Archived: Glendon House

Glendon House provides accommodation and care for up to 36 people, many of whom are living with dementia. At the time of our inspection 30 people were living in the home.

A registered manager was 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.

At the last inspection on 21 and 24 of March 2016, we asked the provider to take actions to make sure that care and treatment was provided to people in a safe way. This was because we found that actions to mitigate known risks were not always taken. This action had been completed but further improvements were still required.

The provider was also required to implement suitable systems to monitor and mitigate risks to the welfare of people who lived in the home. They were also required to evaluate practice in this area. This action had not been completed. During this inspection we found that the provider was still in breach of this regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not managed in a safe way and were not regularly audited. It was unclear whether people who were prescribed topical creams were administered them as prescribed due to the gaps on the administration records.

There was a lack of effective systems in place to monitor and assess the quality of the service being delivered. Regular audits of people’s medicines were not carried out and the audits undertaken by the provider did not highlight that people’s care records were not being completed appropriately.

Mealtimes at Glendon House were busy and at times people became distressed. Whilst referrals were made to relevant healthcare professionals when concerns had been identified regarding a person’s nutritional and hydration needs, records relating to how staff supported people in maintaining these needs were not always completed.

Steps were taken to assess and mitigate environmental risks. Risk assessments for the home were in place and regular checks of the kitchen and the cleanliness of the home took place. Accidents and incidents were recorded and monitored and measures had been taken to prevent further occurrences.

The manager was approachable and knew people who lived in Glendon House well. They also had a good overview of the culture of the home. Staff were supported through regular supervisions and were clear about their responsibilities.

People felt safe living in Glendon House and staff knew what constituted abuse. Staff also knew what actions they would take to report any concerns around abuse. There were safe recruitment practices in place and appropriate references were sought before staff started working in the home.

There were enough staff on duty to support people and people were supported by staff who had received training relevant to their role. Staff were also able to request additional training which related to people’s specific support needs.

The service operated in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Appropriate applications had been made to the authorising body for authorisation to deprive people of their liberty in order to keep them safe.

Staff knew how to communicate with people so they could make choices about their care and be involved in reviewing their care needs. People’s care and support needs were assessed on a regular basis and prompt referrals were made to relevant healthcare professionals where concerns were identified.

A range of activities took place in the home for people but these did not always cater for people’s interests. People and their relatives told us that people were not always consulted about their interests before the activities were organised. People were able to have their relatives and friends visit without restriction and visitors were made welcome.

People were supported by staff who were caring and attentive. Staff knew people’s needs well and supported people to be as independent as possible. Staff were encouraging and patient with people. People’s dignity and privacy was consistently upheld and staff spoke respectfully to people and visitors.

Glendon House provides accommodation and care for up to 36 people, many of whom would be living with dementia. At the time of our inspection 28 people were living in the home.

A registered manager was 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 found that there was a breach of regulations because the service didn’t always act appropriately to mitigate identified risks to people’s welfare. This had resulted in three people receiving unsafe care or being exposed to the risk of avoidable harm.

We identified a second breach of regulations because suitable systems were not in place to monitor the way that risks to people’s welfare were being managed in the service. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were required to effectively implement mental capacity assessments. This required a greater understanding of the Mental Capacity Act 2005 by service managers tasked with carrying out the assessments.

There were enough staff to meet people’s needs, although on one of our inspection days the service was short of staff. Staff received the training and support they required to ensure they could provide effective care to people.

Staff had developed good relationships with people and their visitors. They adapted their approach to individuals to ensure people received the style of staff engagement they preferred.

People’s care plans were personalised to their needs and preferences. There was a wide range of social activities that people could participate in. They were encouraged and supported to maintain their faiths and engage with their community.

Environmental risks were well managed in the service and the service managers had the support of people, their relatives and staff. There was a good atmosphere in the home.

Below is a summary of what we found. This summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, people's relatives and from reviewing records.

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

Is the service safe?

Most of the people we spoke with living at Glendon House told us that they felt safe and secure and that staff treated them well. Some people were unable to communicate verbally with us but we did observe and note how they were treated, how they were provided with assistance and what efforts were made to keep them safe.

Those we could speak with told us they knew who to speak to if they felt unhappy about something. Relatives we also spoke with knew what to do if they felt unhappy about anything to do with the care their family member received.

The relative of one person we spoke with told us, "I have no concerns issues or niggles. Quite the opposite in fact. Look - that's what I mean [pointing outside to see a staff member putting a sun hat onto his relative's head]. No sunburn, no harm."

We inspected the staff rotas and found that there were sufficient staff on duty to meet people's needs, and to keep them safe, throughout the day and night. The provider may find it helpful to note however that some staff indicated that additional staff were still needed at busy times.

We saw that the home was clean and well maintained. There was a general handyman carrying out works and general repairs at the time of the inspection.

We noted that staff undertook training in safeguarding of vulnerable adults (SOVA).

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was a Court of Protection order in place dated 25 October 2013 for one person using the service. All staff were able to describe the circumstances when an DoLS application should be made and knew how to submit one so that people who could not make decisions for themselves were protected.

Is the service effective?

All aspects of people's care underwent regular review to ensure quality, safety and satisfaction measures were met or improved upon.

The provider demonstrated that it took great care to ensure the care and wellbeing of the people who used the service. This was shown in individual care plans, daily records book, daily interaction charts and ongoing risk assessments. Where it had been possible we saw evidence of people being involved in decisions about their care and that their needs and wishes were known by staff. We saw evidence of this in a care plan dated 28 April 2014.

We saw evidence that care records and risk assessments were reviewed on a monthly basis or as and when required to ensure information about people's needs were kept up to date. Where relatives or other health or social care professionals were involved we saw that changes or comments were noted, signed and dated. This told us that the home took reasonable steps to work with families to deliver care in a way which was person centred, satisfactory and re-assuring.

Is the service caring?

The provider operated an 'open door' policy to people living in the home, their families and staff. This meant that staff and management could be approached at any time to listen to and act on any concerns or suggestions.

We noted that people were supported respectfully and courteously. We also noted that people were regularly spoken with in a polite manner by staff. We saw that staff smiled and gave words of comfort to people, to which they responded.

Care and support provided to people was individualised and delivered by staff who were informed about their needs.

We noted that other healthcare professionals worked with the home to ensure continuity of care to people where necessary. At the time of the inspection specialist dementia intensive support workers were there to carry out individual care and support.

Is it responsive?

We saw that the staff responded to people on an individual basis. People's likes / dislikes were acted on and we saw every effort made to put the interests and wellbeing of the individual first.

There was a system of recording and managing incidents and complaints. We saw evidence of how the home responded to issues, or requests, which resulted in the home increasing its levels of effectiveness and satisfaction. An example of this was the activities lead and chef working together with people living in the home to create new and more interesting recipes for meals and snacks.

One person we spoke with told us, "I don't really like to socialise much. Sometimes I eat in the dining room but I prefer to eat in my room. They don't mind. They let me make my mind up where I want to go."

We saw staff responding to people's needs and questions in a polite and helpful way. We noticed that whilst staff were busy that they took time out to reassure people, interact with them and engage with them.

On the day of the inspection we noted that the conservatory got hot very quickly. Staff responded promptly by opening windows and doors, moving people to less sunny areas of the conservatory and bringing out cool refreshments.

We noted that important information about people was shared in daily records and interaction charts. These were shared across the management and care teams as part of regular reviews.

Is it well-led?

As part of this inspection we spoke with the manager and staff members. All of them told us how the provider strived to improve the services it offered. Staff told us, "They [the provider] now listen to us. We have an excellent manager who is full of ideas about improving things. Things have changed for the better over the last year." Another member of staff told us, "The provider recognised that more staff were needed and did something about it. It's also a better quality of staff now."

The provider had recently appointed a full time activities lead. We noted that the manager of the home had also initiated a series of improvements aimed at improving the lives of people living with dementia. One such initiative was asking the activities lead to work with the chef, people living in the home and family members to come up with ideas to enhance the quality and choice of food. We saw one such session taking place during the inspection.

We found that people's personal care records, and other records kept in the home, were accurate, safe and filed appropriately and securely. We saw that learning from incidents and complaints was recorded and shared with people who used the service, staff and relevant interested parties.

Care planning had been developed and the improved records helped to ensure that staff met people's individual needs. The majority of people were meaningfully occupied. Following an activity session, one person said 'I enjoyed that; it was good.' People who did not choose to participate in activities were encouraged to watch and discuss what was going on.

Mealtimes were well organised and people were supported by staff to take adequate food and drink. Nutritional assessments were up to date and clear.

The provider responded appropriately to any allegation of abuse and staff understood their responsibilities to report any concerns they may have.

The home was clean and comfortable and there were effective systems to reduce the risks of unsafe premises, or infection.

Medicines were managed safely and associated records had been improved.

The number and competency of staff was appropriate to meet the needs of people living in the home. Staff were supported in their role and received relevant training.

The provider monitored the quality and safety of the service effectively, ensuring that required improvements were completed.

We saw that staff were kind and respectful when providing care to people. However, several staff said that there were not enough staff to meet people's needs. When we examined the provider's records we found that staff were not well supported. Their concerns were not responded to and they did not have access to the training and supervision they needed.

People were not always well presented and some did not have access to meaningful activities or mental stimulation. Individuals had some choice in their daily lives, such as meal options: however other aspects of their daily routines were limited. Care records contained frequent gaps which made it difficult for us to be sure people were had been cared for as planned.

Areas of the home were not clean and so people were not fully protected from infection. Some risks to people had not been addressed. The provider was not monitoring the safety or quality of the service effectively.