We inspected Glenside on 13 March and 14 March 2018. The inspection was unannounced. Glenside Farnborough provides residential accommodation and rehabilitation services for up to 22 people with brain injury and / or neurological conditions. At the time of the inspection 21 people were using the service.At the last inspection, in November 2015, the service was rated Good. At this inspection we rated the service as Requires Improvement. Glenside Farnborough is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
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.
The service had a satisfactory approach to safeguarding. For example there was a suitable policy and procedure in place and staff received appropriate training. Where there had been safeguarding concerns, these were reported appropriately, and any recommendations had been implemented.
A risk assessment process was in place. Risk assessments were comprehensive and reviewed regularly. Other records were comprehensive, accurate and up to date.
Health and safety procedures were satisfactory. Equipment was regularly checked and was judged as safe.
Staff received training about behaviours of people which could challenge the service. There were however concerns about how management had responded to some incidents, where staff had felt threatened and did not feel safe.
Some concerns were expressed about staffing levels, and the ability for staff to subsequently provide satisfactory activities and rehabilitation within the current staffing levels provided.
Staff recruitment, training, supervision and appraisal systems were effective, and suitable records were maintained. However records of staff induction could be improved. We have recommended new staff, who have not worked in the health and social care sector previously, undertake the Care Certificate.
Medicines procedures were to a good standard. People received the correct medicines on time. Suitable records were kept. The service was very clean, and there was a good standard of infection control precautions in place.
Assessment processes were comprehensive to enable decisions about whether people were suitable to move into the service. Care plans were also comprehensive and regularly reviewed. People had some involvement in the care planning process. The service had a suitable approach to assessing people’s mental capacity. Documentation about mental capacity was comprehensive.
People had a choice of meals, and were positive about the food they were provided with. We were concerned about some aspects of the support provided; for example whether food was prepared appropriately for those who were at risk of choking.
People’s healthcare needs were met by external professionals. However there were concerns about whether satisfactory physiotherapy was provided by the service. This meant that people’s rehabilitation was currently not effective as it should be. The registered provider said this would be improved, but people said there had been a problem for some time.
Staff were seen as caring, respectful and supportive. Some people felt frustrated by what they saw as too many rules at the service, and the inability for staff to escort them out of the home if they were unable to go out on their own. People were involved in decision making however, and staff were observed as friendly and attentive.
We had significant concerns about the provision of activities. Although there were records to demonstrate some activities occurred, we received concerns that people did not have enough things to do, that there was a lack of transport available, and there was currently a lack of dedicated staff to provide suitable activities for people.
There was a lack of confidence in the complaints procedure. Although records of complaints management were satisfactory, several relatives we spoke with, said when they had made complaints, improvement had not been sustained. Two relatives said they had given up raising concerns as things did not improve.
Concerns were raised by people and relatives that there had been many changes to the management of the service recently and this had led to inconsistency and uncertainty.
Staff said they thought the team worked well together and the team did their best to ensure people’s needs were met. There was a good system of staff handover, and communication within the team.
The service had a comprehensive system of quality assurance to ensure standards were monitored and improved as necessary. However the system had failed to pick up and address many of the issues we have raised as concerns within this report.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.