Gledhow

Gledhow is a care home providing personal care for 29 older people some of whom may be living with dementia. The service can support up to 50 people.

People’s experience of using the service

People told us they felt safe living at Gledhow. Risk assessments contained the relevant information about risks to mitigate or prevent incidents. Incidents and accidents were reported to CQC and lessons learnt from incidents were shared to drive quality and improvement. There were enough staff to meet people’s needs and recruitment processes were robust. We found medicines were managed safely.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives as staff asked people for their consent and supported them in the least restrictive way. Mental capacity assessments had been completed when a person was being restricted and best interest decisions were carried out in consultation with others.

Quality assurance systems were in place to monitor the home and ensure any improvements required were acted upon. Meetings were held with people, their relatives and staff to ask for their feedback to improve the home.

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 rating for this service was requires improvement (published 8 April 2020).

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (effective, caring and responsive) were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

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

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.

Gledhow is a care home providing personal care for 32 older people some of whom may be living with dementia. The service can support up to 50 people.

People’s experience of using the service

Quality assurance systems had improved since our last inspection as most audits were being carried out and actions taken to improve care. However, care plan audits did not always identify the recording issues we found on inspection. The home was not always well led as records were not always accurate. The management team were open and responsive to our findings during the inspection and always looked to make improvements. Surveys and meetings were held with people, their relatives and staff to ask for their views and their suggestions were used to improve the home.

Staff did not always understand their responsibilities in relation to the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives as staff asked people for their consent and supported them in the least restrictive way. However, mental capacity assessments had not always been completed when a person was being restricted and best interest decisions were not carried out in consultation with others. People were offered choices about their care. People were involved in meal choices and supported to maintain a balanced diet. Health needs were regularly monitored, and staff followed the advice healthcare professionals gave them. Staff received training and support through regular meetings.

People told us they felt safe living at Gledhow and processes were in place to reduce the risk of abuse. There were enough staff to meet people’s needs and recruitment processes were sufficient. Risk assessments were carried out to mitigate potential risks and lessons learnt from incidents were shared in meetings with staff. Medicines management was safe, and people received their medicines on time. Staffing levels were sufficient to meet people’s needs however, some staff felt more staff were required. Health and safety checks were carried out.

People said staff were kind and caring. People were well cared for by staff who treated them with respect and dignity. People were asked by staff how they wished to spend their time and staff interacted positively with people and spoke about them in a respectful and caring way.

Care plans were created and included people’s preferences, likes and dislikes. People and relatives were involved in reviews to ensure their needs were being met and staff supported people in a way they wanted. People’s wishes for end of life care had been recorded and staff were trained to support people when needed. A complaints system was in place and complaints were managed effectively.

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 rating for this service was requires improvement (published 15 February 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection.

Follow up

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.

Gledhow is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gledhow is registered to provide accommodation for people who require personal and nursing care and people living with dementia. During our inspection there were 41 people living in the home. At our last inspection the service was rated as good. At this inspection, we found the service deteriorated to requires improvement.

There was no registered manager in post at the time of our inspection. Two managers from other homes with the providers organisation were currently supporting the home. There was an area manager who had oversight of the home and told us they were planning to become the registered manager to promote consistency. They were also in the process of recruiting a new manager. A registered manager is a person who has registered with the CQC 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.

Systems were not always in place to assess, monitor and improve the quality of the service to identify shortfalls and there was a lack of accurate and robust care records. Audits had not been consistently carried out to ensure continuous monitoring of the service. Temperatures of medicines in people’s rooms had not been recorded, some care plans lacked details about people’s history and relevant checks. We also found some incidents and accidents that had not been recorded accurately.

Medicines were not always managed safely. We found a medicine that had been signed as given. However, this was still in its box when we checked this. There had been medicine errors and a missed signature for a medicine. We found medicines had not always been stored correctly and temperature checks to ensure medicines were stored at the correct temperature had not always been recorded. We have made a recommendation around medicines management.

The provider followed their legal obligations under the Mental Capacity Act 2005 (MCA) and implemented best practice guidance relating to capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications were made. However, we found some best interest decisions had been made by only one person and some reviews that needed to be updated to reflect people’s current needs. We have made a recommendation around best interest decisions.

The provider had robust systems and procedures in place to keep people safe. Staff were competent in their knowledge of what constituted abuse and how to safeguard people. There was a whistleblowing policy in place and staff knew how to raise concerns should this be required.

Risk assessments had been completed and reviewed regularly. Accidents and incidents were managed effectively and action taken to prevent future risks. However, we found some incidents had not been recorded accurately to determine the risk.

Staffing levels were sufficient to meet people's needs and robust recruitment processes were in place to ensure people were of suitable character. We received mixed views about staff levels. The provider was in the process of recruiting staff and used regular agency staff to ensure consistency in the meantime. Staff carried out training to ensure they had adequate skills and knowledge to meet people's needs. Staff were supported with regular supervisions and appraisals.

The home was clean and tidy. Health and safety checks were completed regularly and staff followed the providers procedures for infection control.

Staff were aware of people's nutritional needs and we found people were offered choices about their food preferences. Nutritional assessments were in place so people’s weights could be monitored. People also received appropriate support from staff to maintain their health and wellbeing.

Staff were caring, kind and respected peoples wishes. We saw people were encouraged to remain as independent as possible. People's privacy and dignity was respected. Staff knocked on people's doors before entering and respected peoples wishes when providing care.

Initial assessments were carried out before people came to live at the home to ensure their needs could be met. Care plans were reviewed regularly or when people's needs changed. Care plans included people's preferences, likes and dislikes.

People using the service were supported to participate in activities, to prevent social isolation.

The manager and team leader were honest and open. Staff told us they felt supported and felt confident to raise any concerns. Complaints were managed and actions taken to prevent future occurrences. One complaint was on going and further action was needed in order to address a person’s care needs. The provider was made aware of this and ensured further investigations would be carried out.

Regular meetings took place with people, staff and management within the provider's company to obtain feedback and inform people of changes within the organisation. Surveys were also carried out to gather people’s views.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 17 (Good governance). You can see what action we told the provider to take at the back of the full version of this report.

Gledhow Care Home is a purpose built property. The home is located in a residential area close to local amenities and public transport. There are car parking facilities. There are gardens surrounding the home that are accessible to the people who live there. The accommodation is on two floors with a passenger lift connecting the two. There are 51 single en suite bedrooms. There are several lounge and dining rooms located throughout the home. On the day of our inspection there were 46 people using the service.

There was a registered manager in post on the day of our inspection. 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.

People told us they felt safe living at Gledhow and were confident in staff’s abilities. We saw the provider was thorough in ensuring full background checks were undertaken before new staff commenced working with people, and staff understood how to look for signs of potential abuse and how to report these in a timely way.

We found staff were present in sufficient numbers to provide safe care and support. We saw people received assistance in a timely way when it was needed, and people told us this was usually the case.

Risks associated with people’s care needs were well assessed and documented in care plans, meaning staff had access to information which helped them minimise these risks or take appropriate action to help keep people safe. Medicines were managed safely and where people were able to do this independently they were appropriately supported to do so.

Newly appointed staff received a thorough induction which ensured they were given the skills to be effective in their role. On-going support was given through regular supervision, appraisal and refresher training.

We saw people were supported to access a range of health professionals when needed, including GPs, specialist nurses and falls teams. Care plans contained appropriate assessments of people’s capacity to make decisions and staff understood how the Mental Capacity Act 2005 impacted on the care and support they provided. People told us how they were able to make choices in their daily lives and we saw evidence of consents recorded in their care plans. The provider had made applications for Deprivation of Liberty Safeguards for people where appropriate.

People gave us good feedback about the meals they were served, and we saw they were consulted at regular intervals about menus. We observed the lunchtime meal during out inspection and saw it was a relaxed and sociable occasion, with people receiving patient support from staff when this was needed.

People and visiting relatives gave excellent feedback about the staff and said they would recommend Gledhow to others. We observed a high level of positive interactions between staff and people, and saw people who chose to spend time in their rooms were regularly visited by staff.

People were regularly involved in making decisions about the design and décor in the home, supporting the registered manager’s ambition for the service to reflect somewhere homely rather than a care setting wherever possible. Individual units within the service had been named to reflect a more homely feel and support people’s dignity and sense of independence.

There were a number of initiatives undertaken to ensure people’s lives at Gledhow were fulfilling. People were encouraged to think about ambitions for ways in which they spent their time or things they had felt unable to do for some time, and staff worked to find ways to help people have these experiences.

We saw evidence people and their families were involved in the processes of writing and review of their care plans. Plans contained information about important people and events in people’s lives as well as likes, dislikes and preferences.

The provider had robust systems in place to ensure complaints and concerns were recorded, investigated and responded to in a consistent manner. We saw feedback had been received confirming complaints had been resolved to people’s satisfaction. In addition we saw the provider received regular compliments about the service.

People had access to a good range of activities, and were given a weekly programme in advance to help them choose what they wanted to participate in. People who preferred to stay in their rooms were visited by the activities coordinator to engage in one to one rather than group activities. Records kept about people’s involvement were comprehensive but the information was not fully utilised.

People, visitors and staff were complimentary about the registered manager’s leadership and we saw they were a visible and well-known presence in the service. Staff told us the management team were approachable and felt they were given opportunities to contribute to the running of the home.

The registered manager held regular meetings with both staff and people who used the service and their relatives. We saw these were well documented and showed how feedback was used to generate action plans to help improve the quality of the service. Annual surveys were also used to check opinion and identify actions that could be taken to drive further improvements.

The registered manager oversaw a regular programme of audit activities to ensure various aspects of performance in the service were checked and action taken where needed. These included analysis of events such as accidents and falls to ensure emerging trends were identified and action taken to reduce risk.

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

Is the service safe?

Staff we spoke with were aware of the procedures for protecting vulnerable people and told us they would report any concerns to the manager. We spoke with the manager about the Deprivation of Liberty Safeguards (DoLS) and we were told there was not anyone currently living at Gledhow who was subject to a DoLS.

People and their relatives told us they had developed a good relationship with the staff and felt safe living at the home. Relatives told us they were confident their relatives were very well cared for. One relative we spoke with said, "I feel my relative (person's name) is very safe here."

Gledhow were in the process of upgrading their care plans. We were told this was a long process which they had hoped would have been completed by the end of 2013. We found the transition from the 'old' care plans to the 'new' was causing inconsistencies in how people were cared for.

There were effective recruitment and selection processes in place. The manager showed us the recruitment procedures and confirmed that checks were carried out prior to employees starting work. We looked at three recently recruited staff records to assess the recruitment process that the provider had in place. We saw the recruitment procedures were followed in order to ensure no person was employed without the necessary checks.

Is the service effective?

Generally people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at six people's care plans and saw each person received an assessment before entering the service. Care needs were identified and the plans were written to support the person's needs. A relative of a person who lived at Gledhow told us, "They went through everything with us when my relative (person's name) first came here."

Is the service caring?

We spoke with two relatives of people who used the service, one person said, "They always keep me updated, the care here is very professional and they are very friendly."

People confirmed they were given choices about their daily activities and staff supported them as needed. One person who used the service told us, "I decide when I want to get up, and where I eat my meals. I normally have breakfast in my room and then lunch and dinner in the dining room. Today I decided to eat all my meals in my room."

Is the service responsive?

We saw the activities programme which people could choose to be involved with. During a week's programme we saw, a sherry morning with nibbles, 'name that tune and musical sparkle', bible studies and a film afternoon with ice cream and nibbles. We saw a piano in one of the lounges, a person who used the service told us they played the piano for people.

We were told by the manager there was a resident survey conducted annually. We saw the results of the 2013 survey. The results of this survey were positive in some areas and less so in others.

The provider took account of complaints and comments to improve the service. The home had a complaints procedure, which was displayed in the entrance hall to the home. We asked the manager about any complaints the home had received. We were told they had received one complaint which was currently being investigated.

Is the service well led?

We asked the manager about how the home monitors the quality of service provided. We were told there were formal systems in place to audit and monitor the quality of the service provided on a regular basis. They were able to demonstrate improvements had been made as a result of the surveys and audits carried out. We saw there were several areas of the home that had been refurbished, including some of the bathrooms, the entrance area, both lounge areas and the bistros on each floor.

There was evidence learning from incidents took place and appropriate changes were implemented. We saw in the home's accident report file that they recorded any accidents or incidents. Staff told us they were told during the daily handover if there had been any incidents of concern and where this had resulted in changes had being made.

People had detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported that ensured their needs were met. We spoke with nine people who used the service and they told us they were happy with the care and treatment they received. One person told us, 'I am looked after very well. I am very surprised how good it is.'

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us they had no concerns with the cleanliness of the home. One person said, 'Hygiene is very good and they always clean my room.'

We found people were supported by sufficient numbers of qualified, skilled and experienced staff which met people's needs. People who used the service we spoke with told us there were always enough staff to help them when they needed support. One person said, 'There are always people to help me.'

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided an overview of the quality of the service's provided.