Archived: Glen Rose

Glen Rose is a service that is registered to provide accommodation and nursing for up to 47 older people, most of whom are living with dementia. Accommodation is provided over two floors and there is a lift to provide access to people who have mobility problems. There are two communal areas on the ground floor and one on the first floor that people could choose to spend their time in. At the time of our visit 23 people lived at the home.

We had carried out an unannounced inspection of this home on 26 and 27 April 2016. We found breaches of the legal requirements in relation to; the environment and premises, governance systems and dignity and respect. The environment was unclean and not well maintained. Equipment to meet people’s needs was not always available. Staff did not always demonstrate they treated people with dignity and respect and the systems in place to monitor the service and drive improvements were ineffective.

Following this comprehensive inspection we served three warning notices with respect to these breaches, on the registered provider of the service. We required them to achieve compliance with Regulation 15, Equipment and premises and Regulation 10, dignity and respect, by 21 June 2016. We required them to achieve compliance with Regulation 17, good governance by 20 October 2016.

We undertook this unannounced focused inspection to check they had met the legal requirements and made necessary improvements in relation to the warning notices served. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Glen Rose on our website at www.cqc.org.uk

We found some improvements had been made and the warning notices had been made. However, further improvements were needed and the improvements made needed to be embedded into the home.

At the time of the focussed inspection a registered manager was not in place. 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 provider had appointed a new manager who had submitted an application to become the registered manager to the Commission.

More equipment had been purchased to ensure there was enough to meet people’s needs. Areas in the home that required a level of maintenance had improved but further work was needed. Some areas were much cleaner and more systems were in place to monitor this; however, some areas remained unclean.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude, though one member of staff told us they felt more training sessions would be useful to ensure staff practice remained person centred and not task focused.

Improvements had been made to the systems used to assess quality although further improvements were required to ensure these were fully effective and embedded into the service.

We found one breach 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.

Glen Rose provides accommodation and nursing care for up to 47 older people who are living with dementia and have nursing needs. The home has three floors, 31 bedrooms with 15 of these being shared rooms and three communal areas. At the time of our inspection, 21 people were accommodated in the home.

Although our register showed a registered manager was in place, this person had not been working in the home since February 2016. 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. One of the provider’s general managers was providing the day to day management of the home, with the support of the director of operations. At the time of our inspection the general manager was not present.

People who lived in the home were not always able to tell us their views verbally. Observations demonstrated that people were not always treated with respect and offered choices. They were cared for in an environment that was unclean and not well maintained. Equipment was not always available and when it was, it was not clean. Staff had not consistently received supervisions and training to ensure they could be effective in their role and at times people were left alone for extended periods of time. We have made a recommendation about the deployment of staff and assessment of staffing levels. Not all risks associated with peoples care had been assessed and plans to reduce the risks developed. When risks presented, prompt action was not always taken and at times care plans were not personalised or followed by staff.

This placed people at risk of receiving care and support that did not meet their needs or placed them at further risk.

The systems used by the provider to monitor and assess quality had been ineffective and concerns had not been identified until these were raised with them.. A lack of effective quality systems places people at risk of receiving a service that in ineffective.

Staff demonstrated an understanding of the need for respect and consent. Where required, the Mental Capacity Act 2005 had been applied. We have made a recommendation about recording clarity for best interests decisions. Staff had a good knowledge of safeguarding adults at risk, and were confident to raise any concerns. Recruitment practices ensured staff were safe to work with vulnerable people. Medicines were managed safely.

We identified breaches 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.

On the day of the inspection the registered manager was on leave. However, the area manager who had line responsibility for the registered manager and the director of operations were available to answer any queries we had.

Care and treatment was not planned and delivered in a way that ensured people's safety and welfare. Care plans were computerised and were only accessible to permanent nursing staff. On the day of our inspection there were only agency nurses on duty who did not have access to the computerised care plans. Paper copies of care plans were available, but were not consistently current and up to date. Care plans did not have sufficient information in them, which meant there was a risk that people would not receive safe and consistent care that met their needs.

Some people living at the home demonstrated episodes of challenging and distressed behaviour. There was no guidance in care plans about how to support people in this situation and staff accepted this as normal behaviour. There was no evidence on the day of inspection that people's behaviours were monitored. This meant there was a potential risk that staff would not know when to seek appropriate professional advice to provide support and treatment for people living at the home.

Staffing numbers and care practices at the home meant that people were not always treated with respect and have their dignity protected. Staff interactions with people was mainly task focused. The manner in which some staff spoke to people was not respectful.

Processes were in place to ensure other health and social care professionals involved in people's care had relevant information about people's care needs. However, the monitoring of people's mental health meant there was a risk that appropriate mental health care support was not obtained in a timely manner.

There was not an effective system in place to identify, assess and manage risk to the health, safety and welfare of people living at the home.

Since the last inspection a new manager has been appointed and registered with the Care Quality Commission (CQC).

During the last inspection of the home we identified moderate concerns in how some staff responded to people's communication and requests for help. During this inspection we saw all staff speaking to people in a respectful manner and allowing time for response. We saw people asking for assistance and staff responding promptly. Staff told us that they 'felt supported with the right training' to help them carry out their job.

The service had systems in place to ensure people were protected from abuse, or the risk of abuse and their rights were respected and upheld. Staff had an understanding of safeguarding issues and how to report abuse or allegations of abuse. Visitors told us that they felt that their relatives were 'safe and well cared for.'

People told us that the felt that the quality of care was good and that they were involved in developing and discussing changes to care.

The service had a system in place to adequately monitor the quality of care and actively engaged with people and their relatives in order to seek their views.