Glenkindie Lodge Residential Care Home

Glenkindie Lodge Residential Care Home is a converted building. Communal areas are located on the ground floor, with bedrooms, shower and bathing facilities located on both the ground and first floor.

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

People’s safety was underpinned by the provider’s policies and processes. Family members said their relatives were safe at the service. Potential risks to people were assessed and measures put in place to reduce these. Lessons were learnt and improvements made through the analysis of accidents and incidents. People were supported by sufficient staff who had undergone a robust recruitment process and had undertaken training in topics to promote their safety. Medicine systems were managed safely. People lived in an environment which was well maintained and clean, with safe infection and prevention measures.

People’s health and wellbeing needs were assessed, and their health and welfare monitored by staff. Family members told us their relative had access to health care services and that they were kept informed about their relative’s health and well-being. Staff liaised effectively with health care professionals to achieve good outcomes for people. Staff had the knowledge and experience to meet people’s needs. Staff were supported by ongoing assessment of their competence to fulfil their role and responsibilities. People’s dietary needs were met. The décor and furnishings of the service continue to be improved.

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.

Family members were complimentary about the quality of care provided to their relatives. They spoke of the kind, caring and compassionate approach of staff, and were confident that their relative’s privacy and dignity was promoted.

People’s needs were recorded in care plans, considering all aspects of their care. People had the opportunity to take part in organised activities with the service. An increase in staff employed to organise and facilitate activities, was acknowledged by the provider as being necessary to improve the frequency of activities to include weekends.

Family members were complimentary about the registered manager and management team and were kept informed of key events affecting their relative. Systems, processes and effective governance and management meant the provider kept under review the quality of the service provided. Staff were supported and monitored to enable them to deliver good quality care. The registered manager and senior staff worked effectively with partner agencies to achieve good quality outcomes for people.

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 the service was Requires Improvement, (published 17 March 2022). We identified continued breaches in relation to people’s records relating to the assessment and mitigation of risk and quality monitoring of risk. We placed conditions on the provider’s registration, which required the provider to submit information monthly to the Care Quality Commission to demonstrate how they assessed, mitigated and monitored risk.

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

Why we inspected

This inspection was prompted by a review of the information we held about this service, which included the information submitted by the provider as per the conditions placed on their registration. This inspection was carried out to follow up on actions we told the provider to take at the last inspection.

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.

Glenkindie Lodge Residential Care Home is a residential care home providing personal care for up to 33 older people in one adapted building. Accommodation is provided over two floors. At the time of the inspection 17 people were residing at the service.

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

People’s records had improved and contained greater information as to their care needs and the actions required to reduce potential risk. However, further information was required in key areas, for example, diabetes management and plans to ensure a safe evacuation of the home in case of an emergency.

Mental capacity assessments had been undertaken; however, they did not fully record how people’s capacity had been determined and the best interest decision made.

Staff spoke of not having enough time to sit and talk with people, and our observations showed staff were very busy responding to call bells. The provider had not reviewed staffing numbers with consideration to people’s needs.

We signposted the registered manager to guidance and information to support in the management of infection prevention and control. We identified areas for improvement, which the registered manager addressed at the time of the inspection.

Improvements implemented by the provider and registered manager need to be fully embedded and kept under review to ensure continual and sustained improvement.

Policies and procedures were not fully implemented, for example staff had not had their competency assessed in line with the medicine policy.

The provider had engaged the services of a consultancy firm to support them and the recently appointed registered manager in improving systems and processes to support in the delivery of good quality care.

People’s medicine was managed safely.

Staff had undertaken training in key areas and were regularly supported through supervision and meetings.

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.

People’s health and welfare was monitored, and referrals were made to health care professionals when required. Family members told us they had been encouraged to be involved in decisions about their relative’s care. A family member told us, “I have noticed a greater interest in making contact with me via email or telephone regarding my relative’s care package.”

People’s dietary needs were met.

Improvements to the décor and furnishings were ongoing, and systems and equipment within the home were maintained by external contractors.

Governance and oversight of the service had improved. Audits were undertaken in key areas of risk and improvement plans had been developed and kept under review.

People’s views and that of family members were sought. A family member told us, “The managerial side of things has improved greatly since [registered manager] took over. We now have relatives’ meetings, which gives us a chance to discuss the home generally.”

Family members spoke of their confidence in the registered manager. A family member told us, “[Registered manager] is excellent. She has taken over and is doing a huge amount to improve the experience of the residents who are living in Glenkindie.”

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 Inadequate (published 17 September 2021)

This service has been in Special Measures since 17 September 2021.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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 have found evidence that the provider needs to make improvements. Please see the safe 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 Glenkindie Lodge Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when consideration what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory functions required to keep people safe and to hold providers to account where it is necessary to do so.

We have identified continued breaches in relation to people’s records relating to the assessment and mitigation of risk and quality monitoring of risk.

Full information about CQC’s regulatory response to 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 we receive any concerning information we may inspect sooner.

Glenkindie Lodge Residential Care Home is a residential care home providing personal and nursing care for up to 33 older people. At the time of the inspection 26 people were residing at the service.

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

Records of care tasks were not always completed. We found gaps in the recording of repositioning tasks, oral care records, continence care and health monitoring.

Risk assessments had not always been completed for known risks to people. We found risk associated with legionella, call bells, catheter care, and health conditions that had no risk assessment or strategies implemented to mitigate these risks in place.

Care plans did not consistently have the required information to support staff in understanding a person’s needs and ensuring all information was accessible to them.

People who were at risk of dehydration did not have their needs consistently recorded. We found fluid records did not evidence that people were supported to stay hydrated.

Medicine management system needed to be improved. Records did not evidence people received medicines as prescribed. We found gaps in the recording of medicines.

Unexplained injuries had not always been investigated, and injuries had not always been recorded appropriately.

Staff were recruited safely, however not all staff had received up to date training. The service used a high number of agency staff and at times staffing levels fell below the providers recommended levels.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems and processes were not effective in ensuring the safety of people or the environment.

Systems and processes to ensure the provider and manager had oversight of the service was not always effective in identifying and improving the quality and safety of the service.

People were supported to access healthcare professionals and attend appointments. Staff referred people to external professionals as required.

People and relatives were positive about how staff treated them. People used words such as kind and caring. People felt their dignity was respected.

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 18 March 2020) and there were four breaches of regulation.

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to oversight, records, cleaning and medicines. As a result, we undertook a full comprehensive inspection. We also checked whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to records, risk assessments, staff training, consent, medicines, safeguarding, and oversight at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Glenkindie Lodge Residential Care Home is a residential care home providing personal care and support to 27 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

Glenkindie Lodge Residential Care Home provides accommodation across two floors, with two lifts to the first floor. People with higher dependency needs are accommodated on the first floor. There are four communal lounges and a dining room on the ground floor and a communal lounge on the first floor. There are communal gardens with wheelchair access.

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

Measures were in place to mitigate risks to people. The appropriate recording of risk and mitigation required further development and would need embedding in practice to ensure staff have clear guidance. Measures were in place to reduce the risk of falls from heights.

An improved auditing system was in place to ensure better oversight of the safety and quality of the service. This would need to be continued and embedded to ensure all aspects of safety and quality were regularly monitored.

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. Improvements were still required around the recording of best interest decisions. The manager had implemented a tool to maintain oversight of deprivation of liberty safeguards (DoLs).

A training schedule now provided oversight of staff skills and there had been good progress in the update of training which was ongoing.

People received their ‘as and when’ required medicines in a safe and timely manner.

Measures were in place to ensure chilled foods were stored appropriately to prevent the risk of food poisoning.

A new manager was in post since our last inspection, they had begun to make the improvements required to the service. They had a good understanding of the work that was needed and were committed to ensuring positive change. These improvements now need to be embedded and sustained.

The manager and the deputy manager continued to work in partnership with other professionals to drive improvement and work towards full compliance with the warning notice.

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 requires improvement (published 18 March 2020) and there were multiple breaches of regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We found the service to be partially compliant with the warning notice. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme where we will check that the provider is then fully compliant with the warning notice. If we receive any concerning information we may inspect sooner.

Glenkindie Lodge Residential Care Home is a residential care home providing personal care and support to 22 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

Glenkindie Lodge Residential Care Home provides accommodation across two floors, with two lifts to the first floor. People with higher dependency needs are accommodated on the first floor. There are four communal lounges and a dining room on the ground floor and a communal lounge on the first floor. There are communal gardens with wheelchair access.

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

Risks to people had not been effectively assessed and recorded, the provider and registered manager had not maintained effective oversight in this area.

Lessons had not consistently been learnt when things went wrong. Accidents and incidents had been recorded and collated but had not triggered a review of risk to identify hazards and mitigate the risks going forward. People were protected from the risk of abuse.

As and when required medicine guidance for staff required further development to ensure people received their medicines as prescribed. Medicines were administered by trained senior members of staff and were stored and disposed of appropriately.

Recruitment procedures were not robust and did not ensure safe recruitment practices. The provider and registered manager had not ensured current legislative requirements were met in this area. However, Disclosure and Barring Service (DBS)checks were completed prior to staff working with people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not have evidence of the deprivation of liberty safeguard authorisations which are the legal authorisation required when depriving people of their liberty. Mental capacity assessments had not consistently been completed and meetings had not been held to ensure people were being supported in their best interest until DoLs were applied for.

There were no daily planned activities at the time of the inspection Activities provided by care staff were ad hoc and inconsistent.

People did not receive dignified care at meal times staff were observed to support two people at a time to eat and leave people mid meal to attend to other duties. We have made a recommendation on improving support in this area.

Some of the staff training was overdue. Staff completed an induction and training schedule when they first started with the service.

People told us that staff were kind and caring and we saw that they knew people well. Privacy was supported during personal care and staff had a good understanding of gaining consent before delivering care.

Communal areas were not consistently deep cleaned. However, people’s rooms were clean and fresh. Personal protective equipment such as gloves and aprons were used by staff.

There were suitable numbers of staff to meet people’s needs. The staff and management team worked in partnership with health and social care professionals.

Peoples needs were assessed prior to moving into the service and personalised care plans were in place. People’s individual communication needs were met.

People had enough to eat and drink with nutritionally balanced meals and access to regular snacks and drinks.

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 requires improvement (published 18 December 2018) and there were breaches of regulation. The service remains rated requires improvement.

This service had been rated requires improvement at the last inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to, people’s safety, the providers oversight of the safety of the environment and quality of the service, staff recruitment procedures and consent for care and treatment.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Glenkindie Lodge Residential Home was registered by the Care Quality Commission (CQC) on the 2 November 2017 and this was the first time we had inspected this service.

Glenkindie Lodge Residential Home 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.

Glenkindie Lodge Residential Home provides care and support for up to 33 older people, some of who may be living with dementia. The premises had been adapted and consisted of two floors which included bedrooms, a main lounge, garden room, dining room and an activities room. At the time of our visit there were 26 people using the service.

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.

During this inspection we found that risks to people had not always been identified and managed safely. For example, where people were using thickener in their drinks because of a risk of choking, there were no risk management plans in place to cover the risk of choking or dehydration. One person had numerous falls from their bed, but there was no risk management in place to help reduce that risk.

Mobility assessments did not always demonstrate how moving and handling slings had been safely assessed for people. People shared slings but we found they were not always used correctly, for example, toileting slings were used for general moving and handling procedures, not toileting. Slings were not checked to make sure they were safe to be used. Some people using wheelchairs were at risk of sliding out and there were no management plans in place to reduce this risk.

Some bedrooms doors had been wedged open with different pieces of furniture which meant that people may be put at risk if there was a fire at the service. Not everyone living at the service had in place a personal emergency evacuation plans (PEEPS) to make sure they would get the help they needed in an emergency to keep them safe.

Quality assurance checks were not used effectively to bring about improvements to people’s care and support. Records management was confusing and disorganised and records could not always be accessed at the time of our inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Improvements were required to ensure people were protected from the spread of infection and that the service followed best practice guidance. We found that people were sharing slings used for moving and handling.

Senior staff required further training in relation to the Mental Capacity Act 2005 (MCA) and the process for making best interest decisions for people. Staff understood about safeguarding and the many different types of abuse. They knew how to report any concerns they may have. There had been ongoing recruitment by the provider to improve staffing numbers and the provider followed thorough recruitment procedures to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service. These needed to be strengthened to make sure that the outcomes of accidents, incidents and complaints were shared with all staff to ensure lessons were learnt to reduce the possibility of a recurrence.

People received a needs assessment before they went to live at the service. The induction process had improved to make sure all new staff completed the Care Certificate. The registered manager provided all staff with on-site training that covered core subjects such as moving and handling, fire safety and food hygiene. However senior staff needed further training in Mental Capacity and Deprivation of Liberties. People received enough to eat and drink and staff gave support when they needed help to eat their meals. People were supported to have health appointments when required, including opticians and doctors, to make sure they received healthcare to meet their needs.

The staff were caring and kind and had developed good relationships with people using the service. They engaged with people and welcomed their relatives and friends when they visited. Staff respected people and supported them to make choices about their care and support. People told us staff treated them with dignity.

People were happy with the care they received from the staff team. Staff found the care plans were not easy to use and they found it difficult to find the information they needed. Although some improvements were already taking place in relation to the activities people took part in this needed to be strengthened to make sure people were able to take part in activities that were meaningful to them. The service had a complaints procedure and if a person made a complaint they were listened to and their concerns taken seriously. People could be supported to plan and make choices about their care at their end of life.

The service had a new provider and was registered with CQC on 02 November 2017. This was the first time we had inspected the service under the new provider. We found that the provider had already identified many areas of the service that required improvement. They had drawn up a development plan and were working through this. Improvements that already taken place included upgrading the environment, purchasing new equipment, changes to staffing. After our inspection the provider wanted to confirm with us further improvements they had introduced. These were the introduction of a new electronic records system to improve record keeping and training for the registered manager and the deputy manager in relation to Deprivation of Liberties (DoLS) training.

The provider told us he was committed to improving the service and showed us their plans for the future. These included more specialist training for staff and the registered manager, for example, end of life care and managing behaviours that can challenge. There were plans to continue to improve the provision of activities for people and to introduce new quality assurance systems to monitor the standard of care to improve the service.