Archived: Glastonbury Court

During this inspection we spoke with eight people who used the service, six care staff, three relatives and the quality manager and we looked at nine people's care records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Care records were person centred and updated regularly. Although care records documented that most people received the care they needed we found some records which showed that this was not the case for all the people who used the service.

We looked at rotas and found that there were enough trained and experienced staff on duty to meet people's needs. Staff confirmed this to us.

We found that the service was aware of its responsibilities under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DoLS). We saw that several referrals had been made for a DoLS assessment. However we also found that the use of a lap strap for one person in their wheelchair constituted restraint.

Is the service effective?

People's health and care needs were assessed in consultation with either the person themselves or relatives. People's care plans reflected their healthcare needs and the service worked in conjunction with support from outside professionals to meet them.

Some relatives we spoke with were positive about the service. Others had concerns about how the service communicated with them about their relative and about the quality and consistency of care.

People who used the service told us they were happy with the care provided and spoke positively about the staff. One person told us, 'It's very good here. They wash me and look after me'.

We saw that people's nutritional and pressure care needs were assessed and plans put in place to meet them. We found one person who was at risk of malnutrition had not been appropriately weighed or referred to the dietician.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We were concerned about some disrespectful language used by two members of staff.

People who used the service told us they were happy and felt well cared for.

Is the service responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. We saw that people had been referred to the Falls Prevention Team and to a dietician if they had been assessed as being at risk..

People's preferences and choices had been recorded in their care plans and we observed that care and support was delivered in accordance with people's wishes. One person's plan stated a preference for a male carer and we saw that the service sought to ensure this as often as possible.

We were concerned that staff on duty were not aware that three people who used the service had a Do Not Attempt Resuscitation order in place. This meant they were at risk of receiving inappropriate care should they suffer a cardiac arrest.

We looked at call bell audits and saw that bells were answered promptly.

Is the service well led?

We saw that the service has had a change of leadership since the last inspection. We noted that many improvements had been put in place since we last inspected. The service will shortly close and we saw that people who used the service were being supported with the change to another service. On the day of our inspection groups were being taken to visit the new service. The quality manager had a clear strategy about how to involve the people who used the service in the changes and decisions about the new service.

People that had a higher level of independence told us that they were satisfied with the care and support they received. One person said, 'Staff are OK, I see them often.' One person described the service as, 'Absolutely ideal, couldn't be better.' However they told us that there was, 'Not a lot to do.' Another person said, 'Food is beautiful and I can choose what I want, I don't need to do anything, staff do it all for me.' Another person told us, 'The food is OK, I get what I want and the staff are beautiful.' They also told us that there is not much to do during the day, 'I sit here in the lounge, and I mostly fall asleep'. We spoke with one person who had recently moved into the service who told us, 'I am not happy; this is not what I am used to.'

We found that records relating to people who used the service did not provide an accurate reflection of their needs. We found that there was insufficient skilled and experienced staff on duty to meet people's needs. Staff that had worked at the service for a number of years spoke knowledgably about the people they provided care and support to; however the movement of staff between units and high use of agency staff did not provide continuity of care. Systems were in place to assess and monitor the quality of the service that people received, however we found that these were not being used effectively to make improvements to the service.