Glenroyd

Glenroyd is a residential care home, providing accommodation for persons who require nursing or personal care. The service provides support for up to 78 people including younger adults, older people, and people living with dementia or physical disabilities. At the time of inspection 70 people were using the service.

The property has 4 distinct units over 3 floors with lift access to upper floors. There were communal areas on each floor, multiple shared bathrooms and an accessible rear garden. Aids and adaptations were in place to meet people's individual needs.

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

Relatives told us people were safe and staff were able to meet people's basic care needs, but deployment was not always effective. We received feedback about low staffing levels and the impact of this. Measures were in place for health and safety, IPC and fire safety. However, risks were not consistently managed around people’s dietary needs or incidents. Medicines shortfalls had been identified prior to inspection but the home was working with the local authority and improvements had been made. 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 received in-depth induction, but there had been delays providing training to meet some people’s needs. There was no evidence of periodic supervision to monitor staff competence and we received mixed feedback around managerial support. We observed people were not always supported to wear their hearing aids, dentures or glasses. Communal areas were comfortable and fit for purpose and bedrooms were personalised. There was a positive dining experience and food looked and smelled good.

Some concerns were identified around privacy, but we observed caring interactions and staff spoke about people with dignity and respect. People and their relatives praised the standard of care and were complementary about management and staff. One relative told us, “The staff are outstanding, I couldn’t ask for better. Staff all treat [person] with respect.” Another said, “The team work hard looking after people. I have a great deal of comfort, knowing they have things under control.”

Personalised care promoted choice and control and communication needs were considered. We received feedback from relatives about people’s health and well-being improving because of responsive staff. End of life wishes were recorded, and appropriate training in place. There was a busy timetable of social activities and special events. Relatives spoke positively about how they felt welcome at the home, efforts made by the team and the good atmosphere. One relative said, “It always feels like a happy place.”

There was feedback about low staffing levels and the impact this had. One staff member said, “Because of staffing, I feel deflated when we can’t do what the team wanted to achieve.” However, staff worked hard, and good teamwork and communication attributed to a positive culture. Meetings were held at different levels and there was a ‘resident of the day’ initiative in which relatives were prompted to raise concerns. Audits and clinical governance systems helped identify shortfalls and analyse concerns.

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 (published 15 February 2022).

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

Why we inspected

The inspection was prompted due to concerns received about staffing, falls and dignity. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

Enforcement and Recommendations

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

We identified evidence that some systems and processes were not fully embedded.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The provider had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection.

¿ Staff had received training around the safe use of Personal Protective Equipment (PPE).

¿ Hand sanitiser and PPE stations were available throughout the home. There were posters in the home to promote best practice guidance on how to put on and take off gloves, aprons and masks.

¿ A robust system was in place for people to follow when entering and leaving the building.

¿ The manager was participating in the whole home testing process and had arranged testing for residents and staff. Contingency plans were in place should there be a staff shortage.

¿ We were told about the positive morale throughout the staff team and that management were proud of the way staff and the organisation had worked as a team to protect people they support and colleagues.

Further information is in the detailed findings below.

The inspection visit took place on 24 April 2018 and was unannounced.

At our last inspection we rated the service overall Good. The safe domain required improvement in relation to the number of safeguarding concerns and the safety of several window frames in the home. The window frames were replaced soon after that inspection. At this inspection we found although there had been a high level of safeguarding concerns up until the current registered manager, these had significantly reduced since her arrival. The service improved to good in the safe domain and remained good in the other four domains. We found the evidence continued to support the rating of overall good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in place. 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

People we spoke with told us they felt safe and cared for by staff. One person told us, “I feel safe and well looked after. I rate the care very high.” A relative said, “Glenroyd is everything we hoped for.” There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place and kept under review. These provided guidance for staff in how to safely support people and reduced potential risks to people.

Staff had been recruited safely, trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. There were sufficient staffing levels in place to provide the support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people called for assistance.

Medicines were managed safely. They were ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. People told us they received their medicines when needed. One person said, “My tablets are organised for me. I don’t worry.” A relative commented, “[Family member’s] medication was reviewed and changed. This has made a big difference.

People told us they were supported in the way they wanted and staff provided care in a person centred way. They said staff provided care in a way that respected their dignity, privacy and independence. We saw staff were aware the importance of supporting and responding to people’s diverse needs and treated people with respect and care.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Relatives told us staff were welcoming to people’s families and friends. People told us they enjoyed a variety of social and leisure activities that assisted their well-being.

We saw people were able to see healthcare professionals as needed. They told us staff met their care needs promptly on a daily basis and referred them to other healthcare professionals where required.

People told us they had a choice of food at each meal. We observed a mealtime in each unit. Mealtimes were calm and relaxed and people received sufficient food and drink and the assistance they needed.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The design of the building and facilities in the home were appropriate for the care and support provided. We found equipment had been serviced and maintained as required. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People told us the management team were approachable and willing to listen. They knew who to complain to if they were not satisfied with their care and felt appropriate action would be taken. People also had information about support from an external advocate should this be required.

The registered manager and senior managers sought people's views in a variety of ways and assessed and monitored the quality of the service through audits, resident, relative and staff meetings and surveys

Further information is in the detailed findings below.

Glenroyd nursing home is a purpose built home registered to provide residential and nursing care for up to 78 people. Glenroyd has three floors comprising of bedrooms, toilet and bathing facilities. All bedrooms have en-suite facilities. There are four separate units within the home for nursing, residential and people living with dementia. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There are communal lounge and dining rooms, a reception area, hairdressing salon and a large conservatory. A landscaped garden area is at the rear of the home with seating. Limited parking is available at the front and side of the building. At the time of the inspection 48 people lived at the home.

At the last inspection in April 2014. The service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. 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.

People told us they felt safe living at Glenroyd nursing home and liked living there. Although people said they felt safe, there had been a significant number of safeguarding alerts about people’s care. Many of the alerts were substantiated and showed people had been placed at risk of harm or not protected from harm. The registered manager had reported safeguarding issues as required. This showed there were procedures in place and an open and transparent culture in the home. The management team had worked with the other professionals to improve care and reduce safeguarding concerns.

Risk assessments were in place and in most cases minimised risk. However there was some confusion with risk assessments for one person in relation to bed rails. This could have led to the person being unsafe.

We saw that two upstairs window frames were unsafe. The registered manager made arrangements for these to be made safe quickly. They were part of the rolling programme of refurbishment but were brought forward in response to the safety issue. The home was clean and hygienic when we visited. There were no unpleasant odours. The people we spoke with said they were pleased with the standard of hygiene in place. One person told us, “You cannot smell anything can you? This home is spotless.”

We looked at how the home was being staffed. We saw there were enough staff on shifts to provide safe care. People we spoke with were satisfied with staffing levels. One person said, “I think there are enough staff. Whenever I want something I just ask or press my buzzer.”

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the home. By doing this the management team reduced the risk of employing unsuitable people.

Staff managed medicines competently. They were given as prescribed and stored and disposed of correctly. People told us they felt staff gave them their medicines correctly and when they needed them.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. A member of staff told us, “The training has been good, really helpful.”

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). The registered manager showed us a sample of applications she had submitted. This showed us staff were working within the law to support people who may lack capacity to make their own decisions.

People were offered a choice of healthy and nutritious meals. Staff made sure people’s dietary and fluid intake was sufficient for good nutrition. People said the food was varied and tasty and they had no problems getting snacks or drinks outside of meal times.

People we spoke with told us staff were caring and helpful. They said their health needs were met and any changes in health were managed in a timely manner. Staff responded to any requests for assistance promptly. One person told us, “We are rarely kept waiting. The staff are always about when you want them.” A relative said, “You don’t see people left in distress in this place.”

Staff knew and understood people’s history, likes, dislikes, needs and wishes. We saw staff encouraged people to make decisions and choices wherever possible. People felt they could trust staff and they were polite, caring and respected their privacy.

Staff recognised the importance of social contact, companionship and activities. There was an activities programme in place. People told us they enjoyed activities in the home and going out in the minibus. One person said, “Lots of activities going on. We get out quite a bit. We go to Lytham and the local park.” A relative told us, “There is a new activities co-ordinator. She is very enthusiastic. It is lovely to see some of the activities and to join in.”

People’s friends and relatives were encouraged to be involved in the home and activities and made welcome when they visited. One person told us, “The staff always make my family welcome.”

People told us they knew how to raise a concern or to make a complaint if they were unhappy with something. They said staff listened to them if they had concerns and took action to improve things. One person said, “Things are always sorted properly if anything has gone wrong.”

There were procedures in place to monitor the quality of the service. The registered manager sought people’s views in a variety of ways and dealt with any issues of quality quickly and appropriately. One person told us, “We can always say what we like or don’t like.”

There was a transparent and open culture that encouraged people to express any ideas or concerns. People and their relatives felt their needs and wishes were listened to and acted on. They said staff were easy to talk to and encouraged people to raise questions at any time.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. They told us they were receiving safe and appropriate care which was meeting their needs. They felt that staff were very good and that they received care and support when they wanted it. One person said, "The staff are great. They look after us really well and the food is excellent.'

The home had policies and procedures in relation to the Mental Capacity Act and best interests meetings had been carried out to assist with particular decisions. Staff were aware of Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and an application had recently been submitted. This meant that people would be safeguarded as required.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic. Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained so people were safe.

The registered manager set the staff rotas. They had recently been increased and took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

Is the service effective?

People's health and care needs were assessed and reviewed with them, and they were involved in developing their plans of care. This included the way each person's care was provided, their daily routines, health needs and their hopes and aspirations. We saw that care plans were up to date and reflected people's current individual, dietary, cultural and religious needs.

People confirmed and records showed that they were able to see people in private and that friends and relatives could visit whenever they wished.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people. Good care practices were observed.

People told us that they were happy at Glenroyd nursing home. They said staff were caring and supportive. One person told us, 'All the staff are kind and helpful. They are wonderful.' A relative told us, 'Mum's face lights up when staff walk into the room. Another relative told us, 'The home is very nice. Staff are very friendly and welcoming. They are excellent at their jobs. I would definitely recommend the home. I have been happy with the care from day one as are the rest of the family.'

Care plans were person centred had been maintained, recording the care and support people were receiving. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service, their relatives, friends and other professionals involved with the service had regular meetings to discuss the running of the home and completed satisfaction surveys. Where shortfalls or concerns were raised these were addressed. One relative said, 'I attend the relatives meetings. I find the manager listens and follows through with any ideas or issues. I have no concerns about anything.'

Is the service responsive?

We were told staffing levels had increased and as a result care had improved. People told us that staff had more time to talk with them and they had more activities. One person told us, 'I am very happy here. The staff are super and there is lots going on. We even have trips out in the minibus.' A relative said 'We haven't always been pleased with the care because of poor staffing levels but we are now. The staffing has really improved.

We found a range of meaningful social and leisure activities were organised to stimulate people and maintain skills. People said they enjoyed these and were enthusiastic about them. One person said, 'I love the trips out, they are great.' Relatives said how much they benefitted their family members. One relative said, 'The staff now have time to spend with residents and have smiles on their faces.'

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed promptly. Staff reflected on whether any incidents could have been managed more effectively or if lessons could be learnt. As a result of these measures the quality of the service was continuously improving

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Meetings were held regularly so everyone could discuss support needs and any changes in care or routines. Staff also received regular supervision and training to assist with their development. This helped to ensure that people received a good quality service at all times.

We noted that people looked cared for, they told us they felt safe, and that they felt that staff were very helpful. We noticed people sitting in their wheelchairs for long periods of time, and recommend that the provider seeks advice on the risk factors related with prolonged wheelchair use, and if required, implement any changes to the ways in which people are supported.

We spoke with people about their experience of the care they received, and they told us they experienced safe and appropriate care, treatment and support that met their needs. They told us that understood the care and support choices available to them, and they felt they could express their views, so far as they are able to do so, and were involved in making decisions about their care support. People told us they felt protected and safe, and also that they felt respected and cared about.

We found that the numbers of staff on duty throughout the building allowed for positive interactions to take place.The evidence we found indicated that people's health and care needs were being met. However, we have suggested the following: the monitoring of the systems and the actions the service needs to take to ensure people's needs are met, would provide assurance that the care being provided is safe and appropriate. The provider had a system to regularly assess and monitor the quality of service provided. We have suggested that the new service manager should give priority to understanding the risks associated with providing appropriate and safe care, and take appropriate action if necessary. This would assist in providing assurances to all parties that people receive a safe service that meet their needs.