Archived: Glenside Residential Care Home

Glenside is a residential care home that can provide long and short-term residential care for up to 30 younger and older adults with dementia and mental health needs. At the time of inspection 20 people were using the service

People’s experience of using this service and what we found

Staff did not have restraint training.

Some individual risks assessments for people lacked clear up to date information, however risks to people’s safety and well-being were understood by staff.

Not all staff and relatives felt there were enough staff on duty at times, however we saw evidence that call bells were responded to within short time frames on the day of inspection.

Care plans did not always include the information of which professional had made a recommendation linked to people’s care or contain the required information to ensure staff could respond to a specific need. However, staff knew people well and could tell us people’s needs, wishes and expectations.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had effective safeguarding and whistleblowing systems and policies and staff were knowledgeable about the types of abuse and the actions they should take if they had any concerns that people were at risk.

People were protected against the employment of unsuitable staff. The provider followed safe staff recruitment procedures.

Medicines were managed safely, medicines were administered as prescribed.

People told us the staff team were kind and caring, and we saw staff interacting with people in a patient manner and promoting independence

The registered manager worked in an open and transparent way when incidents occurred at the service in line with their responsibilities under the duty of candour.

The registered manager had systems in place to monitor the quality and safety of the service, and audits to monitor the environment and equipment had been carried out.

The registered manager evaluated their interactions with relatives, staff and other professionals through questionnaires and made changes to practice and operations where necessary.

We have made a recommendation about risk assessments.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was requires improvement (published 17 November 2017).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12, 14 and 15.

However enough improvement had not been made and the provider was still in breach of regulation 17.

The service remains rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence the provider needs to make improvements. Please see the Safe, effective, responsive and well led sections of this report.

Enforcement

We have identified breaches in relation to restraint, mental capacity assessments and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. 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.

Improvements were required to ensure that people were kept safe in the home. People had risk assessments in place which did not specifically address their identified needs or reduce the matters which put them at risk. The environment in which people lived was not always kept clean and hygienic or free from strong odours.

People were not supported to receive the hydration and nutrition that was necessary to keep them in optimum health. Some people had been identified as being underweight and appropriate support was not always in place to monitor, review and help people to improve their nutritional intake.

Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the environment and people’s care had not been identified in a prompt and timely manner, and there had been significant shortfalls as a result.

Improvements were required to ensure people received their medicines. Staff did not always take the time to ensure people had swallowed them and this meant there was a risk that people did not always consume the medicines they required. Improvements were required to review staffing arrangements to ensure people consistently received timely support, particularly around mealtimes which had been slow and unorganised.

People did not always receive appropriate support with their healthcare conditions, or the monitoring and on-going support with long term health conditions. In addition staff needed to be alive to people’s changing needs to ensure they received the support they required at all times.

Further consideration needed to be given to the training, support and supervision staff received to ensure they were competent and capable of providing good care to everyone within the home. Staff had not received regular reviews or feedback about their performance and this was an area which required improvement.

People were not always treated with dignity or respect or have their choices respected. We saw that there were examples of good care however we also saw that some people were not supported to have clean and undamaged clothing and appeared unkempt. Staff did not always display caring attitudes or put people’s needs at the forefront of their mind.

People’s care plans were detailed and written in great length however they were also repetitive and not specific to each identified need. Improvements were required to make them clear and succinct so care staff were in no doubt about the care each person received.

Many people and their relatives provided positive comments to the inspection team about the care they received. An activities programme was in place to add variety to people’s day and we saw examples of staff interacting and praising people when they made attempts to join in.

Staff had an understanding of safeguarding procedures and how they should report any concerns and appropriate procedures were in place for the safe recruitment of staff. There were examples of good care and the registered manager was able to explain how they had made significant efforts to ensure one person could spend their birthday with the people they cared about.

We identified that the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) and we have issued Requirement Notices in relation to three of these breaches which can be found at the end of this report. In relation to the fourth breach of the regulations, full details of this will be added to the report after any representations or appeals have been concluded.

Following feedback to the provider and registered manager, significant action had been taken to address our immediate concerns, particularly with the environment and managing people’s nutritional needs. However further action was required to make further improvements and to sustain the changes that had been implemented.

We found that detailed care assessments formed the basis of the individual care plans, which gave information on people's support requirements, daily routines, hobbies and interests.

We observed how people with dementia were supported over lunch time. We saw that people were encouraged to maintain their independence with eating and drinking. People who required more support with their daily living needs had this provided by staff who treated them with respect and supported people at a relaxed pace.

We saw that records of people's care were held under a secure electronic filing system and records within people's individual care plans were regularly reviewed and updated as people's needs changed.