Archived: Glen Rose

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

Our last inspection had identified concerns regarding the deployment of staff, the management of risks to people and of medicines. People’s dignity had not always been respected and care had not always been designed to meet people’s individual needs. The quality assurance systems were not being effective at assessing and monitoring the quality and safety of care. Due to the nature of our concerns and the provider’s poor track record with compliance with the Regulations, we took enforcement action and placed conditions on the provider’s registration. We required them to submit a range of information to the Care Quality Commission (CQC) on a weekly and monthly basis. We used this information to monitor how the service was performing. In addition, the local authority and clinical commissioning group began to support the service via their quality improvement frameworks. The provider also voluntarily agreed to not take any new admissions to the home to support this process. This continued until May 2018, when due to increasing concerns about the safety and effectiveness of care provided, the local authority placed the service under their safeguarding framework and initiated a large-scale enquiry into the service. Two specific incidents are part of an ongoing safeguarding investigation by the local safeguarding team.

This inspection continued to find some areas where the service was not meeting the fundamental standards.

Staff were not always following risk management plans or guidance. Calls bells had not always been left in reach. Pressure relieving mattresses had not always been set correctly limited their effectiveness as a pressure relieving aid.

Whilst systems were in place to assess and monitor the safety of the service, these were not being fully effective as we continued to find instances where the safety and quality of the service provided had been compromised.

Insufficient action had been taken to monitor people’s nutritional needs.

Despite being made available; the registered nurses were not undertaking additional training relevant to their role and to enhance their clinical skills.

Some local health and social care professionals continued to express concerns about the clinical care provided. They lacked confidence in the leadership team to drive improvements. However, the provider had introduced measures to try and address these concerns and to improve partnership working.

Improvements were needed to ensure that following incidents and accidents, post falls protocols were always followed. In one case, the records did not provide a satisfactory explanation as to how the incident of unexplained bruising had occurred.

Whilst there were still some aspects of the dining experience that needed to improve, where people needed support to eat and drink, this was provided in a way that was dignified and respectful of the individual.

Improvements had been made to ensure the safety of the premises and of some of the equipment within it.

Improvements had been made to ensure that staff were deployed in a manner that helped to ensure people’s safety.

Improvements were needed to ensure that people cared for in their rooms had regular opportunities for meaningful interaction. Despite the home only having 19 people, their needs were very diverse and we were concerned that the provision of 21 hours of dedicated activity time was not sufficient to ensure that each person received regular and meaningful activities.

Overall medicines were being managed safely, although further improvements were needed to ensure that the application of topical creams was documented effectively. Individualised risk assessment and care planning was needed to identify and protect people from accidentally ingesting thickener.

Staff were receiving more regular supervision and felt generally well supported.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. The provider had appropriate policies and procedures which ensured staff had clear guidance about what they must do if they suspected abuse was taking place.

Overall the home was clean and we did not find any malodours. We observed that staff used appropriate personal protective equipment (PPE) and they were aware of how to appropriately handle and dispose of infectious waste.

Where there was doubt about a person’s capacity to make decisions regarding their care and treatment, staff had completed mental capacity assessments which were well documented.

The premises were generally suitable to people’s needs, although we have made a recommendation that the provider continue to explore evidence based practice guidance on how environments can be designed effectively to meet the needs of people living with dementia.

Staff referred to people in a respectful and dignified way and care was provided in a discreet manner.

Staff spoke fondly about the people they supported and it was clear that the permanent staff and longer-term agency staff had developed meaningful relationships with people.

People were encouraged and supported to make decisions about their care and support.

Care plans had improved and now recorded people’s individual preferences about how they liked their care to be delivered. There remained some areas where care plans could be developed further to ensure that staff were able to be responsive to people’s individual needs.

Staff were observed to be attentive to people and engaged with them in a person centred rather than neutral manner.

Information about how to complain was available within the service and the provider maintained a record of the complaints that had been received and how these had been responded to.

We have made a recommendation that the service consider ways in which information about people’s end of life needs and wishes are assessed and documented.

The registered manager was passionate about their role and to driving improvements within the service. Staff were generally positive about the registered manager and most felt supported in their roles. They told us morale was improving.

This is the third consecutive time the service has been rated Requires Improvement. The service is not yet consistently providing good care. We will meet with the provider to discuss the findings of this report and consider the most appropriate regulatory response. We will publish actions we have taken at a later date.

In May 2017 The Care Quality Commission (CQC) re-registered the provider Mr Amin Lakhani under the new business name of Saffronland Homes. There has not been any change in ownership of Glen Rose, just an adjustment to the business title/ provider name. As there has not been any change of ownership or leadership at Glen Rose, this report makes reference to how under the previous provider name of Mr. Amin Lakhani, Glen Rose was not meeting a number of the fundamental standards and was in breach of four Regulations. This inspection checked to see whether those required improvements had been made.

Glen Rose provides accommodation and nursing care for up to 47 older people who are living with dementia and have nursing needs. The accommodation was arranged over the ground and first floors. At the time of our inspection, 26 people were accommodated in the home. The home had two communal lounges and a conservatory although we were told this was not well used and there were plans to develop this into a memory library. During the inspection, the main lounge was not in use as it was being decorated as part of a programme to improve the environment for people using the service. Both floors had a wet room and there was also an assisted bath. A lower ground floor was occupied by the laundry, kitchen, training room and treatment room. There were plans to develop one of the rooms on this floor into a hair salon. There was a small enclosed garden to the side of the building and a larger garden to the rear. Parking was available.

A registered manager was 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.

There were insufficient numbers of suitably qualified, competent, skilled and experienced staff deployed to meet people’s care and treatment needs and to ensure that the fundamental standards were met.

The management of medicines required improvement. The provider’s records showed a high number of medicines errors had occurred within the service. We also found a number of gaps or omissions on people’s medicines administration records. We could not be assured therefore that people were receiving their medicines as prescribed.

Staff did not always offer or provide people with support in a manner that promoted their dignity promoted their dignity. Staff did not consistently offer people choices about how they would like their care to be provided.

Risks associated with the safety of the premises and of the equipment within it had not been adequately assessed and planned for.

People did not always receive person centred care which was responsive to their individual needs. Care plans did not always contain the guidance needed to support staff to effectively and consistently respond to some people’s needs. This had been a concern at our last inspection and was a Regulation that the provider was already in breach of.

Despite a programme of audit we continued to find a number of areas where the service was not meeting the fundamental standards. This meant that the quality assurance systems in place were not being fully effective at driving improvements.

Further work was needed to ensure that the Mental Capacity Act (MCA) 2005 was used effectively and consistently within the service. Deprivation of Liberty Safeguards had been applied for when people needed their liberty to be restricted for them to live safely in the home.

Improvements had been made to ensure that people’s nutritional needs were monitored, but improvements were now required to ensure people were supported to eat and drink in a timely and dignified manner.

People took part in a range of activities. However, our observations and feedback from some relatives and staff indicated that it was often difficult for the staff member responsible for coordinating activities to focus on their role as they were often called upon to supervise the communal areas to help keep people safe.

Incident reports showed that people had experienced a high number of unexplained bruises or skin damage. Whilst these had been investigated by the registered manager, they had not been escalated to the local adult services teams. This is important as it helps to ensure that the relevant agencies have oversight of potential risks within the service and are able to support and advise the leadership team.

Overall the home and items of equipment used for people’s care were clean.

Care staff demonstrated a good understanding of their roles and responsibilities in safeguarding adults at risk.

Appropriate recruitment checks were undertaken before new staff started work within the service.

People had access to healthcare professionals when they required this.

Improvements had been made to make the home’s design to help counter the impairments that people living with dementia experience.

Staff were kind and caring. Where able, staff took the time to engage and listen to people and show concern for their wellbeing.

Complaints policies and procedures were in place and records were kept of the actions taken in response to complaints received.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date once any representations and appeals have been concluded