Glengarriff House

Glengarriff House is registered to provide accommodation and personal care for up to 18 people who live with a learning disability.

The accommodation consists of a main house and three separate self-contained apartments, each having two bedrooms. There were 15 people living at Glengarriff House at the time of the inspection. Nine people lived in the main house and six people lived in the apartments.

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

Staff knew how to keep people safe from abuse and were confident to raise concerns with the registered manager or external agencies. When required, notifications had been completed to inform us of events and incidents.

There were enough staff to meet people’s care needs. Safe recruitment practices were followed to ensure staff were suitable for their roles.

Effective infection prevention and control (IPC) procedures were in place and the service followed best practice and government guidance in relation to the management of COVID-19.

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 27 March 2020).

Why we inspected

We undertook this targeted inspection to check on specific concerns about systems and processes to safeguard people from the risk of abuse and staffing and recruitment. We found no evidence during this inspection that people were at risk of harm from this concern. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

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

Glengarriff House is registered to provide accommodation and personal care for up to 18 people who live with a learning disability and/or who need support to maintain their mental health.

The accommodation consists of a main house and three separate self contained apartments, each having two bedrooms. There were 13 people living at Glengarriff House at the time of the inspection. Nine people lived in the main house and four people lived in the apartments.

The service is larger than current best practice guidance. However, the service had been developed and designed before Registering the Right Support and other best practice guidance was produced. The size of the home having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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. Policies and systems in the service supported this practice. However, improvements were needed to the ways in which some best interests decisions were recorded.

The home applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who live in the home can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Although staff worked within these principles, the registered manager recognised the need to ensure they were more aware of the guidance documents which underpinned their practice.

Staff knew people well. They understood the importance of supporting people as individuals and ensuring their preferences and wishes for their care were met. People benefitted from staff who received training and support to provide person centred care. There were enough staff on duty, who were safely recruited, to provide this support.

People were treated with kindness and their privacy and dignity was upheld. They enjoyed a range of social and leisure activities which were based on their preferences.

People had support to access all of the healthcare they needed. Staff promoted healthier lifestyles and good nutrition for people. Medicines were managed in the right way.

People told us they felt safe and liked living at Glengarriff House. Systems were in place to protect them from the risk of abuse. Other risks to people’s health, safety and welfare had been assessed and plans were in place to minimise those risks. People had benefitted from improved infection prevention and control arrangements.

People and the staff who supported them were satisfied with the way the home was run. They had opportunities to express their views and opinions.

Systems were in place to monitor the quality of the services provided. The registered manager had learned lessons and taken actions to address shortfalls identified. The provider had not always responded promptly to identified shortfalls regarding the general upkeep of the home environment. However, improvements were made during and after the inspection.

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 25 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Glengarriff House Nursing Home can provide accommodation, nursing and personal care for 18 younger adults who have a learning disability and/or who need support to maintain their mental health. There were 15 people living in the service at the time of our inspection visit. The accommodation is a courtyard setting where there is a two storey older property and a separate building where there are two self contained flats.

The service was run by a company who was the registered provider. There was 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

At our inspection on 23 February 2016 we rated the domains ‘effective’, ‘caring’ and ‘responsive’ as ‘good’. We said that the domains ‘safe’ and ‘well led’ were ‘requires improvement’. Our overall rating of the service was ‘requires improvement’. In more detail, we found that there were not always enough care staff on duty and people were not always provided with a relaxed and enjoyable dining experience. In addition, we found that quality checks had not quickly addressed these problems and had not resolved the various defects we found in the accommodation. We concluded that the registered persons’ failure to operate suitable quality checks was a breach of the regulations.

Shortly after our inspection visit the registered persons told us that they had made the improvements that were necessary to address each of our concerns. We completed a further inspection on 7 December 2016 to check on the progress that had been made. We found that each of our concerns had been addressed and that the breach of regulations had been rectified. However, we did not revise our original ratings. This was because we needed to be sure that the progress which had been made would be sustained. In addition, we noted that there were other concerns that needed to be addressed. These were further defects in the accommodation and a shortfall in the completion of some fire safety checks.

At the present inspection we found that the particular defects in the accommodation we had identified at our last inspection had been put right. We also noted that fire safety checks had been completed in the right way. However, we found that there were further defects in the accommodation that needed to be addressed.

Our other findings at the present inspection were as follows. Nurses and care staff knew how to respond to any concerns that might arise so that people were kept safe from abuse. People were supported to take reasonable risks and most of the necessary steps had been taken to avoid preventable accidents. Medicines were managed safely. There were enough nurses and care staff on duty and background checks on new nurses and care staff had been completed in the right way.

Nurses and care staff had received training and guidance and they knew how to care for people in the right way. People were helped to eat and drink enough and they had been supported to receive all of the healthcare they needed.

People were helped to make decisions for themselves. When people lacked mental capacity the registered persons had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.

Nurses and care staff were kind and people were treated with compassion and respect. People’s right to privacy was promoted and there were arrangements to help them to access independent lay advocacy services if necessary. Confidential information was kept private.

People had been provided with all of the assistance they needed and had agreed to receive. Nurses and care staff promoted positive outcomes for people who sometimes became distressed. People were supported to pursue their hobbies and interests and there were arrangements to quickly resolve complaints.

Although people had been consulted about the development of their home their suggested improvements had not always been quickly implemented. Quality checks had been completed but they had not always resulted in shortfalls in the accommodation being promptly addressed. In addition, the registered persons had not continuously displayed the quality ratings we had previously given the service. However, they had told us about significant events that had occurred in the service and good team working was promoted. Nurses and care staff were enabled to speak out if they had any concerns about how well the service was meeting people’s needs.

Glengarriff House Nursing Home can provide accommodation, nursing and personal care for 18 people who have a learning disability or who have special mental health needs. The accommodation comprises the main house and six self-contained flats. There were 15 people living in the service at the time of our inspection. All of the people had a learning disability and some also had special communication needs and used sign assisted language to express themselves.

The service was owned and operated by a company who was the registered provider. There was 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 this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

We carried out an unannounced comprehensive inspection of this service on 23 February 2016 and found that there was one breach of legal requirements. This was because quality checks had not been robust and this had led to a number of shortfalls not being identified and quickly addressed. These included there not being enough staff on duty, problems with catering arrangements and defects in the accommodation.

After our inspection on 23 February 2016 the registered persons prepared an action plan. It said what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that all of the problems we noted would be addressed so that people consistently received safe care. The registered persons said that all of the necessary improvements would be completed by 15 May 2016.

This report only covers our findings in relation to the action taken by the registered persons to meet the breach of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Prime Life Limited on our website at www.cqc.org.uk

At this inspection, we found that the registered persons had introduced most of the improvements that were necessary to ensure that people safely and reliably benefited from receiving safe care. This meant that the relevant legal requirement had been met. However, a small number of further improvements still needed to be made to ensure that the service continued to reliably care for people in the right way.

Glengarriff House Nursing Home can provide accommodation, nursing and personal care for 18 people who have a learning disability or who have special mental health needs. The accommodation comprises the main house and four self-contained flats. There were 14 people living in the service at the time of our inspection. All of the people had a learning disability and some also had special communication needs and used a combination of words, signs and gestures to express themselves.

There was 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.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because quality checks had not been robust and this had led to a number of shortfalls not being identified and quickly addressed. You can see what action we told the registered persons to take at the end of the full version of this report.

There were not always enough staff on duty to provide everyone with all of the care they needed. Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People had been helped to stay safe by avoiding unnecessary accidents, medicines were managed safely and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to support people in the right way including how to respond to people who had special communication needs. People had been supported to eat and drink enough and they had been helped to receive all of the healthcare assistance they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken all of the necessary steps to ensure that people’s legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy and respected confidential information. However, some of the arrangements at meal times did not support people to enjoy dining in a dignified way.

People had received all of the practical assistance they needed. Most of the people who could become distressed had received suitable support and reassurance. People had been consulted about the care they wanted to receive and staff supported people to express their individuality. Staff had supported most people to pursue a wide range of interests and hobbies and there was a system for resolving complaints.

People and their relatives had been consulted about the development of the service. Staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

The service had a mini bus which was regularly used to take people on outings to the cinema, the seaside and on shopping trips.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in the main building. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with a learning disability.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service the staff supporting them. We also looked at three care records. We were unable to speak with health and social care professionals or family and friends as there were no visitors to the home on the day of our inspection. .

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We saw the home had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment.

The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift and updated peoples care records at least twice a day.

We found staff attended training courses to meet the individual needs of people in their care such as managing restraint and challenging behaviours.

Is the service caring?

We observed staff speak with people in a kind and caring way and give them time to answer questions. We saw no one was rushed and staff helped people to do things in their own time. We saw all staff had a very good rapport with people and there was a lot of chat and laughter.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent. We saw when staff praised a person for their achievements they treated them as equals.

The people who were able to communicate with us told us they well were cared for.

Is the service responsive?

We saw care was responsive to people's individual needs. We saw one person who wanted to keep fit was supported to join a local gym.

We saw when care workers raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We saw people were well supported by the staff on duty. Several people were supported by one to one care for up to 12 hours a day.

All the staff we spoke with told us the manager was approachable and supported them with professional and personnel problems. One staff member said, 'XX is very approachable for all sorts of things. This is a good place to work.'

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, 'I do the things I want to, I go on the bus.' Another person said, 'I cook my own meals, I check to see if the food is not out of date and I clean my toilet.'

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. We asked a person if they felt safe in the home and they replied, 'I feel safe, the staff check on me.'

We found the staff team were supported through training. We saw various staff communicate with a person using a mixture of speech and sign language during our visit. A person who used the service told us, 'The staff are good.'

We found further improvements were needed in how the provider assessed and monitored the quality of the service. A relative told us they felt more could be done to the upkeep of the building. A person who used the service told us, 'I feel listened to.'

We saw each person's care plan contained an eating, drinking and nutritional assessment. We were present when lunch was prepared. The food was appetising and freshly produced. One member of staff told us, 'People get homemade food all the time and there is rarely any left on people's plates.'

We observed the interaction between staff and people who used the service by using the Short Observational Framework Tool (SOFI). We saw staff positively interacted with people frequently. We saw people were engaged in activity by staff members at regular intervals.

Although we saw the building was maintained effectively, three bathrooms and some other areas were in a poor state of d'cor. We were told these rooms would be redecorated within the next few months.

We confirmed there was an effective complaints policy in place although this was not provided to people living at the home in an accessible format.