Archived: Glenkealey

This focused inspection took place on 3 and 5 September 2018 and was unannounced. At the time of the inspection, there were 14 people living in the home.

Glenkealey was previously inspected in January 2018 and was rated ‘requires improvement’. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvements were needed as risks to people’s health and safety had not always been assessed or managed safely. People’s medicines were not being stored safely. Poor infection control procedures and the lack of clear workflow systems within the laundry had placed people at increased risk. Quality assurance systems had been ineffective.

Following our inspection in January 2018 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. We undertook this unannounced focused inspection of Glenkealey, in September 2018, to look at whether people were receiving safe care and treatment and to check that improvements to meet the legal requirements planned by the provider had been made.

We inspected the home against two of the five questions we ask about services: is the home safe and is the home well led? This was because the home was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At this inspection, in September 2018, we found risks associated with people’s care were now being effectively managed. Medicines which required refrigeration were stored safely. Laundry processes had sufficiently improved to help prevent the spread of infection and reduce the risk of cross contamination. However, we found further improvements were needed to ensure people received their medicines as prescribed and that the environment was safe for people to live in.

The home had a registered manager 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 home is run.

People’s medicines were not always managed safely. We looked at the Medication Administration Records (MARs) for 14 people. We found people’s MARs were not accurate and therefore staff were unable to assure themselves that people were receiving their medicines as prescribed by their doctor. Where people were prescribed medicines they only needed to take occasionally, such as for the management of pain or anxiety, staff had not been provided with guidance to aid their decision making and to help ensure those medicines were administered in a consistent way. There was some good practice in relation to the management of medicines. People were given time and encouragement to take their medicines at their own pace, staff had received training in the safe administration of medicines and people medicines were stored securely.

People were not always protected from the risk of harm as they were living in an environment that may not be safe. Whilst some premises checks had been completed we noted others had not, we found a number of fire doors did not close properly when tested. This would have significantly reduced resistance to the effects of fire and smoke. Where the home had carried out remedial works, this had left holes in the walls and cavities. These had not been filled with a suitable fire-resistant material and as such would not reduce the spread of smoke. We also noted that fire retardant ceiling tiles were missing in the downstairs office and residents’ lounge and the homes fire risk assessment needed to be updated.

People told us they were happy living at the home and liked the staff that supported them. Relatives did not have any concerns about people’s safety. People were protected from the risk of abuse. The registered manager and staff understood their role and responsibilities to keep people safe from harm and ensure people's rights were protected. Risks associated with people’s care had been appropriately assessed. There were enough staff to meet people's needs and checks were carried out on staff before they started work to assess their suitability.

People, relatives and staff were positive about the leadership of the home and told us the home was well managed. The provider had systems in place to review, monitor and improve the quality of care provided. We looked at the home’s quality assurance and governance systems and found while some systems were working well, others had not been effective and had not found the concerns we found during this inspection.

The registered manager had notified the Care Quality Commission of all significant events, which had occurred in line with their legal responsibilities. We found the provider had displayed their rating in the home and on their web site.

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

Glenkealey is a ‘care home’, operated by Saffron Care Ltd. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People living at Glenkealey were older people, many living with physical health conditions mental health needs or dementia. The service accommodates up to 15 people in one adapted building, with a lift to access many of the rooms on the first floor. Some stair lifts were in use to access other rooms. 12 people were living at the service at the time of the inspection.

The home had a registered manager. 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.

In July 2015, Glenkealey was rated as requires improvement, with breaches of Regulation 9 (Person Centred Care), 12 (Safe Care and Treatment) and 13 (Safeguarding service users from abuse).

The last inspection of Glenkealey took place on 19 October 2016, when the service was rated as good overall, with the key question of safe rated as ‘requires improvement’. There was a breach of Regulation 12 Health and Social Care Act 2008 Regulated Activities Regulations 2014 (Safe Care and Treatment). Following the inspection the registered provider and registered manager sent us an action plan telling us what they were going to do to address the concerns we had identified.

This inspection in January 2018 started as a focussed inspection to review improvements made following the breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in October 2016. However during this inspection we identified the breach had not been addressed and we found further concerns. As a result we completed a comprehensive inspection. The inspection was also carried out to follow up concerns we had received about a person who had received an injury while living at the service.

Although we found some good practice, we identified areas of concern and the service is rated as requires improvement.

People in the management structure, such as the registered manager and nominated individual had a ‘visible presence’ in the service on a daily basis. Lines of accountability and responsibility were understood and there was a clear organisational structure. The registered manager had recently appointed a member of staff to help them carry out some duties such as rotas and some audits. However the culture and values of the organisation were not well developed or shared widely amongst the staff team.

Systems had not always been operated effectively to assess, monitor and improve the quality and safety of the services provided, or mitigate the risks to people from their care or the environment.

People were not always being kept safe, because the service had not always identified or acted on concerns about risks to people’s safety. We found there was not sufficient separation between clean and dirty clothes and linens, the laundry could not easily be kept clean and there were no handwashing facilities in that area. This meant staff were carrying soiled items through the kitchen while meals were being prepared and having to wash their hands in a sink in the kitchen after handling potentially contaminated items. Concerns about the laundry had been highlighted on the inspection in 2016, but actions had not been taken to resolve the concerns.

Following the inspection we asked the local authority environmental health officer to visit the service. The environmental health officer discussed alterations with the registered manager and will monitor this to ensure people are protected by the changes made.

We identified concerns over the assessment of risks relating to people’s health, for example from long term conditions and the oversight of risks relating to people’s fluid intake.

People were not being kept safe because the service did not always complete a full pre-admission assessment, before deciding Glenkealey was able to meet their needs. During the inspection we found one person’s care needs had not been fully risk assessed prior to moving to the service. The service had relied on care plans provided by supporting agencies, which did not contain full information about the person’s healthcare. This had left the person at risk of their needs not being met safely.

Care plans did not always contain sufficient detail to enable staff to respond to people’s needs, for example how to approach them in ways that made use of remaining vision. People living with specific support needs such as visual impairment or dementia had not always received information in formats tailored to meet their needs.

People received their medicines as prescribed. However actions had not been taken to ensure they were stored safely. We found the temperature of the medicines refrigerator had been recorded but no action had been taken when the temperature had been consistently recorded as operating outside the safe recommended temperature levels. This meant medicines may not have been as effective in use. These concerns had also been identified at the previous inspection in 2016.

People were protected from abuse, although staff were not always clear about who to report concerns to outside of the service. Staff had received training in identifying and reporting concerns about abuse and the registered manager confirmed this would be re-enforced in further training and staff meetings.

People’s rights with regard to the Mental Capacity Act 2005 were respected, but not always consistently applied. Staff had received training in the Mental Capacity Act 2005 and applications had been made under the Deprivation of Liberty Safeguards (DoLS) where appropriate. Systems were in place for the proper management of complaints. The service learned from incidents and accidents, which were analysed to see if a repetition could be avoided; actions were taken where identified. For example some people had pressure mats in their room to ensure staff were alerted to them being out of bed at night where they were at risk of falling.

Some areas of the building were looking tired and worn. Some renovations had taken place, for example with a downstairs bathroom and the replacement of some first floor windows. However, there had been little advance in the environmental adaptation for supporting people living with dementia since the last inspection, despite this being previously identified as needing attention. The registered manager told us they had some ideas for doing so.

People and staff were supported to share their views of the service at meetings, and through a series of questionnaires. These were then analysed and action plans drawn up to address any issues raised. For example new towels and bedding had been purchased as a result of feedback received.

People were supported by sufficient numbers of staff on duty to meet their needs. A full recruitment process was in place which ensured staff were recruited safely. This included the taking up of disclosure and barring service (police) checks and previous employment references, and assessments of risk where some information was not available.

Activities were provided that met people’s interests and wishes. Visitors were welcome to visit at any time and have a continuing involvement in their relations care if they wished. Feedback people living at the service and visitors was positive. One visitor compared their experience of their relation being cared for at Glenkealey with another service they had lived in, and said “The staff really care - it’s so much better here. I have no concerns about them here.” A relative told us about how much they appreciated the way the service recognised the things their relation liked and helped celebrate milestones and successes with them. They told us how their relation enjoyed music and how they often were able to have a “little dance” together during the day. They also told us how the service had supported them to share a significant wedding anniversary together with a cake and celebration.

Some people living at the service were living with dementia. We saw positive examples of staff supporting people well. Staff were attentive to people’s needs. We saw a person being supported to walk to the lounge, and staff ensured they were comfortably settled with a drink before leaving them. Staff understood people’s likes and dislikes, and were aware of their emotional needs. We saw staff using appropriate touch to reassure people, and taking advantage of opportunities to engage with people for short periods throughout the day.

Since the last inspection the service had implemented a computer tablet based system for the recording of care plans and daily records. This alerted staff to people being at risk of falls and alerted the manager to any elements of people’s care plans that had not been fulfilled that day. For example one person had not received a prescribed cream, to which the registered manager was alerted. However records showed staff had indicated the cream had not been needed that day.

We identified a number of breaches of Regulations on this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Glenkealey provides care and accommodation for up to 15 people, and was full at the time of the inspection. People living at the home were older people, some but not all of whom were living with dementia or had mental health needs.

The home had a registered manager 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.

Glenkealey had previously been inspected on 4 and 8 June 2015, when they had been rated as Requires Improvement overall. There had been breaches of Regulations 9 (Person centred care), 12 (Safe care and treatment) and 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at that time. The provider sent us an action plan telling us what actions they intended to take to put things right.

On this inspection we found actions had been taken to address the concerns identified on that inspection. For example we found that care plans had been re-written to include more information about the person’s wishes with regards to their care. There had been a significant increase in the activities provided to help entertain and engage people in accordance with their wishes and choices. These had improved the homes ratings in key areas from ‘Requires improvement’ to ‘Good’. We identified some concerns in relation to people’s safety, which meant the home was still in breach of Regulation 12 (Safe Care and Treatment). However, the registered manager took immediate action to address the majority of the issues while we were still at the home, and following the inspection confirmed to us the further actions they had taken to prevent a re-occurrence.

On this inspection we found people had not always received safe care or were not being protected by the home’s systems for assessing and mitigating risk. Sufficient information to help staff assess the risks to one person from poor hydration was not being recorded. Eye drops which needed refrigeration, were not being stored at the correct temperature to ensure they were safe and effective. Risks to people from the environment had not always been assessed; not all areas had been well maintained, and robust infection control practices were not always put into practice. We found action had not been taken to support and protect a person appropriately following a fall.

Immediate action was taken by the registered manager to address this at the time of the inspection.

Staff understood about people’s right to refuse care. However decisions about people’s capacity and decisions made in their best interests were not always being reached or recorded within the framework of the Mental Capacity Act 2005 (MCA). Appropriate applications had been made under the Deprivation of Liberty Safeguards (DoLS), which helped ensure people’s rights and safety were respected.

We have made a recommendation about the implementation of the Mental Capacity Act 2005.

Staff understood how to keep people safe from abuse. They understood how to report any concerns about people’s well-being. Minor changes were needed to the home’s safeguarding policy to ensure it reflected the local policies and procedures regarding investigation of concerns.

We have made a recommendation about seeking guidance on the procedure for investigation of safeguarding concerns to update the home’s policy.

People were protected from the risks associated with staff recruitment. A full recruitment procedure was followed for new staff and there were enough staff on duty both day and night to meet people’s needs. We saw staff being able to respond to people’s needs in a timely way. People told us and we saw they had the skills, knowledge and experience to support people effectively. Staff told us they were well supported, and worked well as a team. They told us poor care was not tolerated.

The environment had been adapted to provide a comfortable home for people, some of whom were living with dementia. Each person had their own room, some of which had sea views. There were attractive level gardens, with wide pathways, adapted to meet the needs of people living with sensory impairments or dementia

People told us they enjoyed their meals, and we saw people eating well. The home’s cook had a good understanding of people’s dietary needs, and had information available to ensure people received their food in appropriate textures, for example to help people with swallowing difficulties.

People were supported by staff who addressed and related to them in a friendly and positive manner. Staff respected people’s individuality and spoke to them with respect. Staff ensured they understood people’s communication, and that people understood what they needed them to understand. People told us the home was friendly, and visitors were welcome at any time.

People’s privacy was respected. Care took place in private, and people’s dignity was supported. Staff understood the importance to people of caring for their appearance and dressing well.

People’s needs and wishes regarding their care were understood by staff who ensured they were followed through. For example staff understood and respected people’s wishes with regard to getting up early or going to bed late. People had good medical and community healthcare support available, including GPs, nurses, podiatrists, dental and optical services. Specialist healthcare, for example to support people with managing long term health conditions was available to people if they needed and wished for this.

People could take part in activities provided, or not as they wished. Since the last inspection the home had made efforts to provide more activities and be more flexible in their provision. On the day of the inspection there was a visiting singer, which people really enjoyed singing along with. In the afternoon people played games and quizzes. One person told us they liked to spend time in their room watching television. Staff understood and respected this. Other people had been going out more and staff told us how much they had enjoyed this.

Systems were in place for the safe management of complaints and concerns. People told us they had no concerns about raising any issues with the home’s management.

People and others were consulted about their views on how the service could be improved. Questionnaires were sent out regularly to people living at the home, staff, relatives and other interested parties. Where suggestions were made these were considered and actioned where possible. Positive information was shared to support good practice.

The home had a set of written values and the provider told us these were regularly discussed to ensure they were shared across the staff team. The registered manager took advantage of learning resources to improve the home and develop their skills and knowledge. This involved attending courses and local forums, reading reports and journals and using the internet.

Records were well maintained, and safe systems were in place to ensure they were destroyed when no longer needed.

We identified a breach of regulations during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We found that people's consent had been obtained for care and treatment provided to them by the service.

People who lived at the home told us they were well looked after and were happy. One person told us "Very good, it's the best home going'. A family member of one of the people who lives at the house told us 'I know [my relative] is happy and well looked after'.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People's health and welfare needs were met by sufficient numbers of appropriate care staff.

People told us that they felt safe and knew what to do if they had concerns. One person told us that they would feel comfortable making a complaint. People told us that they would not hesitate to report any issues to any member of staff. A family member told us that they had raised some minor issues and these had all been dealt with quickly and had been resolved.

People we spoke with told us they felt involved in their care. During this visit we saw that staff spoke to people politely, respectfully and kindly. We heard friendly banter and affection being mutually shared. We saw no negative interactions.

People were complimentary about the staff and the care they received. They said they felt safe living at the home and that staff knew how to look after them.

The home was clean, warm and comfortable and people told us they were happy with the decor and furnishings at the home. One person told us that since our last inspection they were 'pleased' that they could lock their bedroom door and they felt 'safe'.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People we spoke with said they were happy with the care and support they received, that staff respected their privacy and were supported to make decisions and choices about how they spent their day. Records did not support this.Two people were concerned that their privacy was not respected. Staff interacted well with the people in the home.

Some information in care plans gave good directions about how the person's personal care needs were to be met. Some information was missing.

Some people confirmed they felt safe at Glenkealey but two people told us that they did not.

The home was generally clean, tidy and comfortable. We had some concerns about some aspects of cleanliness and maintenance. D'cor in the home was looking tired.

Medications were stored securely.

Staff and most people who lived at the home said there were enough staff on duty to meet care needs within the home.However, two people said that there were not enough staff to accompany them into the community. Staff confirmed this.

People told us 'Staff are usually busy but they are all caring and friendly'.

Training records showed that all staff required training updates.

One person said that staff 'Very often ask' what she thinks about things. We saw some questionnaires which had recently been returned by relatives. All included many positive comments.