Gloucestershire House - Care Home with Nursing Physical Disabilities

Care and support were provided to people living with physical disabilities as a primary care need, however in some cases people also lived with learning disabilities as a secondary care need. Due to this reason, we assessed the care provision under Right Support, Right Care, Right Culture.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

While people’s feedback about living at the service was largely positive, we identified concerns relating to the safe management of risks, medicines, infection prevention and control, staffing and consent. We also identified significant shortfalls in relation to governance systems.

We found 2 breaches of the legal regulation relating to safe care and treatment and good governance.

Staff treated people with kindness, dignity and respect, and people were involved in decisions about their care and support. We observed positive interactions between people and staff throughout the assessment. We found staff knew people well, understood their preferences and promoted their independence, choice and control. People had access to a range of activities, community opportunities and healthcare support, and there were examples of innovative approaches to promoting independence and inclusion. However, systems to identify, assess and manage risks were not always effective. People’s care plans and risk assessments did not consistently provide staff with sufficient guidance to manage identified risks safely. We found shortcomings in environmental risk management, medicines management, infection prevention and control practices, consent documentation and aspects of staffing and staff development. Although staff demonstrated good knowledge of people and leaders acted promptly on some of the concerns raised during the assessment, these issues meant people could not always be assured of consistently safe care.

The service continued to demonstrate good working practices with healthcare professionals, supporting people to maintain relationships, participate in their communities and pursue meaningful goals. However, governance and quality assurance systems were not robust enough to identify and address concerns in a timely way. Audits, monitoring processes and oversight arrangements had not consistently identified or addressed without delay the issues found during this assessment.

Overall, although people experienced compassionate and person-centred care, improvements were needed to governance, oversight and risk management to ensure people consistently received safe, high-quality care and support.