The Glen

The Glen 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 care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of inspection there were six people living at the service.

The registered manager was not present on the day of the inspection. 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 registered manager for The Glen oversaw several services and a service manager was responsible for the day to day running of the individual service. The locality manager for The Glen was present during the inspection.

At the last inspection, we rated The Glen as 'Good.' Since that inspection, some elements of The Glen have remained good, while other areas have become outstanding. The provider had made some changes and improvements to the environment to help support communication and to help people feel more relaxed. Staff had developed and built on the good support previously provided, they had worked with healthcare professionals to increase people's quality of life.

The Glen accommodates up to nine people. People living at The Glen had some complex health needs. Staff had to use creative ways to support people to live the lives they chose. Staff were determined to provide people with the best possible opportunities in life. Staff linked people to specialist health professionals who updated them on the latest research and supported people with the latest treatments.

People were given support to live a more active and meaningful life. It was clear that staff were very caring and committed to supporting people to live fulfilled lives. Staff shared the provider's vision, that 'everyone is unique, every day is special.' Staff tried to make every day special by trying to ensure people had a good day every day. People smiled and laughed with staff and staff responded to people and colleagues with kindness and respect. Staff felt supported, included and valued by the whole management team, one stated "I would never do anything else ."

Staff worked innovatively with people, their families, friends and health professionals to overcome challenges, big or small. The staff team had an excellent working relationship with a range of professionals. These professionals told us how staff always valued their suggestions and created action plans to implement them. Relatives echoed this, praising the "amazing" relationship they had with staff had with

people and praised the support staff provided to their loved ones.

Staff supported people to increase their skills, including cooking, cleaning and budgeting to enable them to live more independently. People had developed skills and grown in confidence and some had moved on to live more independently. The provider had adapted the premises to accommodate and adjust to people's changing needs. Noise was a particular issue for some people so the provider had adapted the premises to reduce the amount of noise. This had led to one person becoming less upset and anxious.

Since the last inspection, the manager had worked with speech and language therapists to introduce assistive technologies. These technologies enabled people to explain their wishes and preferences more clearly. A tablet computer had been used to help people to choose what meals and activities they would like to take part in, by using pictures and using sounds and voice activation. One person had recently used this method to indicate their interest in horses, staff explored this and as a result the person now had horse riding lessons.

People's needs were constantly assessed and support was constantly adjusted to meet people's changing needs. Staff had an extremely good understanding of people's needs and responded to any changes to people's physical and emotional health. Staff could tell us how people communicated when happy, sad or in pain and understood how people communicated.

Each person was involved in developing a support plan detailing their dreams and aspirations and the support they needed to achieve. People and their loved ones were involved in planning the support they might need should they become unwell or at the end of their life. Risk was well managed without restricting people from activities they enjoyed.

The provider had researched continuous improvement opportunities to improve how they recorded, monitored analysed and responded to every aspect of people's day to day lives. For example, a computer system enabled staff to build a virtual picture of each person, detailing and analysing health conditions and any incidents. This provided staff with a more detailed insight of people when providing care and when formulating plans with health professionals.

People had a say about who was appointed to support them and induction training focused on people's specific needs. Staff attended a range of training including interactive training which tried to replicate how it feels to live with autism. Staff told us that this helped them to understand and support people. The managers made sure that there continued to be enough staff around when people needed them. Staff continued to be recruited safely.

The leadership of the service was strong and the managers had a 'can do' attitude supporting people to achieve despite their complex needs. Staff regularly attended a variety of forums on best practice. Key information on best practice was then disseminated to the rest of the team. The Glen were featured in a recognised national best practice guide for adult social care provider's seeking a 'good' or 'outstanding' rating.

Each person's unique needs relating to eating and drinking were supported in a unique and innovative way. Staff worked with dieticians and speech and language therapists to formulate plans, which supported people to control their diabetes, and to lose or gain weight. People were supported to take part in a range of physical activities, such as swimming and walking.

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 support this practice. People were supported to have as much control over their medicines as they were able. People's information was kept securely in the office and staff respected people's privacy, dignity and confidentiality.

Staff knew what action to take if they witnessed or suspected abuse. Information about abuse was communicated to people in a way that was meaningful to them, using pictures, straightforward language and signs. Managers actively encouraged staff and relatives to share concerns and complaints.

The managers were constantly looking at ways to improve and made improvements in response to questionnaires sent to staff, relatives and health and social care professionals. The manager had analysed the responses and made changes including; organising tailored training for staff and some redecoration of the premises. The registered manager used effective systems to continually monitor the quality of the service and had ongoing plans for improving the service people received.

The registered manager and registered provider (LDC) attended and chaired a variety of different forums for health and social care professionals in East Kent. The forums enabled LDC to build up relationships with professionals and organisations locally. LDC also attended a host of public events and recruitment fayres to improve people's knowledge of and attract people to a career in health and social care.

Further information is in the detailed findings below.

The five questions we ask about services and what we found