Archived: Glebe House Retirement Home

This unannounced inspection took place over two days, 29 September and 4 October 2016. At the time of the inspection there were 16 people living in the service.

There was a registered manager in post who also co-owns 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.

Improvements were needed in fire safety and the storage of hazardous fluids. The service needs to ensure that the checks in place to monitor the safety of the environment are effective enough and meets current guidelines and that staff are competent in the use of fire extinguishers and evacuation equipment. Further work is needed to ensure identifying and acting on any potential risk is embedded in staff practice.

People told us they felt safe. Staff understood their responsibilities to ensure people were kept safe from abuse and knew who to report their concerns to within the service. However, if the need occurred, not all were aware of the external safeguarding agencies to contact.

People and their visitors spoke about the caring staff and friendly atmosphere of the service. Staff had good relationships with people who used the service and spoke about them in a caring and compassionate manner. However, improvements were needed in the staffing levels and knowledge in supporting people with dementia, to ensure all interactions with people are meaningful and caring. Also in the range of activities offered to prevent the risk of social isolation. We have made recommendations to support the service in identifying how many staff they need and in improving staff’s knowledge of dementia care, and arranging simulating activities.

People were supported by staff to take their medicines as prescribed. Health care needs were met through developing good working relationships with external health care professionals.

The service was in the process of implementing new care plans. Improvements were needed in how people’s ability to make decisions were assessed and recorded. We have made a recommendation to support the service in ensuring any restrictive practices are lawful.

People told us that the ‘home cooked’ food was good, and that they were supported to have enough to eat and drink. Dietary needs and nutrition were being monitored and advice sought from appropriate health professionals as needed. However, improvements were needed in people’s dining experience.

A complaints procedure was in place to ensure people’s comments, concerns and complaints were listened to and addressed in a timely manner. There were systems in place to seek the views of people using and working for the service. However we have made a recommendation to further build on the work being undertaken. This is so people and staff can be more influential in driving improvements.

The service had checks in place to monitor the running of the service. But improvements were needed to ensure they were able to independently identify any shortfalls in the quality of service being provided as part of driving continuous improvements.

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information we had gathered 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 a summary of what we found '

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor's book. This meant that appropriate actions were taken to ensure that the people using the service were protected from others who did not have the right to access the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, the staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA). We also saw that the staff had been provided with training in safeguarding vulnerable adults from abuse.

People told us they felt safe. One person said 'I cannot find fault with anyone here. They look after you so well and yes I feel absolutely safe here.'

The provider had taken steps to ensure that people were cared for in a clean environment and to ensure the risk of infection was reduced. We found the environment to be clean and there were cleaning schedules in place to ensure that each area of the service was regularly cleaned and systems in place to reduce the risk of infection.

We observed there to be enough staff on duty to meet people's needs and we saw that people were regularly supervised for their safety. Staff we spoke with told us they had time to spend with people on a one to one basis to chat and enable people to access trips out into the local community.

Is the service effective?

People we spoke with told us their needs were met. We observed staff caring for people in an appropriate manner and offering them choices. The manager and staff spoken with and observed showed a good understanding of people's needs and acted in accordance with people's wishes. We looked at three care plans which told us about people's needs and how staff should meet them. 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 other health care professionals. This showed us that people experienced safe, effective and appropriate care that met their needs and protected their rights.

Is the service caring?

Our observations indicated that people were happy living at Glebe House. It was evident that people using the service had a good relationship and rapport with the staff who supported them. Several people told us the staff were, 'Kind and caring.' One person told us, 'They pay attention to the little details that matter like turning down your bed at night, laying out your night clothes and making a fuss of you on your birthday with a cake.'

People were supported by staff who were kind, caring and respectful. Care workers supported people with patience and genuine affection, assisting people who required additional support in a dignified manner and at their own pace.

Is the service responsive?

People's care records viewed showed us that their individual physical, mental and social care needs were assessed prior to admission to the service. Daily records evidenced that where concerns about the health and well-being of people had been identified appropriate action had been taken to ensure they were provided with the support they needed. This included access to health care professionals such as a doctor or district nurse.

We saw staff responding to people's requests. One person told us, 'My call bell is always handy and when I call they come quickly.'

We spoke with the cook and saw records in the kitchen which told us that people's dietary needs were known and people could have their meals at different times of the day and their individual dietary requests had been accommodated.

Is the service well-led?

Staff we spoke with were very positive about the leadership of the service and said that they felt well supported.

We saw that people using the service, relatives and visiting professionals were consulted in the form of an annual satisfaction survey. Their views about the support and care provided to people who used the service were analysed and action taken to respond to their views and improve the service provided.

During our inspection we spoke with five people who used the service. The people who used the service told us that they were well cared for. One person said, 'I have been here nine years and would not want to be anywhere else.' Another said, 'The staff are very kind here, nothing is too much trouble even when they are rushed off their feet.'

We saw that staff interacted with people who used the service in a respectful, caring and professional manner. Staff were attentive to the needs of people and responded to requests for assistance promptly.

We found shortfalls in the service's available and organised activities which were provided for people. This meant that people were not able to make choices about joining in activities and living active lives.

We looked at the care records of four people who used the service. We found care records were not always being audited and reviewed and did not contain accurate up to date information.

We reviewed the service's maintenance programme and found that the service was being safely maintained.