provided accommodation for people suffering from neurological problems. Some people were able to tell us about their experience, others were not.

We observed that people had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support. We also saw that staff supported people’s changing needs and development.

We saw that people looked well cared for and they were treated with courtesy and respect by staff. Those who wished to were engaged in activities of their choice. One relative told us, “It’s an outstanding facility and we’re all very lucky to have found it”.

We saw that guidance regarding safeguarding people from abuse was available to staff and they had received recent relevant training. One person that we spoke with told us, “The staff are very capable and I feel as safe here as I have anywhere”.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged.

We saw that there was an effective complaints system in place and that complaints and comments were sought from people who used the service and their relatives. A person we spoke with told us, “I have never made a complaint but I did make a positive comment in the book”.

The inspection took place on 16 and 17 November 2015 and was unannounced. Glenside Farnborough provides residential accommodation and rehabilitation services for up to 22 people with brain injury and/ or neurological conditions. At the time of our inspection 14 people were living in the home. The home is a three storey building, with staff offices on the top floor. People were able to access both residential floors of the home and the garden as they wished.

The home had a 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.

Staff understood indicators of abuse, and followed procedures to protect people from harm. Training and guidance ensured staff knew the actions required to report and record safeguarding concerns.

Risks were identified and managed to reduce the risk of harm to people, visitors and others in the home. Regular checks and servicing ensured equipment was fit for purpose.

Staffing was sufficient to meet people’s identified needs. Levels varied in accordance with people’s changing needs. Rehabilitation assistants undergoing induction to the home worked in addition to rostered workers. This ensured that people were supported by a sufficient number of staff with the skills to meet their needs safely.

The registered manager completed a checklist to ensure all the regulatory requirements relating to staff employment were met. This ensured that people were supported by staff who had undergone relevant pre-employment checks to ensure their suitability for their role.

People were protected from the risks of unsafe medicines management and administration. Medicines were stored and disposed of safely. Team leaders who administered people’s medicines had appropriate training and competency assessments to ensure they did so safely.

Rehabilitation assistants completed and refreshed training to ensure they retained the skills required to support people effectively. They were supported through supervisory and team meetings to discuss and resolve issues to promote people’s effective care.

Rehabilitation assistants understood and implemented the principles of the Mental Capacity Act (MCA) 2005. They supported people to make decisions about their care, and consulted with relatives and others appropriately when people had been assessed as lacking the mental capacity to make a specific decision.

People’s dietary needs and preferences were known. Effective actions protected people from the risks of malnutrition or dehydration, and enabled people to eat independently where appropriate.

People were supported by regular therapy reviews to develop skills to promote their independence and promote their health. Effective communication ensured planned rehabilitation programmes were followed.

People and their relatives told us staff treated them with care and compassion. Relatives told us of the relief they felt because of the depth of kindness their loved ones experienced in the care provided. People were not rushed to respond to questions or make decisions, because rehabiliation assistants understood that some people required time to consider options and make their preference known.

People’s dignity and privacy was promoted. People were encouraged to leave their rooms locked to protect their private space, and staff respected people’s preference when they wished to be alone.

People’s needs were assessed with them or those able to lawfully represent them. Regular reviews ensured their care and support was updated in response to their progression towards independence or changing health needs. People agreed timetables to support their progression towards planned goals.

People were able to socialise as they wanted, and were encouraged to join in activities in the home and local community. Meaningful activities ensured people were engaged in activities that provided them with purpose and enjoyment.

Effective communication and the provider’s complaints procedure ensured that issues and concerns were addressed and resolved appropriately. People and those important to them were supported through regular meetings and contact with staff to share information and discuss any concerns. Feedback indicated that people and their relatives were satisfied with the care and support provided.

The home’s culture enabled people’s rehabilation and independence, because rehabilitation assistants understood their roles and the requirement to empower people to regain life skills. They took pride in empowering people to achieve their agreed goals.

Staff were highly committed to delivering high quality care. They listened to people’s comments, and worked with them to deliver the support they wanted. The registered manager was described as open, creative and supportive by relatives and staff. She used feedback from people, their relatives and staff to drive improvements to the quality of care provided, and nurtured staff skills. Staff were respectful of each other, and valued each other’s skills and support.

A system of robust audits and reviews ensured areas of development were identified, and an action plan demonstrated progression and completion of actions required. This information was shared in the home to explain to people, staff and visitors how their feedback, audit findings and national reviews were used to ensure people experienced high quality care at Glenside Farnborough.