Archived: Glendaph Nursing Home

Examples were seen of good efforts being made to respond to people's changing needs such as setting up palliative care support for one person and liaising with specialists regarding possible surgery for another person. It was positive to see one man who had been bed bound and very ill on admission in 2010 being taken outside in a wheelchair for some fresh air.

People told us they thought the meals were nice and they were given a choice. Only a few people get offered the opportunity to eat in a social setting because the downstairs lounge is small and there is no dining room.

Some of the care staff had worked in the home for many years. One person told us he was worried that a care worker he had known for many years was leaving soon. She usually helped this person do his physiotherapy exercises. There were only two permanent nurses employed at the time of this review and efforts to recruit locally had been unsuccessful.

One person had raised a complaint about the way they had been treated by a care worker, and the manager dealt with this quickly and appropriately. Concerns had been raised recently by two families to outside agencies. They were offered support by Wye Valley NHS Trust in addressing these.

Evidence continued to show that people were not being provided with sufficient personalised and meaningful activities. The appointment of a care worker to a part time role as activities co-ordinator had not been backed up with actual time to do the role, training or resources so she had not been able to have a big impact on the quality of life of people in the home. At a recent review meeting a family member told the PCT nurse there were no concerns but they would like more activities to be provided and for their relative to come out of their bedroom more often.

We found that care planning had been improved through the hard work of the manager and clinical lead nurse. There were still gaps in important areas such as dementia care, and social and emotional needs. Errors and inconsistencies were found on important records such as wound management plans.

The Wye Valley NHS Trust continued to be concerned about how people's health, care and welfare needs were being met. Their monitoring visits and review of individuals' care that were started in October 2010 were continuing.

Safeguarding alerts continue to be raised about the care and treatment provided to individuals. Concerns relate to areas such as a lack of drinks being given which puts people at risk of dehydration, pressure sores and existing medical conditions becoming worse. One person had been provided with the wrong pressure relieving mattress for 14 weeks before a visiting health professional noticed this. During this time the person's pressure areas deteriorated.

The call bell system had not been properly maintained for many months. We found it not working at all but no action had been taken to tell people in the home or to repair it. There was no system in place to check the system was working effectively on a regular basis.

Infection control and cleaning arrangements had been improved but staff were observed to not always be following basic good practice.

The clinical lead nurse had worked hard and improved the way medicines were managed. The system was safe at the time we inspected it on 26 July 2011.

There had been little progress on the improvement needed to the internal environment. People were seen in bedrooms with stained and torn carpets, chipped old furniture, insufficient storage, rusty beds and tables and ripped arm chairs. There was a shortage of basics such as flannels, and thin ripped sheets and frayed towels were in use. Refurbishment had started in one bedroom but the work did not progress over the two weeks we visited as part of this review. The cost of the refurbishment had not been assessed and there was no time frame from completion.

The standard of specialised equipment available to meet people's physical care and

handling needs had improved. Support with assessing people's handling and equipment needs continues to be provided by the Wye Valley NHS Trust as the home does not employ a specialist.

Wye Valley NHS Trust had provided training for the Glendaph nurses on specific clinical areas. The manager had also set up training to cover some of the training gaps in areas such as moving and handling and safeguarding vulnerable adults. Gaps remained in basic areas such as the induction for new workers, first aid for nurses and infection control for all staff groups. There was no training plan in place and no training budget.

The fire safety improvement order had not been fully met but work was progressing with the upgrade to the electrical system near to completion.

For the first time in 2011 we assessed what systems Geoshine Ltd had in place to monitor the quality of the service and ensure essential standards could be reached and maintained without the close monitoring of regulators and other agencies. We found that the Quality Awards advertised in the home, on literature and on the web site were not current.

'The new policy regarding internal quality assurance processes was incomplete, included headings that had been newly inserted in freehand and did not specify timescales for key activities such as audits. We found that many audits had not started and where Dr George had identified poor levels of care through a spot check process this had not led to improvements in overall systems to benefit all of the people living in the home

There was a lack of financial planning for the business and there were no running cost budgets. There were no clear lines of accountability between Dr George, the manager and the clinical lead nurse and communication between Dr George and his senior team was not always effective.

The manager has been in post since January 2011 but she had not submitted her own application to be registered with us. For not establishing an effective quality assurance system or having a registered manager in place Geoshine Ltd was in breach of two conditions placed on its registration at this location.

Dr George, the sole director of Geoshine Ltd, agreed a voluntary block on new people being admitted to the home with external agencies in May 2011. This block remains in place. This was positive, but the company must speed up the improvements to fully meet the needs and provide dignity and respect to the people currently living in the home.

Geoshine Ltd need to demonstrate that effective overall management systems have been put in place before the level of confidence in the service will increase and agencies will agree to support new people being placed at the home.

A part time activities worker is employed but some feedback indicates people would like more opportunities to take part in social activities. Religious services for different faiths were now being held in the home.

When health and social care professionals have held review meetings for individuals, often with their relatives present, feedback about the care provided was generally positive.

External agencies continue to be concerned about how people's health, care and welfare needs are being met. Herefordshire County Council and Primary Care Trust held a meeting with the relatives of people in the home in May 2011 to share their concerns and to encourage two way communications which will help them as they continue to monitor the service.

We found that people were not having some of their assessed health and care needs met such as regular baths and monitoring of health areas such as weight and blood pressure. We were concerned that a higher number of people than we would expect were developing sores in the home. Over a nine day period in April five people developed sore areas on their body.

The continued shortfalls in the way medicines were managed by the home had put all people using medicines at risk of not receiving their medicines correctly.

The standard of specialised equipment available to meet people's physical care and handling needs was being improved. Support about people's handling needs was being provided by the Herefordshire Primary Care Trust as the home owner does not employ a specialist.

The staff training records show that the majority of the current team staff team were not trained to a level we would expect in a specialist service.