Glenholme Holdingham Grange

People's experience of using this service:

Regular quality assurance checks had been carried out which supported good governance. Processes were in place to ensure medicines were administered and managed safely. The service followed safe infection, prevention and control procedures.

People felt well cared for by staff. There were a wide range of meaningful activities that people could access in their room, in groups or in the community. During our site inspection we observed visitors coming and going freely.

Most people and relatives told us call bells were responded within a couple of minutes. Some people told us there had been occasions at night when call bells were not always responded to quickly.

We observed people were treated with respect and dignity. People were supported to have maximum choice and control of their lives. The environment had improved and better supported people living with dementia and sensory loss.

When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed and where required best interest decisions had been recorded.

Care plans were electronic and reflected people's personal preferences and how they liked their care to be provided. The care plans had been reviewed monthly and contained information about people and their care needs.

People enjoyed the meals offered and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

Staff had received regular supervision and plans were in place to ensure people received this on a regular basis. Staff had received training to support their role.

People had good health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs. The provider and staff worked in partnership with health and care professionals.

When required notifications had been completed to inform us of events and incidents.

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 29 April 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. 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 carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Glenholme Holdingham Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Staff had access to personal protective equipment (PPE) and followed national guidance around putting on and removing (donning and doffing) PPE. Staff did not consistently wear PPE according to national guidance.

The home was clean and an infection control policy was in place. The QA systems were not consistently effective.

Medicine guidance for ‘as required’ medicines (PRN) was not consistently in place in Eslaforde.

Staffing arrangements did not consistently ensure people’s care needs were met. There were not always adequate numbers of staff to ensure people were well supported. Staff had received training for their roles. New staff were recruited safely.

The risks to people’s care were assessed and measures were in place to mitigate these risks. People were cared for safely.

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 knew how to keep people safe from abuse and were confident to raise concerns with the registered manager or external agencies. When required, notifications had been completed to inform us of events and incidents.

People and their relatives knew how to raise a complaint and would feel confident to do so if needed.

People had access to a range of professional support and working arrangements were in place with healthcare professionals.

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 4 August 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 10 but remained in breach of regulation 17.

Why we inspected

We received concerns in relation to staffing, staff attitudes and responses to people. As a result, we undertook a focussed inspection to review the key questions of safe, caring 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.

The overall rating for the service has remained requires improvement. 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 coronavirus and other infection outbreaks effectively.

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 the failure to ensure quality monitoring systems are effective.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

People’s experience of using this service:

Regular quality checks had been carried out, however these checks had not identified some of the issues we found on inspection.

Processes were not in place to ensure medicines were administered and managed safely.

We observed occasions when people were not treated with respect and dignity.

People told us that there was usually sufficient trained and experienced staff however on the day of inspection we observed occasions when there were insufficient staff available to respond to people.

There were activities on offer. However people in one of the units did not participate in any activities during the day of inspection. The activities coordinator was looking at how they could develop this area further.

The environment in Elsaforde was not adapted to support people living with dementia.

People were supported to have maximum choice and control of their lives. The processes in service did not consistently support this practice.When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed. However, best interest decisions were not specific to individual decisions.

Care plans did not consistently reflect people's personal preferences and how they liked their care to be provided.The care plans had been reviewed and contained information about people and their care needs.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people’s care plans.

Staff followed guidance provided to manage people's nutrition and pressure care.

Staff had received training to support their role.

Staff had received regular supervision and plans were in place to ensure people received this on a regular basis.

People had good health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs. The provider and staff worked in partnership with health and care professionals.

People felt well cared for by staff.

When required notifications had been completed to inform us of events and incidents.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and dignity. Details of action we have asked the provider to take can be found at the end of this report. More information is in the detailed findings below.

Why we inspected: This was a scheduled inspection. The inspection was the first inspection for this location following their registration in July 2018. We brought the comprehensive inspection forward because there had been a number of reported incidents where we had concerns.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor intelligence 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.