Archived: Glenarie Manor

At the present time, the service is still currently registered with the old provider. This is because the new provider is currently going through the registration process with CQC to register the service under ‘their name’. Once this registration process is complete, they will become the legal provider of the regulated activity, accommodation with personal or nursing care for people who live at the home.

This inspection took place on the 01 February 2018 and was unannounced. We undertook this inspection to check that whilst the provider’s registration process with CQC was being undertaken, the service was safe and well-led. This type of inspection is called a focused inspection and this report will only cover our findings in relation to the domains of safe and well-led.

Glenarie Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Glenarie Manor supports people living with complex mental health needs and provides accommodation with nursing care. The home can accommodate up to 26 people. At the time of our visit, 25 people lived at the home.

The home is a large, Victorian house situated in Sefton Park. Local shops and public transport are within walking distance. Accommodation consists of 26 single bedrooms. On the ground floor, there is a communal dining room for people to use and on the first floor there is TV room and games room.

The service had a manager who was in the process of registering with the Care Quality Commission (CQC) . A registered manager is a person who has registered with CQC 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 spoke with six people who lived in the home. They all gave positive feedback about the home and the new staff who worked in it. It was clear from what people said that the service had significantly improved under the new provider and that they felt they had a much better quality of life. Everyone we spoke with was happy with the support they received and during our visit we observed people were relaxed and comfortable with staff members. One person told us they didn’t realise how strict the home was before the new provider came into manage the service and another said that they felt life now held much more opportunities for them.

The manager had a clear understanding of how to protect vulnerable people from abuse and safeguarding incidents were reported appropriately to the Local Authority and CQC.

People’s risks were assessed and we saw that staff had clear guidance on how to prevent or mitigate these risks. The number of staff on duty was sufficient to meet people needs and records showed that safe recruitment procedures had been followed when new staff members were employed.

Accidents and incidents had been properly documented and appropriate action had been taken to prevent further harm. Complaints received had been listened to and responded to in a timely manner by the manager.

The home was safe and suitable for the people who lived there. Health and safety checks were completed on the premises and its equipment to keep it in good repair. The manager told us about the improvement plans they had in place to refurbish and improve people’s living environment over the coming months.

There were a range of quality assurance checks in place to monitor the quality and safety of the service. The manager was open and transparent about the current checks in place and told us that further improvements were required to ensure that the current checks were sufficiently robust to mitigate risks to people’s health, safety and welfare. They told us that they were supported by the regional manager and the provider and both could be relied upon for managerial support as and when required.

We saw that staff meetings took place and the manager met regularly with the nurses to ensure that their practice was consistent with the needs of the home.

We found that the current management of the service was good. Significant improvements to the service and people’s well-being had been made since the new provider had taken over. The manager in post was open, transparent and a good role model for other staff members providing support. People told us that they were much happier since our last inspection and it was clear they felt safe.

The home is a large, victorian house situated in Sefton Park. Local shops and public transport are within walking distance. Accommodation consists of 26 single bedrooms. On the ground floor, there is a communal dining room for people to use and on the first floor there is TV room and games room.

At the time of our inspection. There was no 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’.

We asked the provider about the lack of a registered manager. They told us that there was currently an acting manager in post. The acting manager had previously been employed at the home as the deputy manager. The provider told us the acting manager had not yet applied to become the registered manager. This meant that the acting manager had not been verified by The Care Quality Commission (CQC) as a ‘fit’ person. The provider and the acting manager were requested to ensure an application to become the registered manager was submitted without further delay.

During our visit, we found that the provider did not have a clear understanding of people’s needs or the care they required yet they were heavily involved in the day to day management and delivery of the service. It was clear from what we saw and from our discussions with the provider that the provider controlled the management of the service. When we spoke with the provider during the visit, they told us that they did not own the home. They told us the home was owned by another person. This was not known to The Commission prior to our visit and had not been previously declared. We had concerns that the owner of the home was not registered with The Commission as a ‘registered person’. We spoke to the provider about this. The owner was intermittently available in the home throughout our visit.

During our visit, we identified serious concerns with the health, welfare and safety of people who lived at the home. We found multiple breaches of the Health and Social Care Act regulations that placed people at serious risk of harm. We found breaches in relation to Regulations 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

We spoke briefly to three people who lived at the home. Of the three people we spoke with, two were happy with their care, one was unhappy with the way they were cared for.

We found that a number of safeguarding incidents had not been documented or appropriately reported. This meant that there was no evidence these incidents were properly investigated and responded to by the provider. There was no evidence that staff members including the provider and acting manager had received regular safeguarding training. This meant there was risk staff would not know what to do in the event of an allegation of abuse being made. During our visit we had serious safeguarding concerns about the way in which care was delivered and the way in which people were treated. After our visit we made safeguarding referrals for each person who lived at the home. These safeguarding concerns are currently under investigation by the Local Authority and the Police.

We found that staffing levels and the deployment of staff during the day was poor. Staff did not engage with people in any meaningful way and there were no planned social activities to promote people’s mental well-being. This increased the risk of people becoming socially isolated.

Staff were not recruited safely. Some staff were recruited without appropriate references or criminal convictions checks being undertaken. Care staff received poor supervision and nursing staff received little clinical supervision in their job role. This meant the provider could not be sure staff employed were suitable to work with vulnerable people. The skills and abilities of the staff team had also not been appropriately assessed to ensure they had the skills to work with vulnerable people.

Staff records showed that staff had not received suitable training to do their job role effectively Care staff had received no formal training in mental health or any other health and social care topics on a regular basis. The provider acknowledged this. This meant the provider could not be sure that staff knew how to provide safe and appropriate care to people with complex needs. This placed people at risk of harm.

The management of people’s medication was unsafe. They did not demonstrate that people always received the medicines they needed. Medication administration records were poorly completed which made it difficult for medications to be accounted for. Some of the medication in the home was out of date and unfit for use. Other prescribed medicines had had the dispensing labels removed, but had been kept for general use within the home. This is illegal. Medicines prescribed for one person must never be used for someone else.

We reviewed five people’s care records. Care plans were brief, did not accurately reflect people’s needs and wishes and were not person centred. People risk assessments failed to provide staff with any guidance on how to manage people’s risk sand care for them safely. This placed people at risk of harm.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to. People’s capacity to make their own specific decisions had not been assessed and there was no evidence that any best interest meetings had taken place or least restrictive options explored when restrictions on people’s liberty were implemented.

People’s mealtimes and access to food and drink was restricted to certain times and people were unable to have anything to eat or drink outside of the dining area. Mealtime menus were displayed in the dining area but on the day we visited people’s lunch did not match what was advertised. One of the people we spoke with said they did not think they could ask for an alternative meal if they did not like what was on the menu.

We spoke to the cook on duty and found that they had a limited knowledge of people’s dietary requirements. When asked, they were unsure who was on a diabetic diet. This meant there was a risk people who lived with diabetes would not receive a diet suitable to their needs. The cook also had no clear understanding of the cultural diet one person required or the foods that were acceptable to them.

People’s independence was not promoted. A structured rehabilitation programme was promoted by the provider but we found no evidence that this programme was in place. People were restricted in how they lived their lives due to daily regimes imposed by the provider and we saw limited evidence that people were treated with compassion or that the provider cared about people’s welfare. People were sometimes subject to disciplinary action if they failed to follow house rules.

The premises was well maintained. There were safety certificates in place for the home’s passenger lift, electrical installation and moving and handling equipment. We found however that the provider’s gas safety certificate was out of date and improvements required by Merseyside Fire Authority in relation to the home’s fire safety provision had not been addressed in a timely manner.

The provider had a complaints procedure in place but it was out of date. We saw that complaints had not always been appropriately responded to, if responded to at all.

The service was not well led. There were no adequate systems in place to ensure the service was safe, effective, caring, responsive and well led. There were no care plan audits, medication audits, environmental audits, infection control audits or adequate accident and incident monitoring in place to ensure people were safe and well cared for. All the policies and procedures we looked at were out of date and there was no evidence they were followed. At the end of our visit, we discussed the serious concerns we had about the service with the provider and acting manager. The provider and acting manager were unable to provide a satisfactory explanation as to why the issues we identified during our inspection had not been picked up and addressed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not i

We asked people whether they gave consent to the care, treatment and support they received and what happened if they refused. We asked if their care and support met their individual needs. People said they had lots of choices and could refuse to do something if they wanted to. People said the staff were good or excellent.

We asked people if they knew how to complain if they were unhappy about anything at the home and they said yes, "just tell the staff'" and pointed out a sign on the wall detailing how to make a complaint. None of the people that we spoke to had ever made a formal or written complaint. We looked at policies and documents and records of complaints.

We looked at the layout and design, general appearance and maintenance of the premises, risk assessments and the safety and security of people living in the building. We talked to the maintenance manager. We talked to people and asked them if they felt safe both during the day and at night, and if they felt their property was safe. Everyone we spoke to felt safe at all times.

We asked people using the service if they thought the staff had enough skills and training to provide care and support for them and they said they did think so. We asked staff if they felt they had enough training for the job that they did and they said that they did. One person said that they had been on several training courses and then they trained others.

We looked at documentation for workers. The provider was able to demonstrate a detailed and clearly documented induction program for all staff. We looked at the records for staff training, which were comprehensive and up to date. The records included training on fire safety, people's human rights, safeguarding and infection control. Staff said they had discussed their learning and development plans with their manager and that they felt supported by their managers.

We observed staff caring for and supporting people using the service. There was a friendly atmosphere and staff were caring and pleasant towards people. Staff acted as if they knew people well and understood their needs and concerns.

We asked people who used the service to tell us if they were making decisions about their care and support and people told us they were. People who used the service gave us lots of examples of the choices they were making on a daily basis and told us about a range of things they did with the support of staff. This indicated that staff were supporting people to make choices and that they used their independent living skills. People told us staff supported them with their needs.

We asked people who used the service if they felt confident to raise any concerns they had about their service. People told us they did and that they also felt safe.

People gave us feedback about staff. People told us that staff were 'Good' and one person told us they felt staff were 'really great.'.