Glenfields Care Home Limited

Glenfields Care Home Limited is a residential care home providing personal care to up to 28 people who may be living with dementia, physical disabilities or sensory impairments. At the time of the inspection, 25 people were using the service.

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

Quality assurance systems had not identified and addressed shortfalls which were found during the inspection which included issues with medicines and records including risk assessments, fire and recruitment. People’s medicines were administered safely and staff were knowledgeable about when people needed their medicines, although there was a lack of guidance in place for staff. We have made a recommendation about medicines processes. The manager and provider started working to address the shortfalls we found.

People were supported by trained staff with the skills and knowledge to meet people’s needs safely and in a timely manner. Recruitment processes helped ensure staff were suitable to work with people, although recording and organisation systems needed reviewing. The manager monitored staffing levels which were safe. We received mixed feedback about staffing levels. However, people and their relatives were positive about staff and the care they provided.

Although shortfalls were found in the regular reviewing of risk assessments and fire records, staff effectively managed risks to people’s safety and wellbeing. People were protected from abuse, one relative said, “The best thing about this service is that it is clean, friendly with no fear my relative is suffering any abuse.”

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.

There was a caring, positive culture at the service and most people, and their relatives were happy with the service provided. Systems were in place to gather feedback from people, their relatives and staff to develop the service. Staff were supported by the provider and the manager and were positive about the changes made since the manager had been in post.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation.

At our last inspection we recommended the provider ensured staff received appropriate training to record all reviews and monitoring of risks and take action to update their practice accordingly. At this inspection we found some improvements had been made.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

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.

We received concerns in relation to care provided, cleanliness, staffing levels and records. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the 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.

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

Enforcement

We have identified a breach in relation to the quality assurance systems at this inspection. 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 and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Glenfields Care Home Limited is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 28 people.

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

Quality assurance systems and processes were not effectively followed. Audits completed did not identify the shortfalls we found during the inspection. Records relating to risk were in place. However, there was no recorded reviews to show people’s care was been monitored. We have made a recommendation about this.

People living at Glenfields Care Home Limited were happy and supported well by caring staff. Staff understood their roles clearly and knew what was expected of them. Staff were recruited safely and understood the principles of keeping people safe. Medicines were managed safely.

People were 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.

The provider worked in partnership with professionals to ensure people received appropriate care for their needs.

For more details, please see the full report which is on the Care Quality Commission website at

www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 January 2019). We also inspected the service on 13 January 2021. This was a targeted inspection, looking at IPC only and was not rated. (published 22 January 2021)

Why we inspected

The inspection was prompted in part due to concerns received about a lack of communication with relatives, access to visiting people and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management oversight and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

¿ Systems were in place to isolate people with COVID-19 to minimise transmission. The service had good supplies of personal protective equipment (PPE) that were readily available in stations

throughout the service.

¿ People who were isolating had their own dedicated staff to meet their support needs. Staff maintained social distancing where possible and the environment promoted people to remain socially distanced.

¿ Staff demonstrated a good understanding of the appropriate application and removal of PPE. Clinical waste bins were positioned so that staff could access them when required.

¿ The environment was very clean and additional cleaning was taking place including frequently touched surfaces.

¿ At the time of our visit the service was closed for non-essential visitors. A visitor’s protocol was in place to ensure anyone entering the service was temperature tested, completed hand disinfection and provided with information to remain safe during their visit.

Further information is in the detailed findings below.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

At this inspection we found the service remained good.

People felt safe and staff had been trained and understood their responsibilities around safeguarding adults and reporting concerns.

Risks to people’s physical and mental health had been identified and guidance was available for staff to manage those risks. The environment and equipment was safely maintained.

Staff recruitment was robust and there were sufficient staff on duty to meet people’s needs. Staff were well trained in basic care and in specialist subjects giving them the knowledge they required to care for people who used the service.

People were 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.

People had access to healthcare professionals from the community such as their GP or community nurses.

Staff maintained positive relationships with people and showed care and compassion in their interactions.

Staff were caring, maintaining positive relationships with people. Feedback was positive from people, their families and professionals.

There was a quality monitoring system in place which identified where improvements were needed. These had been acted upon.

People and staff were invited to share their views and give feedback about the service. They attended regular meetings where they could discuss any issues related to the day to day running of the service.

Further information is in the detailed findings below

The home is registered to provide accommodation and care for up to 28 older people, including people who are living with dementia. On the day of the inspection there were 23 people living at the home. The home is situated on the outskirts of Driffield, in the East Riding of Yorkshire. There are various communal areas where people can spend the day, a garden and an enclosed courtyard. The second floor of the home is accessed by a stair lift and there are ramps to the premises to enable wheelchair access.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at Glenfields Care Home.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff told us that they were well supported by the registered provider and registered manager, and felt that they were valued. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them.

We checked medication systems and saw that medicines were stored, recorded and administered safely. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff.

People told us that they were very happy with the food provided and people's nutritional needs had been assessed. We observed that people’s individual food and drink requirements were met.

We saw that any complaints made to the home had been thoroughly investigated and that people had been provided with details of the investigation and outcome. There were also systems in place to seek feedback from people who lived at the home, relatives and staff.

Staff, people who lived at the home, relatives and health care professionals told us that the home was well managed. Quality audits undertaken by the registered provider and registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety and well-being. Staff told us that, on occasions, feedback received at the home was used as a learning opportunity and to make improvements to the service provided.

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

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

Is the service safe?

We found that people were safe because they had their care and healthcare needs fully assessed, risk assessed and planned for, so that staff had clear instructions to follow and were able to help meet peoples' needs. People said, "I was happy here right from the start" and "We are well cared for and we want for nothing".

We saw that care plan documentation protected people from inappropriate or unsafe care because they were pertinent to peoples' needs, wishes and preferences and they had been appropriately reviewed each month, or as a person's needs changed. Care was provided for older people that may or may not have had a dementia type condition and this was clearly recorded in their documentation. The manager and staff were aware of their requirements under the Mental Capacity Act 2005.

We saw that the service maintained accurate and up to date records to show how people had been supported, how they presented and how staff had been trained in caring for them. Records enabled safe accountability of the care people had received.

Is the service effective?

We found that care plans were effective at instructing staff on how to best support people with meeting their care needs and they enabled people to have the support they required, reviewed as their needs changed.

From the information people gave us about liking the food and having menu choices, and from observing the mid-day meal we were able to see that the food and drink provision was effective in meeting peoples' nutritional needs. The kitchen was well maintained and the cook effectively managed budgets and cleaning schedules.

We found that people were effectively cared for because staff were experienced workers and had completed training courses to equip them with the skills they required.

Is the service caring?

We observed staff being caring when they provided care and support to people that used the service. Staff gave people time to do things at their own pace, encouraged independence and showed empathy. Staff knew peoples' wishes and preferences and included and encouraged them to make choices throughout the day. People said, "We are quite content here. The staff are very kind" and "I was happy here right from the start".

Is the service responsive?

From the information people gave us about the support they received, observing care provided and looking at care file documentation we found that the service responded well to peoples' care and health care needs.

People were encouraged to be active and to make their own decisions about daily life. They received help and support from health care professionals when required and the service coordinated this. The service also ensured people made their choices about rising, going to bed, what to eat, what to do.

Is the service well led?

We found that the manager led the way with ensuring peoples' care and health care needs were met. The manager spent some of their time involved with the daily support that people received and facilitated and guided the care and cleaning staff in their tasks. The manager ensured people that used the service had up to date care plans in place for staff to follow and ensured peoples' health care needs were met. This was because there were established links with health care professionals.

There had been a lapse in operating the quality assurance and monitoring systems in 2013 and so people had not been asked their views of the service and audits had not been carried out to determine where improvements were needed. The systems had been revised and put into greater use since our last inspection in January 2014 and we found that a wave of audits had been completed and people that used the service and their relatives had been asked to complete satisfaction surveys. This meant that the provider had clearer information about where the service needed to be improved.

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

When we looked round the premises we found that the environment was clean, hygienic and well cared for and so people were protected from the risk of infection. Equipment was always available to staff and some of them had completed appropriate training to ensure safe systems of work were followed.

When we looked round the premises we found that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. There was evidence of this from the maintenance contracts in place, the certificates of servicing or repair and the insurance cover available.

We found that people were protected from unsafe or unsuitable equipment because the provider had ensured people were assessed for the use of equipment and equipment was appropriately maintained.

We found that the provider had a system to regularly assess and monitor the quality of service that people received, but it had not been used effectively since 2012 and so the provider had no way of knowing how the service needed to be improved.

We found that there was an effective complaints system available and people were able to make their 'niggles' known before they became complaints.

We found that people were included in deciding their care needs and encouraged to make decisions whenever possible. We found that the provider and staff obtained peoples' consent to support before they received it, that their needs were well planned for and met using good care plan systems and documentation, and that people received their medication safely.

We found that staff working in the service had been appropriately recruited, vetted and supervised to carry out their roles and we saw that there were effective quality monitoring systems and audits in operation to assess for shortfalls in the performance of service delivery. One person that used the service told us, "You would find no better place than this."