Glendale Residential Care Home

Glendale Residential Care Home is a 'care home' which accommodates up to 20 older people who may or may not be living with dementia in one adapted building. 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. At the time of our inspection there were 12 people living at the service.

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

People received care that was well coordinated, person centred and met their varying needs. Care staff had received additional training to meet people’s needs.

Staff ensured the environment was clean, inviting and safe. People had a variety of options open to them to visit and speak with loved ones.

The registered manager was constantly making improvements to the service with support from the provider. The provider had learnt lessons from the previous inspection and supported good improvement within the home.

Staff and relatives felt able to raise concerns and were confident these would be dealt with in an open and transparent manner.

The registered manager and provider had recognised staff morale was key to good care provision during the pandemic. To promote this, they had put in place excellent support for staff which had resulted in a flexible, caring and motivated staff team.

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.

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 and inadequate in the well led domain (published 23 March 2020) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment; staffing; good governance and fit and proper persons, director.. 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 they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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 were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement 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 Glendale Residential care home 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.

Glendale Residential Care Home is a 'care home' which accommodates up to 20 older people who may or may not being living with dementia in one adapted building. 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. At the time of our inspection there were 16 people living at the service.

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

The provider had delegated the daily running and quality monitoring of the service to the care manager. The service was not in a good state of cleanliness. The registered manager who failed to take enough action to ensure that people were protected from risk of infection. The care manager took immediate action to address this risk and mitigate future risk following inspection.

The registered persons had not acted to safeguard people from risk of scolding from exposed hot water pipes, despite previous assurances that they had taken this action following the previous inspection. Immediate action was taken by the care manager to mitigate this risk.

The provider consisted of two directors. The directors had failed to learn lessons from previous inspections about the importance of maintaining and safe and clean environment for people. The director’s oversight of the service was poor and the service continued to breach regulations over a sustained period of time.

However, whilst we had serious concerns about the environment and investment at the service, we found that peoples care had improved.

Staff had been trained in safeguarding vulnerable adults. They told us that the care manager took safety concerns seriously and acted to rectify them. Although they often had to push for the provider to rectify issues around the service.

People and relatives told us they felt safe. Staff had been trained in safe care practices for moving and handling and we observed people were supported well.

Peoples individual risks, such as risk of poor skin integrity, pressure care and choking where clearly assessed and interventions in place to manage these well.

Medicines were managed safely, and the service had recently received an outstanding rating from local commissioning teams for their medication practices. Peoples medications were regularly reviewed with health care professionals and reduced or changed as needed.

The service had reduced peoples falls, infections and skin damage by working with Prosper, a collaboration between local authority, universities and clinical commissioning groups focused on improving resident safety in care homes.

Staff understood the principles of mental capacity and people’s right to choose how they wished to be cared for. Appropriate assessments had taken place when people were deprived of their liberty, and applications made to the local authority.

People had access to health and social care professionals to manage their physical and mental health needs. The manager had acted on concerns around poor links with dentists and now every person had a dental plan and dentist.

Peoples nutritional needs were managed safely, and dining experience had improved and was person centred. There had been significant dietitian involvement with people, but needs were now managed so well people had been discharged from this service.

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.

Staff were very caring and treated people with dignity and respect and promoted their independence. They supported people to make daily choices about their care and activity. People told us staff were kind.

Care plans were in place to manage peoples identified risks in a person-centred way. One-page profiles gave staff clear guidance about how people liked to be cared for.

People were supported to maintain relationships important to them. Activities were stimulating, and the care manager worked with people, staff and relatives to identify potential new opportunities for people to engage with the local community, including open events at the home.

Staff had received end of life training. The care manager had acted on previous recommendations about improving discussions around end of life care and had developed information packs for relatives.

The care manager was proactive if people and relatives raised concerns and behaved in a compassionate way to people. Relatives, people and staff told us they were transparent and open.

Whilst the care manager carried out robust audit’s issues found were not always acted upon by the registered manager who had the authority to make improvements that required investment. Following the inspection, the care manager immediately addressed the shortfalls we found to the environment and we met with the registered manager to discuss how they would ensure that environmental concerns were identified, managed and mitigated in the future.

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 15 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will 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.

Glendale Residential Care Home is a ‘care home’ which accommodates up to 20 people in one adapted building. 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. At the time of our inspection there were 14 people living at the service.

Rating at last inspection: Inadequate (Published 6 September 2018). The service was placed in special measures.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We previously inspected Glendale in July 2018 where the service was rated ‘Inadequate’ and placed in special measures. This was because we found that since our inspection in March 2017 where the service was rated ‘Requires Improvement’ there had been a deterioration in the quality of care with a continued lack of action to reduce the risk of harm to people who used the service. There was a continued breach of Regulations 12 and further breaches of Regulations 9, 10, 11, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People’s experience of using this service:

People’s medicines were managed safely. However, further work was needed to ensure accurate records of carry forward medicines from one month’s cycle to another were maintained.

People’s safety had been considered and risks had been reduced by the introduction of revised guidance, risk management systems and improved systems of auditing. This included improved systems to identify and actions to reduce the risk of harm including responding to safeguarding incidents. All staff had been provided with updated training in safeguarding people from the risk of abuse.

We have made a recommendation about the management of some of the medicines, use of good practice guidance for kitchen audits, and that people’s spiritual and cultural needs be reviewed.

Improvements had been made to provide staff with regular, planned supervision to enable them to discuss their work performance and identify any training and development needs.

All care plans had been reviewed and systems put in place to enable ongoing review with people’s changing needs updated in a timely manner.

People told us they were satisfied with the quality and variety of food they were provided with. Those at risk of inadequate food and fluid intake were monitored and referral for specialist support accessed when needed.

People told us staff treated them with kindness, dignity and were respectful of their choices.

The recent employment of an activities coordinator provided more group and one to one activities for people. However, further work was needed in planning to support people who wanted regular access to the community.

Systems to monitor the quality and safety of the service had improved. A range of regular checks had been carried out by the manager with actions and timescales recorded where improvements were needed. However, whilst we were told the registered manager visited the service on a regular basis, they did not record any formal monitoring of the service. Further work was needed to ensure effective oversight of the service with overall planning for improvement at all levels of the organisation.

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.

This inspection took place following information of concern we received that people were at risk of not having their needs responded to in a safe and effective way. At this inspection we identified a number of concerns.

Following our inspection, we notified relevant stakeholders such as the local safeguarding authority and Essex Fire service of our findings.

At our previous inspections in March 2017 and February 2018, we found concerns in relation to ineffective governance of the service. This included a lack of effective management of risk to people’s health, welfare and safety as well as shortfalls in maintenance and management of the premises. Our inspection in March 2017 found people were not protected from the risks associated with unsuitable staff being employed as the provider did not operate safe recruitment practices, the risk of not receiving their medicines as prescribed, and environmental risks had not been identified and managed. We also found action had not been taken in a timely manner in response to safety concerns highlighted by visits from fire safety officers.

At our inspection in February 2018 inspection we found some improvements had been made. However, there was a continued failure to provide staff with the guidance they needed to provide safe care and treatment to people including insufficient planning and monitoring of people’s needs. Following our inspection, we wrote to the provider and requested an action plan which would tell us what they would do to ensure compliance with the law. The registered provider failed to respond to our request.

At this inspection, we found there had been further deterioration in the quality of care which meant the provider continued to be in breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the need for consent, staffing, fit and proper persons employed, person centred care and good governance.

Glendale Residential Care Home is a ‘care home’ which accommodates up to 20 people in one adapted building. 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. At the time of our inspection there were 17 people living at the service.

The service had a registered manager who was also the registered provider of Glendale and another registered service. 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 were not protected from being cared for by unsuitable staff because safe recruitment systems were not in place and operated effectively. There were insufficient numbers of staff available at all times. This meant there weren’t enough staff to fully enhance people's quality of life. Whilst some staff were seen to be kind and caring, further work was needed to imbed a culture of caring throughout the service.

There were inadequate numbers of skilled and knowledgeable staff employed and available to meet people’s needs at all times. Staffing rotas did not always reflect the actual staff working.

People were not always supported by staff that had the necessary skills and knowledge to meet their health, welfare and safety needs. Staff had received a variety of training relevant to their roles. However, this learning was not always being put into practice, when supporting people living with dementia and when presented with distressed behaviours that were challenging to themselves or others.

Care plans failed to provide staff with guidance and staff were unclear of the strategies in place to support people whose behaviour can be challenging. Staff lacked understanding about the need to assess people’s capacity to consent to care and treatment and action they should take when people’s freedom of movement was restricted which placed people at the risk of not having their human rights upheld and prevent the risk of harm.

Visits from a fire officer highlighted a number of areas where action was required by the provider to improve the safety of the environment and protect people from the risk of harm.

There were systems in place to manage people’s medicines safely and ensure they received their medicines as prescribed. However, we found staff who administered medicines were not routinely competency assessed and further work was needed to provide protocols to guide staff where people received medicines as and when required, for example, those prescribed for pain relief.

Not all staff were familiar with safeguarding procedures and not all received adequate training on recognising and responding to acts of abuse and keeping people safe.

People had access to some healthcare services. However, they did not have regular access to a dentist. It was not always recorded by staff what action had been taken to support people who had been identified as losing weight.

The registered manager and staff did not have up to date, skills and knowledge as to current good practice in meeting the needs of people with a cognitive disability including those living with dementia.

The leadership, governance arrangements and culture in the service did not always support the delivery of high quality care. There remained an inconsistent approach to assessing risks to people’s health, welfare and safety. Internal assurance systems continued not to identify the shortfalls that we identified at this inspection. As a result, people were not provided with care which met their needs and kept them safe. There was a blame culture where the provider did not promote a culture that encouraged openness, transparency and honesty at all levels.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

This unannounced inspection took place on 21 and 27 February 2018.

The service had 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. The previous registered manager had left since our last inspection. The provider, who was also the owner of the service, was now the registered manager and there was also a new deputy manager in post.

We had previously inspected Glendale Residential Home on 12 April 2017, when the service was under a different registration. We found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There had been a number of changes at the service since our last visit and a high turnover of staff. The provider had recruited a new deputy manager and the service and staff team were now more settled. The new management team had addressed the concerns found in our last inspection and the support people received was safer and more personalised. Some of the changes had only recently been implemented and more time was needed to measure whether they were sustainable. This included new measures to check on the quality and safety of the service.

Since our last inspection, the provider had concentrated on minimising risk to the safety and we found people received safe support when they arrived at the service. However, planned improvements to the pre-admission assessment process had not been implemented prior to our return to the service. We found the provider had admitted new people to the service without an adequate assessment of their needs and potential risk, leading to unnecessary disruption on their arrival.

The provider and deputy manager were visible and hands-on and promoted an open culture for people, families and staff.

The building work at the property was completed and people benefited from the new décor and furniture. The service was more ordered, which improved the safety of people receiving medicines and minimised the risk of infection.

People had personalised risk assessments and care plans tailored to their individual needs and preferences. There were improved measures to ensure the safe evacuation of people in an emergency. There were sufficient, safely recruited staff to meet people’s needs. Staff knew how to support people who were at risk of abuse.

Staff skills had increased, in particular in the area of dementia. Staff were well supported by the management team and worked well together. Staff worked alongside outside professionals to meet people’s health and social care needs.

The provider met their responsibility under the Mental Capacity Act 2005 (MCA). Where people did not have capacity to make decisions, the provider ensured decisions were made in the person’s best interest.

People had enough to drink and eat. The provider had employed a new activities coordinator to support people to remain active and stimulated. People and their families felt able to complain and be confident their feedback would make a difference. The provider ensured people were consulted about decisions at the service, including menu choices.

Staff knew people well and supported them with kindness. People were treated with respect and dignity. Staff communicated well with families

During this inspection, we identified a breach 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 this report.