Archived: The Glebe Care Home

Was it safe?

Staff followed the Mental Capacity Act 2005 to make sure that people were asked for their consent before they received care. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Before people received care they were asked for their consent and the provider acted in accordance with their wishes. Where people's capacity to consent to their care was sometimes changeable because of their medical condition. Staff, were able to describe how they assessed their capacity to make decisions about their care. People's care records accounted for the types of decisions they were able to make and the circumstances under which decisions were made in their best interests.

People's care was planned and delivered in a way that was intended to ensure their safety and welfare. People's care plans detailed their health needs and the care interventions that staff needed to follow, to ensure these were safely met.

Staff knew their responsibilities and those of others, for decision making about people's care. The provider's written procedures supported staff to report any concerns about people's safety and welfare. For example, changes in people's medical conditions and accidents and incidents, including the suspected or witnessed abuse of any person using the service.

People were cared for in a clean, hygienic environment and received their medicines when they needed them. Staff understood their roles and responsibilities and they were provided with the guidance, training and equipment they needed for this. People were protected from the risk of infection and against unsafe medicines practice because there were appropriate arrangements in place for these.

The provider carried out regular monitoring visits to check that people's care needs were being safely met and that they were protected against the risks of unsafe premises. There were proper maintenance arrangements, risk assessments and contingency plans and procedures in place to ensure people's safety. This included known possible emergencies, such as a fire.

Was it effective?

People experienced care and support that met their needs. One person told us, 'I am quite settled here now; staff listen and support me properly, how I want them to.'

People's care plans met with recognised guidance and were recorded in a way that informed staff about their known daily living choices and lifestyle preferences.

People were mostly satisfied with their environment and the arrangements for their access to their own rooms and communal areas. Not all toilets provided disabled access and the shower facility was not accessible to people with mobility problems. However, some disabled toilet provision was suitably located and bathroom equipment and facilities were being reviewed by the provider in response to people's changing needs.

People were cared for in a clean, hygienic environment and received their medicines when they needed them. Staff understood their roles and responsibilities and they were provided with the guidance, training and equipment they needed for this.

Was it Caring?

People experienced care and support that met their needs and protected their rights. One person told us, 'The staff, are lovely and caring.'

We saw that before people received care, staff explained how they were going to support them and agreed this with them. For example, giving people their medicines and supporting them with their meals. Staff took time to check with people whether they were experiencing pain and took appropriate action. They also promoted people's dignity, privacy and independence.

Was it responsive?

Records showed that staff responded to changes in people's health needs and referred them to relevant outside health care professionals where required.

We saw that improvements had been made in response to national guidance and from our previous inspection reports. They included record keeping for people's personal care plans, medicines and for their consent to their care.

The provider agreed people's care with them where possible and acted according to their wishes and best interests. We found that some changes either had been, or were being implemented from people's expressed views. This included meals, activities, event and garden developments.

Some people were temporarily accommodated and received personal care elsewhere. This was due to extensive building repairs needed to one wing of the home, following unforeseen damage there. The provider had consulted with people and their representatives to agree their arrangements and they were kept informed of progress for their return by regular staff contacts and newsletters.

Was it well led?

Staff said they received the training, guidance and support they needed and understood their role and responsibilities for meeting people's care needs and reporting any concerns or changes in people's health and safety needs.

Staff, were kept informed about people's care and usually received feedback about any changes or any learning from incidents or from the provider's checks of care and safety.

People knew how to complain. One person told us, 'Staff listen and do their best to put things right if there is a problem. Staff said they felt comfortable to raise concerns they may have about people's care at any time with the manager, who they said was approachable and listened to them.

The provider had effective systems to regularly assess and monitor the quality of service that people received and they carried out regular monitoring visits to check that people's care needs were being properly met. People were regularly consulted with individually or by way of group meetings and their views obtained about their care and daily living arrangements.

This visit was a follow up inspection to check if action had been taken to the findings of last visit which was on 17 April 2013. At the last visit people were satisfied with the care received. However we found it was not always clear how decisions were being reached about peoples care and records were not always kept up to date.

At this visit we found that staff knew people well and could describe their care needs to us. There had not been progress to consider people's capacity to make decisions and demonstrate that decisions were being reached in people's best interests where people did not have the capacity.

We observed that people's records were securely stored. We looked at six care plans and found these not always updated with significant changes. This meant that there was a risk that staff may be unaware of significant changes and people may not receive the care they needed.

People told us they were generally satisfied with their care at the home. All felt their needs were being met and confirmed that staff were usually available when they needed them and listened and acted on what they said. One person said, 'The staff are very good, I feel safe here.' People said they were satisfied with their environment, which was usually kept clean and fresh. They said they enjoyed the food and some of the social activities and outings organised with them. One person told us, 'The food is very good, I am pleased my friend can join me for lunch; they usually do.'

We found that although consent was obtained to some aspects of people's care, this was not consistently done. We also found that some people's care records were not always accurately kept.

We found that the arrangements in place did not ensure people's appropriate, legal consent was obtained in relation to their care and treatment. Although decisions made in people's best interests were referred to in their care records, we did not see evidence of how these decisions had been reached.

People, and relatives, told us they were happy with the care provided at the home, "They look after us very well here". However, people also said that there were not enough activities provided for them. We found that the planning of care did not always ensure the welfare and safety of people using the service.

People described staff as friendly, kind and patient. A relative told us, 'Nothing is too much trouble for them'. People told us they sometimes had to wait for assistance from staff. We found that staff had not received all the required training.

We found that records were kept securely but were not always accurate or up to date.