Archived: The Glynn Residential Home

The Glynn is a residential care home providing personal care to 28 people aged 65 and over at the time of the inspection. The service can support up to 38 people.

The Glynn accommodates 38 people over two floors, with communal areas on the ground floor.

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

People were at risk of avoidable harm because risks had not been adequately assessed, monitored or mitigated. Care records did not contain sufficient information for staff to know how to care for people safely or understand their individual risks. Staff had not received adequate safety related training. Equipment was not assessed for individual use, or robustly checked to ensure people could use this safely. Systems and processes did not ensure the safe management of medicines or suitably skilled and trained staff.

Quality assurance processes were weak and no improvement had been made to address the breach at the last inspection or recognise further breaches in regulations we identified at this inspection. Audits were incomplete and ineffective and did not identify issues highlighted through the inspection process. Records of people's care were not accurate or detailed.

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 13 July 2019) and there was a breach of regulation 17, Good governance. The provider sent us an action plan to show what they would do to improve. At this inspection, enough improvement had not been made/ sustained and the provider was still in breach of regulation 17, with further breaches identified in regulation 12, Safe care and treatment, regulation 13, Safeguarding service users from abuse and improper treatment and regulation 18, Staffing. There was a breach in part of the registration regulations in relation to the requirement to notify CQC of significant events.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to whistleblowing concerns received about poor management of risks. The inspection was also prompted in part by notification of a specific incident following which a person using the service died following a serious injury. This is subject to a separate investigation by CQC. The information CQC received about the incident indicated concerns about the management of individual risks to people's health and safety. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider took some immediate actions following the inspection, such as arranging for lifting to be serviced and referring to the GP for people's specific health needs.

We reviewed the information we held about the service. No significant areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Glynn on our website at www.cqc.org.uk.

Enforcement.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people's safe care and treatment, safeguarding people from abuse, staff skills and staff training, and management of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to notify CQC of safeguarding concerns. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We met with the provider following the inspection, to seek immediate assurances about the concerns found. We liaised with the local authority to ensure their support for the provider to improve.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: People told us they felt well cared for by staff who were kind. Relatives said they were always made to feel welcome when visiting their family member.

The environment was not clean, we saw carpets were stained and worn, and two radiators were very hot to touch on day one. Wesaw one window restrictor had broken in the bathroom. This was replaced the same day. On day two, radiator covers had been ordered for the home. The registered manager told us they would look at the redecoration and carpets in the home. An action plan was sent to us after the inspection to support the plan to complete this.

Records relating to people's care were not always fully completed in line with their needs. This was addressed immediately by the registered manager by the second day of inspection.

Further guidance was needed to ensure people received their ‘as required’ medicines when they needed them.

We did not always see staff engagement with people on day one. For example, staff did not always engage in conversation with people when they entered the room. We did not see much interaction around activities on either day of the inspection. On day two we saw staff engagement had improved.

Systems were in place to monitor the quality of care provided and improve the service. However, we found these systems were ineffective and failed to highlight the shortfalls we identified during the inspection.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Staffing numbers were sufficient to keep people safe, however we felt deployment of staff should be looked at by the registered manager.

The provider followed safe recruitment procedures to ensure staff employed were suitable for their role. Incidents and accidents were investigated, and actions were taken to prevent recurrence.

Staff completed an initial induction. Staff felt supported and received supervision and appraisals of their performance.

Care was delivered by staff who were trained and knowledgeable about people's care and support needs. People were provided with a nutritious and varied diet and they were mostly complimentary about the quality and choice of food offered.

People and their relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

People's views and concerns were listened to and action was taken to improve the service as a result.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published May 2018).

Enforcement: We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and documentation. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At the last inspection in July and August 2017 we rated the service as ‘Inadequate’ and identified six breaches which related to dignity and respect, person-centred care, staffing, safe care and treatment, consent and good governance. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The Glynn Residential Home provides accommodation and personal care for up to 38 older people, some who are living with dementia. There were 29 people using the service when we visited.

The home had a registered manager. The registered manager was new to the role but not to the service. 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.

We saw improvements to people’s care plans which were more person centred. We saw mental capacity assessments in place for people. However we saw two people had been living at the home for over two weeks but their care plans had not been completed in full. We spoke to the registered manager about this who completed this with family by the second day of inspection.

We saw staffing levels and staff interaction had improved, we saw people were engaged more with staff and activities were more visible on both days of the inspection. Staff told us they felt valued and felt supported by the new registered manager. We saw recruitment was robust and training was in place for all staff. Staff were aware of safeguarding people and who to contact if they had any concerns.

Medicine management had improved with twice weekly audits in place.

We saw moving and handling techniques in the home. On one occasion we saw staff unable to transfer one person out of their chair, the person clearly did not want to move. However we did see some good moving and handling practices on the second day of inspection. We spoke to the registered manager of the importance of ensuring appropriate information was in the person’s care plan to support staff on what they should do on these occasions. The second day of inspection this had been documented in the moving and handling risk assessments and staff were fully aware of these.

We saw people’s privacy and dignity was respected. Staff were respectful of people’s needs and we saw occasions where staff spoke discreetly to people around their personal care needs, however we also overheard staff speaking loudly about a sensitive matter which was overheard by the inspectors. We spoke to the registered manager about this one occasion and this was addressed immediately.

We saw complaints and compliments were recorded and responded to appropriately. We saw a more robust audit trail within the home. The new registered manager had a good insight of where the home was at and what they needed to put in place to improve standards. We saw accident and incident analysis at the home. The registered manager told us, “We know where we were and where we are now, moving forward we have tried so hard to improve on areas identified at the last inspection and we will continue to do this.”

At the last inspection in April 2016 we rated the service as ‘Requires Improvement’. We identified three breaches in the regulations and issued requirement notices in relation to people’s mental capacity and assurance about the quality of the service. We issued a warning notice because medicines were not always administered in a safe way. This inspection was to check improvements had been made and to review the ratings. However, we found although there had been improvements to the management of medicines, there were continued breaches in the regulations and three new breaches. Continued breaches were in regulation 11 need for consent, regulation 12 safe care and treatment and regulation 17 good governance. Further breaches were in regulation 9 person centred care, regulation 10 dignity and respect and regulation 18 staffing.

The Glynn Residential Home provides accommodation and personal care for up to 38 older people, some of who are living with dementia. Accommodation is provided over two floors with communal areas, including three lounges and a dining room, on the ground floor. There were 31 people using the service when we visited.

The home had a 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.

Staff understood how to follow safeguarding and whistleblowing procedures to keep people safe from abuse. People’s individual risks were not always known or recognised by staff, and there was missing information in care records about how to care for people safely.

Staffing did not meet people’s needs; lounges were unattended for long periods of time as staff were attending to others.

Induction for new staff did not include moving and handling training and staff lacked knowledge of how to assist people safely with moving and handling.

Medicines management had improved but not all matters identified in the warning notice were actioned by the first day of the inspection, although had been addressed by the third day we visited.

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, in line with the policies and systems in the service. Mental capacity assessments were not always clear.

People had access to other professionals to support their care needs. People’s food and drink needs were suitably met overall.

Staff spoke kindly with people but did not always use respectful language when speaking about people. People were not always sufficiently supported to go to the toilet in spite of their repeated requests for help.

There were very few activities taking place, particularly for people who could not walk or communicate verbally. Some people spent much of their day in their chairs with little interaction other than when staff carried out personal care tasks.

Care records, particularly information about people upon admission to the home lacked detail and did not correspond with care practice.

Complaints and compliments were recorded and responded to appropriately, although not everyone knew the complaints process..

Staff reported effective teamwork and praise for the way the home was run.

We found poor governance and lack of management oversight of practice and documentation. Records showed the premises and equipment were maintained. Some audits were in place, although the findings of the inspection showed these were not robust or accurate.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We previously inspected the service on 28 and 29 April 2015 and at that time we found the registered provider was not meeting the regulations relating to management of medicines and managing risk. We asked the registered provider to make improvements. On this visit we checked to see if improvements had been made

The Glynn Residential Care home is a privately owned home registered to care for up to 38 people over the age of 65. Accommodation is in single rooms in a large converted house over two floors. At the time of this inspection there were 32 people using the service.

The service is required to have a 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 service had a registered manager.

People who lived at The Glynn told us they felt safe.

We found medicines were not always managed in a safe way for people. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse, Risk assessments minimised risk whilst promoting people’s independence.

There were enough suitably trained staff to meet the assessed needs of people who used the service.

People’s capacity was not always considered when decisions needed to be made because some people who lacked mental capacity had not been considered for Deprivation of Liberty (DoLS) authorisation to ensure their rights were protected in line with legislation. This was a breach of regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent.

People were supported to eat a good balanced diet and people enjoyed the food served. A range of healthcare professionals were involved in people’s care as the need arose.

People’s individual needs were met by the adaptation, design and decoration of the service.

Staff were caring and supported people in a way that maintained their dignity and privacy and people were supported to be as independent as possible in their daily lives.

People’s needs were reviewed as soon as their situation changed. People and their representatives were involved in care planning and reviews.

People told us they knew how to complain and told us staff were always approachable.

The registered manager had an overview of the service. They audited and monitored aspects of the service, however this system had not picked up and addressed the problems we found. This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.

The culture of the organisation was open and transparent and the managers were visible in the service.

The care manager held meetings with people who used the service, relatives and staff to gain feedback about the service they provided to people.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with 11 of the people who lived in the home who all gave very positive comments:

'The staff are very kind. They look after me well'

'It's as nice a home as you will get. The staff are nice'

'The staff are welcoming and very caring'

'It's like home from home'

'I am very happy with the care I get'

People told us how they preferred to be supported and the routines they like to keep and said that staff respected these. We spoke with three relatives who were happy with the manager and staff and the support they gave. People we spoke with during the visit told us they felt safe in the home. They said if they had any concerns they would report them to the manager or senior staff and they felt they would be dealt with.

We spoke with the manager, care manager, administrator and four care staff. All staff were very knowledgeable about the people they supported. They said they encouraged people's independence and supported them in the way they wished.

We looked at six people's care records and accident records. We found these documented incidents and identified risks well. However, they did not provide sufficient information about the analysis of the risks identified and action to be taken to manage the risks. We asked the manager to continue to develop their care processes and analysis of accidents so as to reflect actions taken and support provided.

We looked at the homes ongoing training programme. We saw staff had recently completed a range of training which included dementia, infection control and safeguarding.

We spoke with five residents and eight relatives who were visiting to gain their views of the home. People spoken with all said they enjoyed the food, there was plenty and they had a choice. Their comments included:

'It's the best place to live'

'You couldn't find better'

'The staff are really nice they look after us'

We saw how staff maintained people's privacy and dignity when carrying out personal care and maintained confidentiality when speaking to people and other staff.

We spoke with the manager/owner, the care manager, house manager, the administrator and five carers. All the staff we spoke with were knowledgeable about the people who live in the home and their care needs. People's individual needs and preferences were clearly stated in their care plan and staff demonstrated that they listened to and acted on people's wishes.

No one had any concerns during their time at The Glynn but knew what to do if they did. All the people spoken with had positive comments about the home and how staff related to them. Comments from relatives included

'This place is brilliant'

'I am very happy with the care my relative receives. The staff are lovely'

'They really look after my relative and me too. The care is really good '

Due to the nature of the allegations, two inspectors visited just before six o'clock in the morning. We found that five people were up, but did not find evidence of people being got out of bed prematurely. We spoke with the majority of the people who lived in the home, with two relatives, three care staff, a visiting district nurse, the manager and deputy manager.

All the people spoken with who lived in the home were complimentary about the care and support they received. Some comments were, 'The staff are good and kind,' and 'I am glad I moved here.'

People said they were happy with the quality of food provided and some of their comments were,' I like the food it's always good,' and 'If I want more I can get it.'

One relative said they were informed if their family member was not well. They said, 'If I have a query about something they always check it out for me. The care is good and the food is home cooked and good.' Another relative said, 'The food is good. The staff are kind, but there is just not enough of them and there are not enough activities during the day.'