Archived: Gulliver House

Updated 26 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced and was carried out by an adult social care inspector. Inspection site visit activity started on 30 April 2018 and ended on 2 May 2018. We visited the office location on 30 April 2018 to see the manager and staff; and to review care records and policies and procedures. The office is in a property in Whitehaven where nine people live, so we also met people on that day and on the second day of our inspection where we met with other people who use the services.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. This was received in a timely manner and in good detail. We also reviewed the information we held about the service, such as notifications we had received from the registered provider. A notification is information about important events which the service is required to send us by law. We also spoke with social workers, health care practitioners and commissioners of care during our regular meetings with them. We planned the inspection using this information.

We met with the registered manager, the administrator, five support workers and the support worker lead for outreach services on the first day. On 2 May 2018 we met with three other support workers and the deputy manager.

On the first day of the inspection we met with five of the seven people living in Gulliver House. We also met a new person who was planning to move in. On 2 May 2018 we met with three people who lived in Gulliver House and two people living in the wider community when we had the opportunity to talk to people at length about their experiences.

We spoke with people, asked their views and observed them in the shared spaces at Gulliver House. We read four case files for people living in the tenancies in Gulliver House and three case file for people living in the wider community. These included care and support plans, assessments, recovery and contingency plans.

We also spoke with staff and asked them about the work they did. We looked at five staff files. These included information about recruitment, induction, training and any welfare or competence matters. We also received a copy of the training matrix and the training plan for the service.

We looked at quality audits and we received copies of quality reports prepared by the organisation as a result of surveys and audits.

Updated 26 June 2018

This was an unannounced inspection that took place from 30 April 2018 to 2 May 2018. The service was last inspected in January 2016 when it was rated as good.

Gulliver House is the base for supported living and outreach services for people living with enduring mental health issues. Gulliver House itself has nine bedrooms for people who need support to help them recover or stabilise. There were seven people living in these tenancies at Gulliver House when we inspected. The service also provides outreach support to people in the local community. At the time of our inspection nine people were being supported in the wider community.

This service provides care and support to people living in one 'supported living' setting [Gulliver House], so that they can live in their own home as independently as possible. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Gulliver House receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a suitably qualified and experienced 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 staff and people who use the service told us the registered manager was very approachable and people trusted her ability and her integrity. The service had an open and inclusive culture where people were consulted and where staff views were respected.

Staff had received training on ensuring people were kept free from harm and abuse. The staff team understood how to report any safeguarding matters and the registered manager responded to any risks. Turning Point had a confidential phone line for staff to report any concerns.

Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed, action taken to reduce risks and consideration of the issues under a 'lessons learned' approach.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. There had been a temporary increase in night staff to meet the assessed needs of people in the service.

Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.

Medicines were appropriately managed. People had their medicines reviewed by specialist nurses, psychiatrists and by local GP's. Self-medication was encouraged as people moved through their recovery plan.

Staff were trained in infection control and supported people in their own environment.

Induction, training and supervision had helped to develop the staff team. Staff received training around principles of care in relation to people living with complex mental health conditions. They also received induction and on-going training in a wide range of subjects. Restraint had not been used in this service.

Consent was sought for interactions. Even when people were in the service under an order related to the Mental Health Act they were still consulted about preferences.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to get good health care support from local GPs, specialist community mental health nurses and psychiatrists. Staff supported people to get help with physical health problems. Staff worked with people to support and encourage them to visit relevant health care providers.

Staff supported people to shop, budget and prepare food. Healthy eating was covered in group work and staff encouraged people to cook as much as possible.

Staff displayed a caring and respectful attitude and were also able to support people who were suffering from the symptoms of mental ill health. People told us the staff were caring and that they understood their needs. Independent and specialised advocacy could be sourced for individuals as people in the service were under the care of mental health professionals. People were supported to use services like Citizens Advice Bureau.

Each person had been assessed by a psychiatrist and we saw full assessment of need on file from social workers and other specialists. The staff team continued the assessment process once the person started to use the service. Detailed care and support plans were in place, along with contingency plans for any mental health crisis. Many of the people in the service had written their own assessment of need and parts of their care plans.

People were encouraged to do their own household chores and to manage their own affairs. They were supported by staff to manage their lives. People in Gulliver House attended regular group sessions as part of their recovery. People were encouraged to go out and to engage, where possible, with sport, learning and social events in the wider community.

Complaint procedures were in place. There had been no complaints received about the service.

Turning Point had a suitable quality monitoring system used in all their services. This service used the quality assurance system to good effect. This was evident in internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.

Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.