Archived: Glenside Farnborough

Glenside Farnborough is a care home providing personal care to up to 22 people are living with an acquired brain injury. At the time of inspection, the service was supporting 17 people. The home accommodates people in one adapted building.

People's experience of using this service and what we found

The provider had systems and processes in place to manage medicines safely and protect people from the risk of abuse. Infection control measures were in place to minimise the risk of infection. The provider acted on or learnt from incidents, such as making improvements in medicines administration procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice.

Staff had developed caring relationships with people they supported and knew them and their needs well. Staff respected people's dignity and privacy and promoted their independence.

People's care and support met their needs and reflected their preferences. The provider had recruited an activities co-ordinator to support people to engage in activities and reduce the risk of social isolation.

Management processes were in place to monitor and improve the quality of the service. There was a positive and open culture. The management team sought feedback from people, relatives and staff. Feedback was positive across all areas and reflected the positive changes the provider had made since our last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 November 2019) and we found one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Glenside Farnborough is a care home providing personal care to up to 22 people who may be living with an acquired brain injury. At the time of inspection, the service was supporting 17 people. The home accommodates people in one adapted building.

People’s experience of using this service and what we found

Medicines administration was not always managed safely. The manager put safety measures in place while we were inspecting to minimise potential risk to people.

Staff understood signs of possible abuse and how to raise concerns if needed. The manager and senior staff understood their responsibilities in relation to safeguarding. Risks to people were assessed and understood by staff. People were supported by staff who had undergone appropriate recruitment checks

There were systems in place to monitor and improve the service, however these still required further improvements. The manager had been in the service four months and made many improvements to date.

We received positive feedback about the management of the service from relatives and staff. The manager promoted a positive, open and honest culture within the service and understood their regulatory responsibilities. The service worked well with other agencies to get the best outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, though some improvements had been made, enough improvement had not been made/sustained and the provider was still in breach of one regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 December 2018. Three breaches of legal requirements were found relating to safe care and treatment, good governance and fit and proper persons employed. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions were not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Glenside Farnborough on our website at www.cqc.org.uk.

Enforcement

We have identified one continued breach in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on the 17 and 18 December 2018 and was unannounced.

During our previous inspection on 13 and 14 March 2018, we identified the provider had breached Regulations 9, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people did not have satisfactory rehabilitation and physiotherapy programmes in place. The provider had not dealt with complaints effectively. The provider's quality assurance process had not picked up on areas that needed improving. Staff were not always supported effectively.

We asked the provider to take action to address these issues and at this inspection, we checked whether the provider had made improvements. At this inspection we found the provider had made and sustained the required improvements in relation to the breaches in Regulations 9, 16 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There had been some improvements in relation to the Breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, however we found that further improvements were needed in this area and therefore there was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we also identified new breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Glenside Farnborough provides residential accommodation and rehabilitation services for up to 22 people with people with a brain injury, neurological condition or both. At the time of the inspection 20 people were using the service.

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 service did not have a registered manager at the time of inspection, but the provider had put in place a manager who was currently ‘stepping’ in to the role and planned to apply to become the registered manager.

The provider did not have effective recruitment processes in place to make sure the staff they employed were suitable to work in a care setting. Medicines were not always managed safely and staff did not all have regular competency checks. Health and safety checks were not consistently completed. Quality monitoring systems were not effective in identifying areas for improvement.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Risk assessments were in place and actions documented to minimise risks to people.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence. Infection control measures were in place to manage the risk of infection.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet people’s individual complex needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

The manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People reported they were treated in a kind and caring manner by staff. People were supported by staff to express their views and to be involved in decisions about their care. People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

The service was responsive and involved people and their families where appropriate in developing their support plans. These were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

This is the second time the service has been rated Requires Improvement.

At the last inspection, in November 2015, the service was rated Good. At this inspection we rated the service as Requires Improvement. Glenside Farnborough is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager. 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 service had a satisfactory approach to safeguarding. For example there was a suitable policy and procedure in place and staff received appropriate training. Where there had been safeguarding concerns, these were reported appropriately, and any recommendations had been implemented.

A risk assessment process was in place. Risk assessments were comprehensive and reviewed regularly. Other records were comprehensive, accurate and up to date.

Health and safety procedures were satisfactory. Equipment was regularly checked and was judged as safe.

Staff received training about behaviours of people which could challenge the service. There were however concerns about how management had responded to some incidents, where staff had felt threatened and did not feel safe.

Some concerns were expressed about staffing levels, and the ability for staff to subsequently provide satisfactory activities and rehabilitation within the current staffing levels provided.

Staff recruitment, training, supervision and appraisal systems were effective, and suitable records were maintained. However records of staff induction could be improved. We have recommended new staff, who have not worked in the health and social care sector previously, undertake the Care Certificate.

Medicines procedures were to a good standard. People received the correct medicines on time. Suitable records were kept. The service was very clean, and there was a good standard of infection control precautions in place.

Assessment processes were comprehensive to enable decisions about whether people were suitable to move into the service. Care plans were also comprehensive and regularly reviewed. People had some involvement in the care planning process. The service had a suitable approach to assessing people’s mental capacity. Documentation about mental capacity was comprehensive.

People had a choice of meals, and were positive about the food they were provided with. We were concerned about some aspects of the support provided; for example whether food was prepared appropriately for those who were at risk of choking.

People’s healthcare needs were met by external professionals. However there were concerns about whether satisfactory physiotherapy was provided by the service. This meant that people’s rehabilitation was currently not effective as it should be. The registered provider said this would be improved, but people said there had been a problem for some time.

Staff were seen as caring, respectful and supportive. Some people felt frustrated by what they saw as too many rules at the service, and the inability for staff to escort them out of the home if they were unable to go out on their own. People were involved in decision making however, and staff were observed as friendly and attentive.

We had significant concerns about the provision of activities. Although there were records to demonstrate some activities occurred, we received concerns that people did not have enough things to do, that there was a lack of transport available, and there was currently a lack of dedicated staff to provide suitable activities for people.

There was a lack of confidence in the complaints procedure. Although records of complaints management were satisfactory, several relatives we spoke with, said when they had made complaints, improvement had not been sustained. Two relatives said they had given up raising concerns as things did not improve.

Concerns were raised by people and relatives that there had been many changes to the management of the service recently and this had led to inconsistency and uncertainty.

Staff said they thought the team worked well together and the team did their best to ensure people’s needs were met. There was a good system of staff handover, and communication within the team.

The service had a comprehensive system of quality assurance to ensure standards were monitored and improved as necessary. However the system had failed to pick up and address many of the issues we have raised as concerns within this report.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

People who used the service and their relatives told us that they were happy with the care and support provided at Glenside. One person told us, 'I think it's the same for everyone, but we plan my week so that there's a mixture of treatment, work and fun to help me improve. Now I'm here it's easier for my family to visit too'.

We found that the service monitored people's well- being and provided regular nutritious meals and drink in line with people's needs and preferences. Food and drink was also available on request at any time. One person told us, 'The food here is brilliant. The chef can make anything'.

We found that there were sufficient suitably trained staff with a balance of skills and experience to meet the needs of people who used the service and to enhance their lives.

The service provided formal and informal opportunities for people, their relatives and staff to provide feedback on the care provided at Glenside. We saw evidence that the management team was responsive and keen to improve standards where possible.

We observed that people had their individual needs assessed before admission and that they or their relatives had been involved in planning their care and support. We also saw that staff supported people's changing needs and development.

We saw that people looked well cared for and they were treated with courtesy and respect by staff. Those who wished to were engaged in activities of their choice. One relative told us, 'It's an outstanding facility and we're all very lucky to have found it'.

We saw that guidance regarding safeguarding people from abuse was available to staff and they had received recent relevant training. One person that we spoke with told us, 'The staff are very capable and I feel as safe here as I have anywhere'.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged.

We saw that there was an effective complaints system in place and that complaints and comments were sought from people who used the service and their relatives. A person we spoke with told us, 'I have never made a complaint but I did make a positive comment in the book'.