Archived: Glendale

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and a visiting relative, the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

The service was safe?

Practices in the service protected people, staff and visitors from the risk of harm. Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Appropriate arrangements were in place in relation to obtaining medicine. The system was straightforward and all medicine was checked into the service and recorded appropriately to ensure people's safety.

Each person had a care plan detailing their support and care needs. There was guidance for staff to follow to reduce risks and strategies implemented to make sure people were as safe as possible.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Care documentation viewed showed that mental capacity had been considered. Where people lacked capacity and decisions were made on people's behalf the documentation reflected that the service had consulted with relatives / friends or advocates. This was needed to show that the service had acted in people's best interest and that people's human rights and rights of choice were not compromised. DOL's (Depravation of liberty safeguards) assessments had not been considered for any of the people using the service as peoples liberty was not restricted. The manager agreed to keep this under review.

Is the service effective?

The service was effective overall. People told us that they were happy with the care that they received and that their care needs were met. One person we spoke with told us, 'I am very happy here I have no concerns'. A relative said " Staff treat my Mother well. I am happy she is here". We saw that staff were attentive to people using the service and responded promptly when needed. People's health and care needs were assessed with them and /or their representatives where possible.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of four people who lived within the service. These had sufficient detail and guidelines about the support needed to meet the people's needs.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs.

We found that the manager and staff were approachable and encouraged people to voice any concerns or ideas for change. People were consulted and were given the opportunity to contribute towards the running of the service. We noted evidence of regular meetings which enabled people to air their views.

People who used the service were weighed regularly and weight fluctuations were noted and acted upon. We found that food and fluid intake were appropriately logged and that special diet requirements were respected where needed. This meant that the provider was responsive and made reasonable adjustments in service provision to meet people's individual needs.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

Staff we spoke with had a good understanding of the different policies and procedures. They knew where to access them and where they get further advice from. Staff told us that they felt well supported and were given the information they needed to support the people who lived in the service.

The manager took an active role in the running of the home and met with staff and people who lived in the service to listen to what they had to say. We saw minutes of regular staff meetings where changes or issues with peoples' care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about running the service.

You can see our judgements on the front page of this report.

Our inspection of 07 August 2013 found that there was a lack of effective systems in place, for monitoring the quality of the service provided, to ensure that people received the care they needed. At this inspection we found that there were improvements to the handover system to ensure that staff had relevant information about people's needs. There was a clear system for leadership in the service including a designated leader of each shift. The manager and the registered provider were making regular checks of the delivery of care, such as care records and medication, to ensure that any shortfalls were identified and acted upon. Accidents and incidents were monitored to identify trends and reduce risks.

Our inspection of 03 September 2013 found that people did not always receive care that met their needs, because staff were not provided with accurate information about the care people required. At this inspection we found that people had care plans that reflected their needs and staff understood the care they needed to provide to each individual.

At this inspection we found that people that used the service were happy with the care and treatment they were receiving. One person told us 'The staff are very good, no complaints' and another said 'I'm really quite happy here'. We found that most people had an updated care plan that provided staff with more detail about their care needs. However, some people were still to have their plans reviewed as they did not provide staff with clear information about the support the person required.

We found that staff and the manager understood what was meant by abuse and how to prevent and report it. The risks in relation to fire in the premises had been fully assessed and repairs made to fire doors to ensure they closed properly.

People that used the service told us they were happy with the care they were receiving. One person said 'They don't mind what they do for me'. 'It's very good, I can't grumble at all' and another said 'I can't fault it here at all'. Some people that used the service felt that the service was managed well and comments included 'I am getting by alright, things are ok' and 'It's running well.' Others told us that they did not feel the registered manager of the service would take action if they raised concerns about the service. One person said 'I am not confident that [the manager] would do much about it if I had a problem'.

However, we found that there was still a lack of effective systems in place to monitor the care provided to people to ensure their welfare. The provider had not identified that there had been a medication error the previous day and staff in charge of the service were unclear about their responsibilities for checking that medication had been given. We found that there was a lack of effective systems for ensuring staff were aware of changes in people's needs and care plans and for responding to changes in people's needs. The manager had been absent from the home for the previous week, but the responsibility for monitoring people's care and updating their care plans as needed had not been suitably delegated. There was a lack of effective systems in place to ensure staff knew who to report changes in people's needs to.

We found that the provider had not ensured that the fire evacuation procedure for the home was effective and met the requirements of fire safety guidance.

We found that the service did not have effective systems in place for meeting people's needs and ensuring their safety. We saw examples of where people's needs had not been met as a result. Some people had not been supported to take the medication they needed and some people did not have their nutritional needs effectively monitored. There were still some fire doors that were not closing properly when the fire alarm sounded. People had not been protected against the risks associated with hot water in the service.

There were enough staff employed to meet people's needs, but the fire evacuation procedure had not been suitably tested to check that there were enough staff to carry it out. Staff did not always know who was responsible for the running of the service and the manager had not identified where systems within the service had failed.

The manager had failed to respond appropriately to an allegation of theft in the service.

At our inspection on 16 December 2012 we saw that people's care records did not always provide staff with information about how to meet people's needs, in particular 'Do not attempt resuscitation' ('DNAR') forms were not easily accessible to staff. At this inspection we saw this information was on people's care records, easily accessible to staff. However, one staff member was not aware of such a decision being in place for one person living at the service. The manager informed the staff member of this arrangement during the inspection.

We saw that the staff in charge in the manager's absence were not always suitably skilled to provide clear leadership and direction. Staff were not always clear what action they would take to report a safeguarding concern to a responsible authority for investigation. We saw that people's care records did not always provide staff with information about how to meet people's needs.

We saw that areas of the environment had been improved. However, some fire doors were routinely propped open which placed people at risk in the event of a fire. Of concern was that this practice was first identified by the fire authority on 5 May 2011 and at our inspection on 27 July 2011. We received an action plan that stated closures had been fitted to all doors.