Glenfield Woodlands Care Home

Glenfield Woodlands is a residential care home providing personal care to up to 17 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 16 people using the service.

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

Risk assessments did not always ensure people’s safety in relation to falls. We were not assured infection prevention and control measures were sufficient to protect people from the spread of harmful bacteria.

Medicines were not always safely administered, and people were not always protected through the effective use of the providers safeguarding system.

People were supported by enough staff, and safe recruitment checks were in place. The provider was responsive to concerns raised during our inspection and took action to improve safety and quality of care.

People’s dignity and respect was not always promoted by staff, and there was a lack of daily activities. Staff competency and people’s needs were not always fully assessed. People were not always provided with meal options during mealtimes, and fluid monitoring was not always effective to ensure people drank enough.

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.

Quality assurance systems and service oversight was not always effective. The nominated individual had a good understanding of their legal responsibilities in relation to duty of candour.

People and their families spoke positively about the care staff and the atmosphere at the service. Feedback from staff indicated they enjoyed working at the service and felt valued by the provider. Staff had opportunity to raise concerns and receive guidance during supervision with their line manager. Staff told us they felt comfortable raising 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 5 March 2019).

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 medicines, moving and handling, care planning and meeting people’s dietary needs. As a result, we undertook a focused inspection to review the key questions of Safe, Effective 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 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.

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

Enforcement and Recommendations

We have identified breaches in relation to safety, respect and dignity, and governance at this inspection. We issued warning notices to the provider for regulation breaches related to safety and governance, requiring the provider to become compliant with these regulations.

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.

We found the following examples of good practice.

The provider ensured there was a sufficient stock of Personal Protective Equipment (PPE) in place and infection control policies were in place. We observed staff wearing PPE in line with national guidance. The provider had ensured staff were skilled in infection prevention control training, which included how to put on and remove personal protective equipment (PPE).

The service was clean and odour free. There were regular areas where staff could use hand sanitising gel.

People had care plans in place which described how staff could reduce the risk of COVID-19 to them as individuals. If a person had tested positive for COVID-19, an isolation care plan was implemented to ensure the person was cared for safely.

There had been works carried out in the service to ensure good infection control and a comfortable living environment. Further works were required in areas of the laundry. However, this had been identified by the registered manager and a plan was in place to resolve these areas.

People’s experience of using this service:

• People told us they felt safe living at Glenfield Woodlands.

• The risks to people had been assessed and people and where appropriate some relatives had been involved in compiling care plans. Relatives had asked for more input in reviewing plans which the registered manager was arranging. Staff were knowledgeable about the range of needs people had.

• People were supported with their medicines in a safe way.

• Appropriate recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support needs had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager.

• People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy.

• People were involved in making decisions about their care and support and their consent about the care and services offered was obtained. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.

• There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through regular meetings, surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

• The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

More information can be found in the detailed findings below.

Rating at last inspection: The home was rated Good at the last inspection in August 2017.

Why we inspected: This inspection was brought forward prompted in part by notification of an incident following which a person using the service sustained a serious injury

Follow up: We will continue to provide ongoing monitoring of this service.

Glenfield Woodlands provides residential care to older people. Glenfield Woodlands is registered to provide care for up to 17 people. At the time of our inspection there were 16 people living at the home.

The service was run by a company that 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 about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 11 November 2015 the service was rated Good.

At this inspection we found the service remained Good.

At the last inspection we asked the provider to take action to ensure bedroom door locks were of a type that would ensure people could not be locked in their room accidently with no means of exiting. There had been improvements and some locks were removed, however there was a second type of lock that also required to be removed which was done on the day of our visit.

There were sufficient staff available to meet people’s personal care needs most of the time.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff told us they had access to information about people’s care and support needs and what was important to people. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were complimentary about the staff and the care offered to their relatives. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment, and people attended routine health checks.

People were provided with a choice of meals that met their dietary needs. Staff had a good understanding of people’s care needs, and people were able to maintain contact with family and friends as visitors were welcome without undue restrictions. There were sufficient person centred activities provided on a regular basis. People and their relatives felt they could raise any issues with the registered manager or staff.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. The provider undertook quality monitoring in the home supported by the registered manager and staff. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from the local authority with regard to the care and service offered to people. Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance to manage any emergency repairs.

We arrived just after lunchtime and saw there were sufficient staff on duty to assist people from the dining room into the lounge. We also observed staff responding to people in a timely manner when they requested assistance by pressing the call bell.

We looked at the care plans and records of three people who used the service. We found people's needs had been assessed and had been used to develop care plans which were regularly reviewed. Records showed people had accessed and were supported by a range of health care professionals. On the day of our visit we noted staff had little time to interact with people who used the service which was often limited to when personal care and support was provided. No activities or stimulation other than watching television were offered or provided to people during our visit, which took place in the afternoon and early evening.

We spoke with the chef who told us people were asked on a daily basis to make a selection from the menu as to the choice of meal for the following day. People we spoke with told us they were happy with the meals provided. Relative's views as to the variety of meals available was mixed. We looked at the provision of food available which was adequate to meet the needs of people and included fresh fruit and vegetables.

Systems for determining staffing levels were not robust and the provider and registered manager could not evidence how staffing levels had been determined based on the needs of people who used the service. Staff had received training in topics related to the health and safety of people. However staff had not received training specific to the needs of people such as dementia awareness or other health related topics.

We found the needs of people had been comprehensively assessed. Assessments had been used to develop care plans detailing the care and support people required and the role of staff in meeting people's assessed needs.

Records were up to date and accurate and provided clear information as to people's needs and their daily lives.

We observed staff providing reassurance to people when they were confused and sitting with them talking about issues which were important to them. Staff regularly served drinks throughout the day to people using the service and visitors and encouraged people to engage in conversation. We spoke with two visitors who were visiting a relative or friend. They told us they were happy with the service their friend or relative received. One visitor said 'They look after people well and they always make me feel welcome.'

Records showed a range of health care professionals were involved in the care of people using the service and their involvement was recorded. We found written records which are required to assess and record the care and support people needed were not always in place and in some instances had not been regularly reviewed. This had the potential for people not to receive the care and support they needed as staff did not have clear guidance as to the support people needed.

Staff recruitment procedures and training were robust and records were in place for the maintenance of the service and systems.