Glenesk Care Home

Glenesk is a care home that provides personal care for up to 22 people in one adapted building. It is registered to provide a service to older people who may be living with dementia or physical disability. At the time of the inspection 21 people lived at the home.

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

Safety and privacy concerns were identified in regard to electric plugs and the layout of the managers station within a communal area. Records for testing water outlets was not clear.

Risk to people’s care needs were monitored and managed effectively. Medicines were administered in a safe way and improvements seen through the introduction of a new electronic system.

Enough staff were available to respond to people’s needs in a timely manner. Staff were following current government guidelines for wearing face masks. Accident and incidents were investigated, and measures were in place to prevent recurrence. People were cared for by staff that protected them from avoidable harm.

Staff completed an induction, received relevant training and supervision support for their roles. People’s needs were assessed, and people were involved in their care planning. People’s choices and preferences were adhered to. People were supported to have sufficient to eat and drink and had a calm and enjoyable dining experience.

The service worked well with agencies and other professionals to provide effective care. The provider was working towards a refurbishment plan to ensure the building would be maintained to a high standard. The provider was working in line with the principles of the mental capacity act.

The care people received was tailored to their individual needs. Care plans reflected people’s needs, their preferences and their choices. People were supported to maintain good well-being and reduce the risk of social isolation.

The service had systems in place to monitor and share continuous learning. The management team showed leadership and were clear about their roles and responsibilities. We received positive feedback about the management of the service from people, families and staff. There was a positive culture throughout the service. The management team was open and honest, encouraged people and families to be involved.

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

Rating at last inspection and update

The last inspection was inspected but not rated, published on 15 February 2022. The previous inspection was requires improvement published 16 March 2020. Where we issued a warning notice in relation to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the previous inspection published 16 March 2020 to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has changed following this inspection.

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

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, which will help inform when we next inspect.

We found the following examples of good practice.

The home was currently in ‘Outbreak’ status which meant the home was closed to non-essential visitors. People were provided with alternative methods of visitation from relatives. This included visits via a window, or communication via an iPad or face time on a mobile phone. The provider had made exceptions for people who were nearing the end of their life or had been assessed as being at increased risk of loneliness with their mental health being affected.

The provider was not currently fully following the government guidelines on essential care givers’ being allowed access to the home. Essential care givers are permitted to offer companionship or help with care needs, even during an outbreak. We have informed the provider of this requirement and they advised us they would make the necessary amendments to their visiting policies.

In ‘non-outbreak’ periods visitors were not permitted to access the home without providing evidence of a negative LFT result. Professionals were required to provide evidence of vaccination against COVID-19. There was sufficient space indoors and outdoors for safe visitation to take place. Visitors were limited to agreed areas of the home to reduce the risk of the spread of infection. Most visits took place in people’s bedrooms with a limit of no more than two people allowed access at one time.

Staff wore PPE where required. Staff wore new PPE after each time personal care was provided. There were ample stocks of PPE. Communal areas had been arranged in a way that encouraged social distancing. Although we were told it was difficult at times to enforce this as people wished to sit together.

Isolation procedures were in place to protect others from the risk of infection. Wherever possible, a dedicated team of staff supported people with their personal care, limiting the risk of the spread of infection.

The provider had processes in place that ensured the safe admission of new people to the home. Evidence of negative LFT and PCR results were required. People isolated in their bedrooms until the necessary negative test results had been received. Increased staff presence and activities within their bedrooms was provided to reduce the impact of isolation on people’s wellbeing.

It was acknowledged isolation for people living with dementia was difficult at times. Increased support from staff was in place where needed. Posters were placed around the home offering guidance and information for people and staff advising them how to spot the signs of COVID-19 and to help to reduce the risk of spreading it.

People and staff were tested regularly. The frequency increased during outbreak status and if people showed symptoms of COVID-19. The provider had ensured they complied with Government guidelines on testing and vaccination for staff.

Regular cleaning of all touch points and other key areas were carried out throughout the day. We observed the home was visibly clean and tidy. The provider told us planned refurbishments of some corridors, bedrooms and bathrooms had been put on hold until the home was free of COVID-19.

There were enough staff to support people safely and to cover any staff holidays, sickness and COVID-19 isolation.

The provider considered staff member’s wellbeing. A variety of initiatives were in place to thank staff for their support.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. Action plans were in place and reviewed. The provider and registered manager met regularly to discuss any infection control concerns.

Glenesk is a care home that provides personal care for up to 22 people in one adapted building. It is registered to provide a service to older people who may be living with dementia or physical disability. At the time of the inspection 20 people lived at the home.

People’s experience of using this service:

People were placed at risk of harm as medicines were not managed safely. Improvements were required to ensure the home was clean and well maintained. Risks associated with people’s care and support were not always managed safely because there was a lack of suitable guidance in place for staff. There was not always sufficient staff in place to support people. Safe recruitment practices were followed.

Work had been done to ensure people’s rights under the Mental Capacity Act 2015 were protected. People were mostly supported to have maximum choice and control of their lives . Some capacity assessments were still required, and we recommended that a further review of mental capacity needs at the service was completed. This would ensure policies and systems supported staff to work with people in the least restrictive way possible. Staff required more effective training and support to enable them to provide high quality care. Mealtimes were positive experiences and people fed-back positively about the quality of the food. People had access to a range of health care professionals. Overall, the home was adapted to meet people’s needs, but some areas were in a poor state of repair and there was limited private space.

People were supported by kind and caring staff. Staff upheld people’s right to privacy and treated them with respect. People were enabled to have control over their lives and were supported to be as independent as possible.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. People and their families were given an opportunity to discuss their wishes for the end of their lives. People were not always given opportunities for meaningful activity, this was attributed to the activity co-ordinator having left. We have been informed that since inspection, a new activity co-ordinator has been recruited and started work. People felt confident to raise issues and there were systems in place to respond to complaints.

Systems to ensure the safety and quality of the service were not fully effective. Where issues were identified on a previous inspection, improvements had not always been made or sustained. This failure to identify and address issues had a negative impact on the quality of the service provided at Glenesk. The management team were responsive to feedback and took swift action to address immediate issues identified on this inspection. The provider recognised that improvements had not been made as required and advised that they were in the process of reviewing the effectiveness of their governance processes. There was positive partnership working with health professionals.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 2 February 2019) and there were multiple breaches of regulation. These included regulation’s 11, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations. 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 saw that improvements had been made, and the provider was no longer in breach of all the regulations we had identified previously. However, we found the provider was still in breach of regulation 17. This is because poor oversight and governance had not effectively resolved all risks at the service.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We intended to complete a focused inspection to review the action plan and ensure that regulations were now met. However, since the inspection we had received further concerns from visiting professionals. So we decided to complete a full comprehensive inspection. This would cover all of our key lines of enquiry (Safe, Effective, Caring, Responsive and Well led) and get an up to date assessment of the service.

Enforcement:

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 any concerning information is received we may inspect sooner.

People’s experience of using this service: People were placed at risk of harm as medicines were not managed safely. There had been a failure to learn from incidents. Improvements were required to ensure the home was clean and well maintained. There were not always enough, adequately trained staff available to meet people’s needs. Action had not always been taken to protect people from improper treatment and abuse. Risks associated with people’s care and support were managed safely. Overall, safe recruitment practices were followed.

Further work was needed to ensure people’s rights under the Mental Capacity Act 2015 were protected. Staff required more effective training and support to enable them to provide high quality care. Mealtimes were positive experiences; however, more work was needed to ensure risks were managed safely. People had access to a range of health care professionals. Overall, the home was adapted to meet people’s needs, but some areas were in a poor state of repair and there was limited private space.

People were supported by kind and caring staff. Staff upheld people’s right to privacy and treated them with respect. People were enabled to have control over their lives and were supported to be as independent as possible.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. People and their families were given an opportunity to discuss their wishes for the end of their lives. People were offered opportunities for meaningful activity. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

Systems to ensure the safety and quality of the service were not fully effective. Where issues had been identified, improvements had not always been made or sustained. This failure to identify and address issues had a negative impact on the quality of the service provided at Glenesk. Sensitive personal information was not stored securely. The management team were responsive to feedback and took swift action to address issues identified in this inspection. There was positive partnership working with health professionals.

The service met the characteristics of Requires Improvement in most areas; more information is in the full report

Rating at last inspection: Requires Improvement (report published on 17 October 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We found breaches in relation to safeguarding people from improper treatment and abuse, safe care and treatment, consent and governance. Please see the action we have told the provider to take at the end of this report. In addition, the provider had failed to notify us of DoLS authorisations as required. This was a breach of regulation and we issued fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up: During our inspection we requested evidence of improvements made in in relation to medicines management. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Glenesk Care Home provides accommodation for older people requiring support with their personal care. The service can accommodate up to 22 older people. At the time of our inspection there were 21 people living at the home.

The service had 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. However, the registered manager only worked part time and the provider had been unable to sustain a full time manager to manage the day to day running of the home. This had impacted on the general day to day oversight of the home.

There was not always sufficient staff to meet people’s needs in a timely and safe way. Staff interactions with people were good but task focussed. Outside of the interaction staff had with people when providing their direct care there was little positive engagement.

There was no area, a part for a person’s bedroom, for people to meet with their family and friends privately. There was a potential for people’s confidentiality to be breached as there was no separate area for the managers’ and staff to complete records and hold staff handover briefings.

The systems in place to monitor the quality of the service did not effectively pick up on the overall experience of people living in the home.

Staff were supported but the level of induction for new staff needed to be improved and staff supervisions needed to be more consistent. Staff did undertake training which helped them to understand the needs of the people they were supporting.

People received care from staff that were kind, compassionate and respectful. Their needs were assessed prior to coming to the home and individualised care plans were in place which were kept under review.

Staff protected people’s dignity and demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

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.

Care plans detailed people’s preferences, likes and dislikes and the plans were regularly reviewed to ensure they remained relevant to meeting people’s needs.

People were encouraged to follow their interests and there was a variety of activities that people could take part in if they wished. Families were welcomed and encouraged to take part in events with their loved ones.

People’s nutritional needs were being met and people were given a choice as to what they ate and where they ate. Support was available if needed and staff sat with people to help encourage people to eat.

Staff knew how to protect people and recruitment practices ensured that people were cared for by staff that were suitable and safe to support them. People could be assured that they were protected from any avoidable harm or abuse.

There were opportunities for people and their families to share their experience of the home. The provider and registered manager were visible and open to feedback, actively looking at ways to improve the service.