This unannounced inspection took place on 14, 16, and 18 May 2018. Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in three units. The two first floor units provide services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. At the time of the inspection visit 53 people were receiving care and support at the home.
Preston Glades is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the time of the inspection visit 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.
At the last inspection, carried out in January 2017 Preston Glades was rated as requires improvement. This was because we identified concerns related to the safe management of medicines, processes for ensuring consent was lawfully achieved and the way in which the service was managed. Following the inspection visit we asked the registered provider to submit an action plan to demonstrate how they intended to make the required improvements to meet the fundamental standards. The registered manager told us improvements would be in place by May 2017.
At this inspection visit carried out in May 2018, we found not all required improvements had been made. Breaches were identified to Regulations, 9, 12, 13, 17, 18, and 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of the Care Quality Commission Registration Regulation 2009.
We found improvements had not been made to ensure people received their medicines safely. Good practice guidance had not been considered and implemented to ensure the safe management of medicines.
Auditing systems established and operated by the registered provider continued to be ineffective as they had failed to identify the concerns we found during the inspection process. For example, monthly audits had failed to identify safeguarding and medicines concerns we identified during the inspection visits.
Risk was not always suitably managed at the home. Risk assessments were not always completed in a timely manner to ensure all risk was suitably addressed. When people displayed behaviours which challenged the service we found risk management plans were not in place to direct staff to protect the person and other people who lived at the home. In addition, staff sometimes failed to ensure risk assessments were followed to protect people from harm.
People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, processes were not always followed to ensure safeguarding concerns were consistently reported to the local authority safeguarding team for review. Processes to ensure people were safe from abuse were not consistently followed by the registered provider.
Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not suitably implemented as suitable checks had not been consistently applied in a timely manner.
Processes to ensure people’s nutritional needs were met were inconsistent. People did not always receive appropriate support to ensure their dietary needs as identified within their care plan were met.
We found deployment of staffing was not always effective to ensure the safe care of people. Staff were not always suitably allocated within roles to ensure people remained safe.
Care plans did not always have all the appropriate person centred information in them to promote individualised care being provided. Religious and cultural needs were not consistently addressed and met.
We noted documentation was not always accurate, accessible and fully complete. Of the eleven care records viewed, we identified concerns within the paperwork for five people. Individuals care plans were sometimes reviewed to accommodate peoples changing needs. Additionally, information relating to investigations into staff conduct were sometimes inaccessible.
The registered provider had failed to ensure notifications were submitted to the Care Quality Commission in a timely manner. During the inspection visit we identified three serious injuries and three safeguarding concerns which the registered provider had a responsibility of reporting to CQC but had not done so.
There were processes in place for managing infection prevention and control within the home. However these were not consistently followed. During the inspection visit we noted the kitchen was not suitably maintained to promote hygiene and we had to request this was deep cleaned. The registered provider took immediate action to ensure the kitchen was clean and suitable for purpose. In addition, there was no care plan in place for one person who had support needs which impacted upon the cleanliness and hygiene standards within the home. We have made a recommendation about this.
Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Whilst good practice guidelines were sometimes considered these were not consistently implemented to ensure all principles of the Mental Capacity Act (MCA) 2005, were lawfully respected. We have made a recommendation about this.
People were supported to have maximum choice and control of their lives in relation to the Mental Capacity Act and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff told us they were happy with the training provided and said the registered manager encouraged staff to develop their skills. Whilst the registered provider had maintained high levels of training at the home, we identified clinical training deficits for qualified nursing staff. This sometime impacted upon the quality of care provided. The registered manager had already identified this training need and had commenced action to ensure training was provided. Following the inspection visit, we received confirmation this had been addressed.
During our inspection visit we observed some activities taking place. People told us activities took place on a regular basis.
People who lived at the home and their relatives told us they had no complaints about the way in which the home was managed. When people had complained they told us they were happy with the way in which the complaint was managed.
People who lived at the home told us they had good relationships with the staff. During the inspection visits we observed staff being patient and kind with people. However, during the first day of the inspection visit we saw that call bells to assist people to summon help had been removed in a high number of rooms across all units. The registered manager investigated why this had occurred but could not identify who had done this. Following the investigation the registered manager took swift action to prevent this from occurring again.
People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people.
End of life care had been discussed when appropriate with people and their relatives. Provisions were in place to promote a dignified and pain free death.
There was ongoing commitment by the registered manager to make the home pleasing for people. We noted refurbishments within the building were ongoing.
Feedback was routinely sought from people who lived at the home. People told us residents meetings took place. Additionally we saw people had been consulted with regarding food quality and choice.
Staff praised the improvements made by the registered manager who was registered with the Care Quality Commission in May 2017. They told us morale and staff turnover had improved at the home since the new registered manager had been recruited.
The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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