Glanmor

Glanmor is a care home providing accommodation and personal care for seven people with mental health needs.

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

At the last inspection we told the provider they needed to improve the fire safety measures in the home, including fitting new fire doors. At this inspection we found the provider had made the improvements necessary to meet legal requirements.

New fire doors had been fitted throughout the home. Fire equipment and the alarm were regularly checked to ensure they were safe. Action had been taken to address all outstanding issues on the home’s fire risk assessment.

People told us they felt safe living at Glanmor. Staff were helping people to follow infection prevention and control measures both in the home and when out in the community.

Staff said they had sufficient personal protective equipment and we observed them following good practice during the visit.

The management team had provided support and guidance to staff, enabling them to do their job effectively.

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 23 July 2019) and there was a 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 to fire safety arrangements and the provider was no longer in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out a comprehensive inspection of this service on 24 June 2019. A breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found.

We undertook this targeted inspection to check they had taken action to address issues in relation to fire safety. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. CQC have introduced targeted inspections to follow up on breaches of regulations or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We also looked at infection prevention and control measures under the Safe Key Question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

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.

Glanmor is a residential care home providing personal care. It is registered to provide personal care and accommodation for up to seven people with mental health and associated health needs. At this inspection six people were being supported by this service.

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

Individual risks were assessed, and action plans devised on minimising the risks. Some risks assessments lacked detail on how to reduce the risk.

Fire safety checks were occurring as required but further action was needed to ensure the safety of people in the event of fire. There was action outstanding in relation to replacement of fire doors.

There were parts of the building that were well decorated but delays in replacing fire doors meant repairs and redecoration had not happened. Better cleaning routines need to be developed. The manager had audited the cleanliness of the property and cleaning schedules were to be developed.

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. We recommend the provider considers current guidance on the legal authority that must be in place before best interest decisions can be taken on behalf of people by their relatives.

Care plans were person centred but lacked detail on how to support people. People knew a care plan was in place.

There were monthly monitoring visits from the director to ensure improvements were taking place. Audits were completed. Further action was needed to pull shortfalls from the audits and from the improvement plan together into a development plan. We have made a recommendation about ensuring reporting of notifiable incidents are reported to CQC.

People we spoke with said they felt safe living at the home. The staff had attended training and knew the procedures for safeguarding people from risk.

Staffing levels were in line the commissioner’s assessment of people's needs. There were two staff and the manager on duty throughout the day. At night there was one member of staff sleeping in the premises and staff said there was “good support from the on-call system.”

Medicines were safely managed. People had access to the GP and to community NHS facilities.

People told us they liked the staff and said they “liked living at the home.” People told us the staff were caring. We saw the staff have good interaction with the people. The staff knew it was important to develop relationships with people and understood how to support people in their preferred manner.

The staff were supported to develop their skills and with their performance. There were regular one to one meetings with the line manager, annual appraisals and team meetings. The staff said morale had improved and there was good team working. They said the manager was approachable and improvements had taken place.

The person we spoke with said they would approach the staff if they had concerns. Complaints were investigated, and the complainants received a response on how their concerns were to be resolved within the timescales.

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 Inadequate (published 31 December 2018). There were multiple breaches of regulations. 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 however there were other parts of the regulations that were breached. This meant there was a continued breach of regulation.

This service has been in Special Measures since 28 November 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Enforcement

At the inspection dated December 2018 we identified breaches in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We imposed conditions on the providers registration. This meant monthly action plans had to be submitted on the audits and any actions taken or to be taken as a result of those audits. This was to demonstrate how service users' needs were being identified and met. The provider has met the conditions on the notice of decisions imposed.

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.

This inspection took place on 8 and 9 October and was unannounced.

A registered manager was in post at the time of this inspection. The registered manager was on a period of absence from the service and was not available during our inspection. 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. Our inspection was supported by the director of the service and a deputy manager.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is part of an ongoing Local Authority safeguarding investigation and may in the future be considered by CQC under our specific incident process. The information shared with CQC about the incident indicated potential concerns about the management of risk of incident within the service. This inspection examined those risks.

At the last comprehensive inspection in June 2016, the service was rated Good overall and Requires Improvement in the 'Safe' domain. We undertook a focused inspection in May 2017 to check that they had followed their plan and to confirm that they now met the legal requirements. Following this focused inspection, the service was rated Good overall and in the ‘Safe domain’.

At this inspection we found concerns across all the five domains and the ‘Safe’ and Well-led domains are now rated as Inadequate. We identified four breaches of the Regulations, Regulation 10 Dignity and respect, Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing.

The overall rating for this service is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The recording of incidents and accidents, subsequent investigations, actions taken and measures to minimise risks had not been safely managed. Staff confided there were times when it had been hard to reach the registered manager and they felt isolated in dealing with situations without appropriate guidance being given.

There were people who at times expressed their frustrations and anxiety using behaviours which staff found difficult to manage. Approaches from staff were not always consistent and documentation in place lacked guidance and mitigation of the risks.

Risks in the home had not always been safely managed or action taken to prevent harm in a timely manner. We found serious fire safety concerns at Glanmor that potentially risked the safe evacuation of people and unsuitable measures in place to manage a fire. Following our inspection, we made an immediate referral to the Fire safety team who have since been out and inspected this service.

Medicine systems did not protect people from potential harm. There were inconsistencies between the records of medicines returned for disposal and records of medicines administered.

Measures to prevent and reduce the risk of infection control had not always been taken. Parts of the home were not clean and in need of maintenance and repair.

Staffing levels in the home were not reflective of the level of needs people had. Staff consistently raised their concerns about staffing levels and we saw during our inspection one staff was left to manage for several hours.

We observed the training matrix and saw there were gaps across training subjects that staff had not completed or refreshed their training. The registered manager of the service had also not refreshed their own practice within the designated timeframes. Staff had not received regular supervisions.

We found that there were inequalities in the way people were treated around the issue of smoking within the service. This had impacted negatively on some people who were being discriminated against.

Each person had a care plan in place, however we saw that these were not always person centred and were focused from the staff’s perception. There was often a lack of guidance on how staff were to support people.

We have concerns about the provider and management team at this service to meet the requirements of the regulations placing people at risk of receiving inappropriate and unsafe care

Prior to this inspection the provider failed to notify us of two serious injury incidents to a person in the service. At this inspection we found a further incident of physical abuse had not been made to The Care Quality Commission. This had not been picked up through the provider’s quality monitoring of the service.

Quality monitoring at the service was not robust. Effective monitoring or regular quality checks had not been completed by the management team in order to identify shortfalls and take timely action to protect people from receiving unsafe care.

You can see what action we told the provider to take at the back of the full version of the report. We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 12 April 2017 and was unannounced.

There was a registered manager in post at 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 and associated Regulations about how the service is run. The registered manager was not available on the day of the inspection due to other commitments.

We previously carried out a comprehensive inspection of this service in June 2016. A breach of legal requirements was found. The service was rated Good overall and Requires Improvement in the ‘Safe’ domain. After the comprehensive inspection, the provider wrote to us to say what actions they would take to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. 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 Glanmor on our website at www.cqc.org.uk. We found on this inspection the provider had taken all the steps to make the necessary improvements.

Medicines held by the home were securely stored and people were supported to take the medicines they had been prescribed. Medicine administration records had been fully completed, which gave details of the medicines people had been supported to take.

People told us they felt safe and staff were kind to them. Comments includes, “I like living at Glanmor. I feel safe here” and “The staff treat me well and are kind”.

There were systems in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting.

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.’

Medicine systems were not always safe. Protocols were developed for medicines to be administered “when required”. The Medicine Administration Records (MAR) charts were not always appropriately completed. MAR charts were not always signed by staff when the medicines were administered and on other occasions the staff had signed the MAR charts but had not administered the medicines. This meant people were not having their medicines as prescribed and there was potential for confusion between staff.

Support plans were developed in line with people’s preferences. The support plans included aspects of care people were able to manage for themselves, and the action plans gave staff guidance on the person’s preference for their delivery of their care and treatment. However, support plans were not developed for people with mental health care needs. This meant staff may not be aware of the potential signs and actions needed for detecting any deterioration in a person’s mental health.

People said they mostly felt safe living at the home. The staff knew the procedures for safeguarding vulnerable adults from abuse. This meant they were able to describe the types of abuse and the actions they need to take if they suspected abuse. A copy of the No Secrets guidance was available for staff working at the service for reference.

Risks were assessed and assessments developed on minimising potential risks. Staff were aware of the risks to people and the actions they must take to ensure people’s safety and for them to take risk’s safely.

People said the staff responded to their request and spent time with them. The staff rota in place showed there was lone working for part of the day and at night. An on call system was in place for staff to gain advice and support. . This meant that staff were able to gain advise and additional support should aggressive incidents towards staff occur when they were lone working.

Staff were supported to maintain and develop their skills. New staff had an induction to prepare them for their role and responsibilities. Training courses were available each month and staff said there was a variety of courses and the quality of the training was good.

People had capacity to make their own decisions. The staff used the most appropriate approach for people who at times, used verbal aggression towards them.

People were supported by the staff to manage their ongoing health conditions. Staff consulted with people about arrangements for making appointments. This included the times of appointments and whether the staff were to accompany them on these visits.

Quality assurance arrangements in place ensured people's safety and well-being. The views of people were gathered and their feedback about the service was positive. Monthly visits from the area manager took place to monitor the quality of the service people received.

We looked at four care plans for people who used the service. The care plans were based upon people's preferences and gave detailed information on all aspects of the person's daily life, such as, communication, diet, finances, mental health and emotional well-being, cultural, spiritual and social values. People had an end of life care plan in place which documented their wishes.

On a previous inspection in November 2012 we found that not all areas of the home were clean and we asked the provider to make improvements. When we visited in May 2013 we found the home to be clean throughout. The provider had also made improvements to the maintenance of the home. A new wet room had been installed and a second bathroom and a shower room had been renovated and repairs carried out which ensured people who used the facilities were safe. A new shower unit had been installed in the second bathroom and copper heating pipes exposed in the entrance hall had been boxed in. The home's policies and procedures were in place and current.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We looked at three care plans for people who used the service. The care plans gave detailed information on all aspects of the person's daily life, such as, communication, diet, personal hygiene, mental health and emotional well-being, cultural, spiritual and social values. The care plans were personalised and provided detailed guidance about how people's needs should be met.

We talked with people about being safe. They said they felt safe in the home and would not hesitate to report any concerns they may have. We saw that staff and people who lived in the home had formed positive relationships. Staff said they felt they knew people well, their likes and dislikes and were familiar with their care plans. Staff said how much they enjoyed their work.

We found that people were not protected against the risks of unsafe or unsuitable premises because the property had not been adequately maintained throughout and we asked the provider to take action. The home regularly audited the quality of its service however we asked the provider to ensure that the cleanliness of the home was maintained and audited.