Archived: Glynn Court Residential Home

Following our inspection in August 2013, we took enforcement action against Glynn Court Limited and the registered manager in respect of this regulation. We carried out further inspections in October 2013 and found the provider had made improvements to the assessment and planning of people's care needs. However, at the time of our inspection, not all risks had been assessed appropriately and care plans were not always followed.

We met with the provider and registered manager in November 2013 and the registered manager told us that they had taken action to comply with the regulations. We carried out a further two-day inspection in January and February 2014 and found that the provider had made some improvements to the assessment and planning of people's care needs. However, we again found that not all risks had been assessed appropriately and care plans were not always followed.

During our previous visits we also identified concerns with a number of other areas within the home; staffing levels, staff supervision and training, medicines management, and record keeping.

During our inspection in September 2014 we checked to make sure that improvements had been made in all areas where we had previously found non compliance.

We spoke with seven people who used the service and eight members of staff, as well as the registered manager. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us that they felt safe. Friends and relatives told us they thought people were safe and had no concerns.

We found the service was safe in relation to the risks to people associated with medicines. The provider had appropriate arrangements in place to manage people's medicines safely.

However, people were not always safe because staff did not always know how to support them appropriately to protect them from identified risks and people were not always supported in line with their care plan.

The home did not have effective systems in place to identify, assess and monitor risks in relation to infection control and the environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with a senior member of staff who told us one person no longer had capacity. However, we found that a mental capacity assessment had not been completed. We were told this person was under supervision to prevent them leaving the premises. However a DoLS application had not been made. This meant that people were at risk of being deprived of their liberty unlawfully.

Is the service caring?

We found the home to be caring. People told us that they were treated well by staff and that they felt listened to and their wishes respected.

During our inspection, we observed staff interacting with people with kindness and respect. People were treated with dignity and their needs attended to.

Is the service effective?

We spoke to a visiting GP who told us they were contacted by the home on a regular basis to seek advice and support in relation to people's care. However, we found the service was not always effective in relation to people's care. Staff were not always aware of people's needs or the risks associated with these.

Is the service responsive?

We found that the service was not always responsive. Although we spoke to a visiting GP who told us they had no concerns about people's care, we found that care plans were not always updated to reflect their changing needs and we saw that where some people had risks relating to their behaviour, these had not been identified by the provider. People had not been protected from inappropriate care as staff had not always identified their changing needs or risks.

Is the service well lead?

We found that the service was not well led. The registered manager had not put systems in place to identify, assess and monitor people's medicines or infection control procedures. Some actions identified as a result of audits and external inspections had not been completed or had been missed.

Staff activities had not been effectively monitored to pick up errors in people's care plans and risk assessments.

Complaints had been responded to but there was no information to explain what investigation had taken place or how the outcome had been determined.

There was no analysis of incidents to inform staff how to learn from these and reduce the risks to people in future.

Staffing levels at night varied between two and three members of staff. Staff told us that when three staff were working, they were able to meet people's needs in a more timely way and felt that the quality of people's care improved. This was echoed by a person who lived in the home who told us that they had noticed a difference when there were three staff on duty. They told us, "They themselves are not so pressurised when there are three of them."

The registered manager was aware of this concern and confirmed that they were taking action to employ more staff so that there were always three members of staff available during the night shift.

We found that night staff did not always have appropriate qualifications, skills and experience to meet people's needs in an emergency. There were some night shifts where no staff on duty had up-to-date training in first aid. This meant that there was a risk staff would not be able to respond effectively in an emergency situation. More robust arrangements were also needed to confirm the qualifications, skills and experience of agency staff who came to work in the home to ensure they were suitable to provide care.

We reviewed the supply process, supporting information and administration records. Medicines were obtained in a timely manner. Staff showed us where and how medicines were stored and temperature records they kept. Since the medicines storage rooms were not secure and the temperature records were not complete we were not assured that the medicines were safe to be administered.

We reviewed the medicines administration records and supporting information. Whilst the service was preparing information to support staff in administering creams and ointments, similar information was lacking for 'how a person preferred to take their medicines', 'if required' and 'variable dose' medicines. Whilst the records for regular medicines were complete most of those with a variable dose lacked the exact dose taken.

We observed the administration of medicines at lunch time where we saw that staff knew how each person liked to take their medicines. We spoke with one person using the service who told us, 'They do not run out of medicines and we only receive those prescribed by the doctor.' We were also told that changes to medicines were explained to both them and their family.

We found that the home had made improvements where we had identified concerns at previous inspections. However, they had not identified and addressed new risks. For example, care had not been planned appropriately for two people who had recently come to live in the home. Records about their care were not always accurate or complete. Although staff who worked in the home felt supported, the home was not following their policy to ensure that new staff received appropriate supervision during their induction period or were supported with their induction training. This put people at risk of receiving unsafe or inappropriate care and meant that the home remains in breach of three regulations.

In spite of these failures, we found that staff were highly motivated and delivered people's care in a kind and sensitive way. Staff were attentive to people's needs and encouraged their independence and choice. We spoke with some people who lived in the home and their relatives. They were very positive about the care they received and told us that staff were very good and treated them well. For example, one person told us that they were "very happy" with their care while a relative told us that they were "very pleased" with the way staff looked after their family member. Staff were also aware of people's needs in relation to eating and drinking and ensured they were given appropriate support to eat their meals.

The registered manager had made some improvements to the handling of complaints. They had, for example, ensured that a person who had raised concerns had received a response in line with the home's policy. Most of the people we spoke with had confidence that staff would listen to them if they had concerns about their care and felt they would be taken seriously.

During this inspection we found that the provider was making improvements to the way they assessed people's needs and planned people's care. People's care plans and risk assessments were being reviewed to ensure that their care was delivered in a safe way. However, we found that not all risks had been assessed appropriately and one person's care plan had not been followed. This meant that there was still a potential risk of people's needs not being met.

The registered manager told us that they would continue their review of people's care to ensure that people's needs were met. However, at the time of our inspection, we found that the home remained not compliant with the regulation about the care and welfare of people who use the service.

During this inspection we found that people were satisfied with the care they received and the way they were treated by care staff. They told us that staff were kind, compassionate and responsive to their needs. However, we found that people's needs had not been assessed properly and care was not planned to ensure their safety and welfare. We also found that records about people's care were not accurate or complete. This put people at risk of receiving inappropriate or unsafe care.

There were arrangements in place to provide training and informal support to staff. Staff told us they felt supported and received training to help them develop in their roles. However, the home was not following their procedures to ensure that all staff received appropriate supervision and appraisal to carry out their work.

The provider had not ensured that complaints about the service were received, handled and responded to appropriately. Although the home had a procedure about managing complaints, we found that this had not been followed to ensure that people who raised concerns received an appropriate response.

The home was clean and there were procedures in place to ensure that standards of cleanliness were maintained. People who lived in the home and their relatives told us that the home was always clean because housekeeping staff worked hard to make this happen. There were some procedures in place to minimise the risk of cross infection.

People reported that the home was clean and that staff followed procedures to ensure that the risk of cross infection was minimised. They also told us they were comfortable and warm in the home and expressed high levels of satisfaction with the food and laundry services provided.

People told us that, on the whole, there were enough staff to meet their needs but there were occasions when staff seemed stretched and they had to wait a short time. However, people had confidence in their care workers, telling us they had the right skills and knowledge to support them effectively. People told us that the manager and staff were approachable, listened to any concerns they had and took action to put things right.

Although the feedback we received from people who used the service was positive, we identified some shortfalls in care planning, risk assessment, infection control audits, staff supervision and the home's complaints procedures. We have made compliance actions to ensure that the home fully complies with the regulations in these areas.