The Care Quality Commission has told Glenside Manor Healthcare Services Limited that it must take steps to protect people living at a complex near Salisbury for people living with an acquired brain injury.
Pembroke Lodge, a care service based in South Newton, Salisbury has been rated as Inadequate overall following an unannounced inspection in November 2018.
Pembroke Lodge is one of six adult social care services and a hospital on the same site which make up Glenside Manor Healthcare and The Glenside Hospital for Neuro Rehabilitation, a long-stay nursing unit for younger adults with acquired brain injury.
This inspection was prompted in response to a number of concerns including staff not having appropriate checks before starting employment, poor working and living conditions for agency staff, competency of staff undertaking maintenance checks and lack of equipment across the Glenside Manor site.
At the time of the inspection, the provider was told it must make immediate improvements to ensure that people were safe. CQC issued three Warning Notices requiring urgent improvements.
- Safe systems of medicine management were not in place. Staff were not knowledgeable about people's individual risks.
- Staff were not following guidance on how to manage difficult behaviours when people expressed their frustrations and anxiety or following incidents of difficult behaviours.
- People's needs were not assessed before they transferred to other locations within the Glenside Manor site.
- People were at risk of abuse. The staff were not knowledgeable about safeguarding procedures.
- Recruitment procedures did not ensure the staff employed were suitable to work with adults at risk. New staff did not receive an induction to prepare them for their roles and staff were not trained to meet the needs of people.
- Staff who carried out maintenance equipment checks were not competent.
- Insufficient numbers of staff were employed to maintain staffing levels. There were language barriers with agency staff who were not able to understand or communicate instructions.
In response to further concerns, inspectors returned to the service again on 30 January to ensure that people living in Pembroke Lodge were safe. Since the inspection, the remaining three residents have been moved to alternative accommodation.
CQC has been working very closely with Wiltshire Clinical Commissing Group, NHS England and other local commissioners to ensure that peoples need are effectively met. All organisations are continuing to work together to monitor Glenside services.
CQC has placed conditions across five of the Glenside Services to ensure staff assess, monitor and improve the safety of people living in the service and provide good overall governance.
Debbie Ivanova, Deputy Chief Inspector of Adult Social Care, said:
“The people currently living at Pembroke Lodge are entitled to safe effective and compassionate services – and it is clear that Glenside Manor has been failing them. No one should be treated with such a lack of respect and dignity.
“We have issued three Warning Notices to ensure Glenside makes the necessary improvements to provide safe care and treatment, to improve staffing, and ensure safeguarding referrals are properly raised when needed.
“Our formal warning sends a clear message that Glenside Manor needs to address these issues as a matter of urgency. Our inspectors will keep the care home under review to ensure that people are not at undue risk of harm. If we find that this provider is not making the required progress we won’t hesitate to use our legal powers to protect the people who use the service.”
You can read the report in full at when it is published on the CQC website at: www.cqc.org.uk/location/1-2825309786
Ends
For media enquiries, contact John Scott, Regional Engagement Manager, on 07789875809. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here www.cqc.org.uk/media/our-media-office. (Please note: the duty press officer is unable to advise members of the public on health or social care matters).
For general enquiries, please call 03000 61 61 61.