Glenwood Care Home is purpose built and provides nursing care, support and accommodation for up to 12 people with a learning disability who may also have a physical disability or mental health need. The home comprises two six bedded bungalows with a connecting link corridor and conservatory. At the time of the inspection there were nine permanent residents. One person stayed in the home for respite care four days a week and another stayed for four days every other week. There was one vacancy.

At the last inspection the overall rating of the service was rated good, but the safe domain was rated as requires improvement because there were some issues relating the safety and suitability of the premises. At this inspection we found that these matters had been addressed.

The people living in the home were unable to converse with us, but we observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care. We saw that people who lived at the home were clean and well dressed and they looked relaxed and comfortable in the care of staff supporting them.

The local authority who commissioned care for people who lived at Glenwood told us that they thought it was a good service.

We found staff had been recruited safely and were appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs. Staffing levels were sufficient to meet the needs of people who lived at the home and enable them to play an active part in the local community.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

The home was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The registered provider understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People’s nutritional needs were met. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people's changing needs. People had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

The service had a complaints procedure which was made available to people and their relatives. We saw the registered provider had listened and responded to issues of concern raised by the family of one person and these were being addressed when we undertook our inspection visit.

The registered provider used a variety of methods to assess and monitor the quality of the service. These included seeking the views of people who used the service and their families or representatives, seeking the views of staff and a regular programme of audits carried out by the registered manager, the regional manager and their Quality Excellence team.

We carried out an unannounced inspection of Glenwood Care Home on 14 December 2015.

The home is purpose built and provides nursing care, support and accommodation for up to 12 people with a learning disability who may also have a physical disability. The home comprises two six bedded bungalows with a connecting link corridor and conservatory. At the time of the inspection there were five permanent residents and another permanent resident was in hospital. Another person was there for long term respite care. The home also provides care for four other people on a short term respite basis and on the day of the inspection one of these people was just going home and another came in later that day.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Prior to this inspection we received feedback from the local authority contract monitoring team and during the inspection we spoke with a visiting health care professional to seek their views of the service. They did not have any concerns about the care.

We found breaches in the regulations related to fire safety and maintenance of the premises. You can see what action we told the provider to take at the back of the full version of the report.

The experiences of people who lived at the home were positive.

People’s needs were assessed and plans were developed to identify what care and support people required to maintain their health and wellbeing and foster their independence where possible.

People were protected from abuse. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People’s health care needs were met and their medicines were administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Staff received suitable induction and training to meet the needs of people living at the home. Staff were well supported by the manager. This meant people were being cared for by suitably qualified, supported and trained staff.

There were systems and processes in place to monitor the quality of the service. Audits were carried out and where shortfalls were identified the manager was using the information to improve the service. This demonstrated that it was a learning organisation.

People living at the service looked happy with the staff supporting them. They looked comfortable when seeing staff they knew and we observed staff asking each person what they would like to eat and drink and what they wanted to do during the day. The staff supported people in making their own choices.

We spoke to two relatives who were very positive about the service and the choices and support offered to their relatives. They made various positive comments such as:

“I can't fault them at all, anything wrong staff ring me up”; “We are always made to feel welcome”;” It's like a home from home”;” Our relative went on holiday recently with the staff and is very happy about the holiday”; “We have had previous meetings with social services and the community matron to help review the care plans in place” and “We are aware of consent forms to be completed for dentist treatment. The home's staff have made all the arrangements for this which we are happy about”.

A representative of the organisation visits Glenwood on a regular basis to check on the standards offered and to see how it was being managed. We looked at a sample of these reports. They showed detailed checks offering ongoing evidence of compliance and actions taken to show good practices in supporting people at the service.

We contacted the local authority’s contracts department prior to our inspection. They advised they had no concerns about Glenwood.

We met everyone living at Glenwood nursing home throughout the day.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

“We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.”

People living at the home looked content: happy and comfortable with the staff supporting them. They looked happy when seeing staff they knew and they used non verbal signs to communicate with staff who knew their needs.

We saw many examples of good communication and patience by support staff, who interacted with people they were supporting in a positive manner. Staff were friendly and respectful to the people they were supporting.

People who live in the home were seen making decisions on, for example when they wanted to get up; whether they spent time in their bedrooms or in the communal lounges or in going out.

We observed staff being respectful of people’s privacy and dignity.

We spoke to four relatives who were all very positive about the service and the standard of care provided. They made various positive comments such as;

“We visit at different times and we have no concerns they are excellent.”

“The staff are lovely with my relative they go out a lot in the specially adapted minibus.”

“We have no problems but if we did we would speak to the manager.”

“We are very pleased they are well looked after.”

Relatives who visit the service regularly told us that they were happy with the care and the staff at the home, they were complimentary about the staff and the manager and said they would not hesitate to raise any concerns or queries with them. They felt that the home was meeting their relatives' needs. One thing they felt they would like to see improvements in was to see more activities on offer especially in the home when people stayed in for the day.

We met visiting professionals to the home, one was a speech and language therapist and two people were from the Primary care trust (PCT) visiting to carry out commissioning reviews of care and support given to people placed at the service. They all expressed how the service had improved over the last 12 months and they were happy with the standards of support given and with the record keeping with care plans showing clearly how people were being supported. They felt that the manager had worked hard in getting a stable team together as the service had recruited a lot of new staff over the last 12 months. They also felt that the people at the home would benefit from more activities being organised especially in house when the weather was bad and when people were staying in all day.

They felt that staff were motivated and positive in getting involved in training provided by them especially in helping them develop skills in supporting people with their meals and enabling them to choose their meals with the use of detailed communication records to help with food diaries.

The staff told us that they were much happier as a team and that over the last 12 months they had a lot of new staff and had received a lot of training. They felt that the manager was very positive and that they had benefited from a lot of changes to be able to support people better and in a more positive way to help people choose what they wanted to do each day, eg they explained that they would help people choose what they wanted to wear by taking their time in getting their clothes out and helping identify their choices through their recognised behaviours in ways they communicate to them.

They felt that as a team they had changed and become more focused in constantly trying to improve their practices and would regularly try to promote good practice with each other. They were very positive and motivated as a team and also felt they needed more facilities and resources to provide more activities in house. They had lots of innovative ideas that they felt would help benefit the people living their.