Glottenham Manor Nursing Home

People’s experience of using this service:

The providers’ governance systems had not identified the shortfalls found at this inspection. Records lacked reference and guidance for staff on how to manage peoples’ health related needs, such as diabetes.

People received safe care and support by enough numbers of staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “It’s safe and lovely here.” Care plans and risk assessments meant peoples’ safety and well-being were protected. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent.

Staff had all received essential training to meet peoples support and care needs. Further service specific training was being arranged by the registered nurses as requested by care staff. There was an induction programme to introduce new staff to the service and during this process they got to know people and their needs well. Staff told us that they felt the induction was in -depth and good. People's dietary needs were assessed, and people were provided with a choice of cooked meals each day. Feedback about the food was positive and people said they enjoyed the meals. People’s health needs were consistently met with involvement from a variety of health and social care professionals.

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 were caring in their approach to the people they supported and at this inspection we saw people were treated with respect and dignity. People and visitors to the service were consistent in their views that staff were kind, caring and supportive. One health professional said, “The home atmosphere is positive, and people seem to be content.” People were relaxed, comfortable and happy in the company of staff and engaged with in a positive way.

People confirmed they were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

Complaints made by people were taken seriously and investigated. Resident and family meetings were recommencing.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “It’s a good place to work, communication is good, and we share information. We all feel we can contribute, and we work as a team.”

Rating at last inspection:

The last rating for this service was requires improvement (19 October 2019) and there were three 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings.

We 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Haven Care Home on our website at www.cqc.org.uk.

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

Glottenham Manor is a nursing home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 46 people. People at the home were living with a range of physical health conditions.

Glottenham Manor is a single building located in a rural setting, in its own grounds, and has accommodation over two floors; many of the bedrooms are on the ground floor together with the communal areas, such as the lounges and the dining area. The first floor is accessed via stairs or a lift and some bedrooms are on the first floor.

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

Some people told us that they did not always feel safe as they said there were not enough staff on duty. People, their relatives and staff told us that they were not enough staff on during the day and night. Call bells were often not answered in a timely manner which meant that people did not always receive support when they wanted.

Care and treatment had not always been managed effectively to ensure that people received enough to drink. Staff management and monitoring of people’s fluid intake was poor. Systems were not in place to check that people were receiving enough fluids. Risks to some people’s skin integrity had not always been managed or mitigated safely.

Although there were quality assurance systems in place, there were some areas of support that were not audited or checked to ensure that people received safe and effective care.

The provider had systems in place to protect people against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns. When staff were employed they were subject to checks to ensure they were safe to work with people in the service.

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. People’s health and nutritional needs were met. One person said, “The food is lovely, and I like everything we have.” Staff were knowledgeable and well trained.

People’s care plans did not always reflect their physical needs and show the care and support that people should receive. People had access to a range of activities that met their interests. People were given information in a way they could understand, and staff understood people’s individual communication needs. People received compassionate end of life care.

Systems and process were in place to assess, monitor and improve the quality of areas such as medicines administration, health and safety, pressure sores, equipment and people’s meal time experiences. Actions were taken from audits of the service to drive improvements to the quality of care people received. People and staff were complimentary about the manager. One person said, I think the home is more relaxed since they took over as manager.” One relative told us, “The manager is very open and understanding and we can approach her at any time.”

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

Rating at last inspection

The last rating for this service was good (Report published 19 January 2017). A focussed inspection was carried out in June 2017 to inspect the safe domain which was rated as good (Report published 4 July 2017)

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, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and leadership 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.

Glottenham Manor Care Home is situated in a rural location in East Sussex. The service is registered to provide accommodation and nursing care for up to 50 people who are older or have a physical disability. There were 38 people living at the service when we visited.

The accommodation is set in large grounds; the service was clean, bright and airy with various communal areas for people to use both inside and outside.

At the last inspection, the service was rated Good overall and Requires Improvement in the ‘safe’ domain.

We carried out an unannounced comprehensive inspection of this service on 31 October 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 18 of the Health and Social Care Act Regulated Activities Regulations 2014, Person Centred Care. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met 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 Glottenham Manor Care Home on our website at www.cqc.org.uk

At this inspection we found the service remained Good overall and is now rated Good in the ‘safe’ domain. The breach of Regulation 18 has now been met.

The service had improved since the last inspection. People’s call bells were now being answered quickly and there were enough staff on duty to meet people’s needs. Regular audits of the call bell responses were completed; any issues investigated and addressed.

People told us they felt safe at the service. Staff recognised different types of abuse and knew who they would report any concerns to, they were confident that the manager or deputy manager would address any issues. Risks to people were identified, assessed and plans were put in place which gave staff the guidance needed to manage and minimise the risks.

People’s medicines were managed safely and in the way they preferred. Staff were recruited safely using systems to ensure they were suitable to support people.

There was sufficient staff to provide care to people throughout the day and night. However, we found some call bells were not answered quickly enough. You can see what action we told the provider to take at the back of the full version of the report.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. However, we observed some inappropriate use of language, such as addressing people by their room number and not their name. We have made a recommendation about this in our report.

Care plans ensured people received the support they needed in the way they wanted. However, people’s preferences and views about their care were not always recorded. We have made a recommendation about this in our report.

When staff were employed they were subject to checks to ensure they were safe to work with people in the service.

Risks to people’s safety had been assessed and actions taken to protect people from the risk of harm. The provider had systems in place to protect people against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns.

Medicines were managed safely and people had access to their medicines when they needed them.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s special dietary needs were clearly documented and staff ensured these needs were met.

The staff were kind and caring and treated people with dignity and respect. Caring relationships were seen throughout the day of our inspection. Staff knew the people they cared for well. People could have visitors from family and friends whenever they wanted. People spoke positively about the care and support they received from staff members.

People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people’s decisions.

People felt well cared for and were supported with a variety of activities.

Peoples health needs were well managed by staff so that they received the treatment and medicines they needed to ensure they remained healthy. Staff responded effectively to people’s needs and people were treated with respect. Staff interacted with people very positively and people responded well to staff.

The culture of the service was open and person focused. The management team provided clear leadership to the staff team and was an active presence in the home.

Audits to monitor the quality of service were being completed. They identified actions to improve the service and these had been carried out. However, audits did not contain call bell response times. We have made a recommendation about this in our report.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans were specific for individual people and evidenced regular review.

Safeguarding procedures and policies were in place and the home used them as required to ensure people's safety.

There were effective recruitment and selection processes in place.

By direct observation and talking to the people who used the service, we found that there were enough qualified, skilled and experienced staff to meet people's needs.

We examined the provider's quality assurance files and spoke to staff and saw that there were effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Staff told us they had regular training and supervision. We saw records that showed that people were involved in decisions about their care and that people were treated with dignity and respect. We looked at training records that showed that staff had received career development to help them perform their roles safely and well. We found that the home was clean and comfortable and the food was well prepared and nutritious.