Background to this inspection
Updated
17 December 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, the registered manager was no longer employed at the service. We are taking action, to address this, outside of the inspection process.
A new manager was in post, but they were not yet registered with CQC. We have referred to them as the ‘manager’ throughout this report.
Service and service type
Glencoe Care Home 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and other professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with the nominated individual, manager, one care worker and two agency staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with three people who used the service. We looked at two staff recruitment and induction files. We also looked at medicine records, health & safety checks and servicing, as well as staff training records.
We conducted a walk around of the service and spent time observing staffs’ interactions with people as well as staffs’ infection prevention and control practice.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We requested additional documentation that was unavailable during the inspection site visit. We visited the service for a second day to collect these documents. We also had contact with a number of professionals who provided feedback on the service.
Updated
17 December 2020
About the service
Glencoe Care Home is a residential care home providing personal care to people aged 65 and over, some of whom were living with dementia. The service has three floors. Glencoe Care Home can accommodate up to 19 people. At the time of this inspection, 13 people lived at the service.
People’s experience of using this service and what we found
People were not safe. Risks to people were not appropriately managed or recorded. There was an insufficient number of suitably qualified staff on duty and robust recruitment processes had not been followed. Staff were unfamiliar with people’s care and support needs.
Staff had not been provided with sufficient training or induction to their role. Medicines had not been managed safely. People had not always received their medicines as prescribed.
People’s nutritional needs were not being met. Guidance from professionals in relation to special diets and fluid monitoring had not been followed. The provider failed to provide a balanced and varied diet.
Appropriate records were not kept in relation to people who used the service. Care plans, risk assessments, monitoring documents and accidents and incidents could not be located at the time of the inspection.
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.
There was a clear lack of systems and processes in place to monitor the quality and safety of the service. The provider had failed to take action following the last inspection to address areas of concern.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Inadequate (published 26 November 2020) and there were multiple breaches of regulation. The provider completed an action and improvement 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 regulations and significant concerns remained.
Why we inspected
We received significant concerns in relation to infection control, staffing and the safety of people who used the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has not changed. This is based on the findings at this inspection.
We have found evidence that the provider needs to make significant improvements. Please see the Safe, Effective and Well-led sections of this full report.
Following the inspection site visit on 10 November 2020, the service was provided with additional support from the local authority and the clinical commissioning group. They implemented support with staffing levels, meals, medicine management, infection control as well as completing clinical assessments for each person who used the service. Despite this input, the provider failed to respond accordingly to implement the recommendations made, therefore, significant risks remained.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Glencoe 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 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 infection prevention and control, medicines, environmental safety and risk assessing, staff recruitment, staffing levels, safeguarding and governance of the service 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
We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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 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.