Glencoe Care Home

Glencoe Care Home is a care home with nursing and accommodates up to 20 people. The service provides care and support to people who are living with dementia. At the time of our inspection there were 19 people living at Glencoe.

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

People told us they were happy with the care they received and felt safe living there. One person said; “I’m very happy” and someone else said; “Couldn’t be happier.”

A survey completed by a relative recorded; “During COVID-19 staff worked twice as hard to keep people safe.” People looked happy and comfortable with staff supporting them. Another recorded; “We are very happy with the care given at these difficult times.” Staff were caring and spent time chatting with people as they moved around the service.

The service had sufficient supplies of Personal Protection Equipment (PPE) available. Signage was in place throughout the service regarding the requirements for wearing PPE and included doffing and donning of PPE safely. Additional information was provided on what PPE needed to be worn when a person was assessed as being at higher risk of infection.

Staff came to work wearing their own clothes then changed into their uniforms in a designated room. Staff completed appropriate training and support to enable them to carry out their role safely, including PPE and dementia care training.

There were supplies of anti-bacterial wipes around the service to enable staff to clean surfaces and any areas, including bathrooms, they had used. There were posters around the service to prompt and remind staff about the infection control procedures in place. All high contact areas were cleaned regularly throughout the day and night.

The environment was safe, with upgrades and redecoration ongoing when possible due to the COVID-19 restriction. People had access to equipment they required.

Procedures were in place regarding self-isolation for people and staff, if they showed symptoms of COVID-19. Specific COVID-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak.

New COVID-19 visitors’ policy had been updated since new guidance was released by the government. This included two designated visitors for each person living in the service. All visitors were required to make appointments and a designated room was made available for visitors and people living in the service. Friends and families were provided with the updated policy detailing the new restrictions. Where visiting was required for compassionate reasons, suitable infection control procedures were in place. Visitors were screened for COVID-19 prior to entering the service. Visitors were required to wear PPE at all times.

People were supported to speak with their friends and family using IT and the telephone as necessary.

Appropriate testing procedures for COVID-19 had been implemented for all staff and people who used the service and followed national guidance regarding the frequency and type of testing. Arrangements had been made to enable people and staff to access the vaccine.

Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19. Staff had completed online infection prevention and control and COVID-19 training. The registered manager worked with all staff to ensure infection prevention and control measures were followed.

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 were supported by a staff team who completed an induction, regular training and were supervised. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activities with staff. Staff knew how to keep people safe from harm.

People were supported by a service that was well managed. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service. Agency staff were not used, and staff covered and supported each other when shifts required filling to cover leave or other absences during the pandemic. People and staff told us the management of the service were hands on, approachable and listened when any concerns or ideas were raised.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified including additional risk to people if they were vulnerable to catching COVID-19. Staff had guidance to help them support people to reduce the risk of avoidable harm.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 20 June 2019) and there was one breach 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 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 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, Effective and Well Led which contain those requirements.

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 Glencoe 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.

People’s experience of using the service:

¿ People told us, “I feel safe knowing I have my call best just by my side” and “Nothing is too much trouble.” Relatives told us, “The manager is very caring and has a good sense of humour” and "We would definitely recommend this home."

¿ The registered manager and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

¿ Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. People’s wellbeing was promoted.

¿ Some activities were provided. Singers and musicians visited and people were taken out in to the local community. However, the activities were not always meaningful and relevant to people’s backgrounds and interests. We have made a recommendation about this issue in the Responsive section of this report.

¿ People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. However, the process for ensuring these mattresses were always set correctly was not robust. We did not evidence any impact on people due to using incorrectly set mattresses. The registered manager assured us that staff were going to be asked to record the setting following the daily checks of these mattresses.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff were recruited safely. However, induction processes were not robustly recorded. Staff shadowed experienced staff until they felt confident to work alone. There were sufficient numbers of staff to ensure people’s needs were met.

¿ The environment was safe and people had access to equipment where needed. Most staff had received appropriate training to enable them to carry out their role safely. Some staff were booked to undertake training required.

¿ Staff were not provided with supervision in line with the policy held at the service. Nurses had not been provided with formal recorded supervision at all in 2019. We have made a recommendation about this issue in the Effective section of this report.

¿ Quality monitoring systems were in place. A recent survey sent out to people and their families had positive responses.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (report published 8 June 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Requires Improvement. At this inspection the provider had taken action to address the concerns found at the last inspection. However, the action taken was not always effective and embedded and concerns remained with the quality assurance monitoring of the service. The overall rating for the service is again Requires Improvement.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced comprehensive inspection took place on the 23 April 2018.

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.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 services general environment required decoration where wallpaper had been damaged due to lounge chairs being brushed against them. There was extensive chipping of paintwork throughout the service due to the movement of hoists and wheelchairs. The ground floor carpet was heavily stained in places. At the time of the inspection the dining room was being decorated and there was a maintenance plan in place to improve the environment.

Both sluice facilities were broken in the days before the inspection. One sluice was being repaired on the day of the inspection. The additional sluice required specialist maintenance and this was being sought. Staff had been instructed of the issues and were working to maintain effective infection control measures. Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedures in place to manage infection control risks.

One person was receiving oxygen in their room. The machine holding the oxygen was being stored outside the door of the room and had a hazard warning in place. However, it was not obvious and a more prominent warning would have alerted people to the hazards where oxygen was being used. We shared this with the registered manager who acted to improve signage.

There were no Personal Emergency Evacuation Plans [PEEPS]. The purpose of these is to support people in the case of emergency by providing individual emergency evacuation plans to support staff and emergency services. The registered manager acknowledged the need to improve this and put a plan in place to develop PEEPS with immediate effect.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely. Regular audits were being carried out. However, we found an excess of some prescribed medicines and creams which had been opened without having the date of opening recorded. Meaning the expiration date could not be determined by staff. There was no effective system in place to ensure staff recorded when they had applied creams to people in line with their care plan.

The service had sufficient staffing levels in place to provide the level of support people required. The registered manager told us they made sure they worked a shift at least once a week to “Keep in touch with what’s going on”. There was limited use of agency nurses to ensure continuity. People told us and we observed staff were responsive and available when they needed them. Call bells were answered quickly.

Staff were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. There was training available to all staff which met the diverse needs of people being supported and which was regularly monitored.

Care plans included evidence of how people’s risks were being managed to ensure they were safe. Records recorded changes in people’s level of risk and how those risks were going to be managed.

Care plans were being reviewed regularly and people’s changing needs were recorded. Records reporting on people’s health including repositioning charts, pressure mattress checks, food and fluid and night checks were not always effectively completed. Mattress pressure checks were ticked with no explanation of what the pressure was or should be. A staff member was not aware of what one mattress pressure should be. This meant the information did not provide staff with the necessary information to support them in delivering care to people.

Some people had restrictions in place to support them safely. While the registered manager had applied for two people to have potentially restrictive care plans, there was not a robust system in place to monitor this. Two applications submitted in 2016 had not been reviewed. No other capacity assessments had been carried out or the best interest processes used assess potential Deprivation of Liberty Safeguards [DoLS] applications. This meant some people who were restricted from leaving the service did not have the necessary ‘best interest’ decisions in place to ensure that restrictions were the least restrictive option available.

Accidents and incidents were being recorded and reported and any lessons learned were shared with staff. The service learned by any mistakes and used this as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

People told us they were informed of their care plan. However; there was no evidence this had been consented to. For example consent for sharing information and keeping photographs of the person.

Staff supported people to access healthcare services. These included social workers, psychiatrists, general practitioners (GP) and speech and language therapists (SALT). Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

People told us the food was good and we saw choices were offered to meet people’s preferences. When people were identified as being at risk due to poor food and fluid intake they were closely monitored and supported to eat high calorie diets. Kitchen staff were aware of people’s dietary needs and preferences and created meals which were appetising.

Staff told us they were supported by the registered manager through regular updates in handovers. However the registered manager acknowledged formal supervision had lapsed for nurses and care staff in recent months.

There were a range of quality assurance arrangements at the service in order to raise standards and drive improvements. However, formal staff and residents meetings had ceased since 2017. Staff told us information was shared on a daily basis with the registered manager and that the manager was available to discuss any issues.

All levels of staff engaged with people using and associated with the service. People’s views were taken into account through regular communication and surveys. The results of the most recent survey had been positive.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

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.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Glencoe on 20 and 21 April 2016. The inspection was unannounced. The service was last inspected in July 2013 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “It is lovely, it is my home. I like it here. People are lovely,” and “It is a very good place to stay. I had no hesitation to come here. ” A health professional told us, “We have always held the home in high regard.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. However records of when people had last seen a dentist were variable. The registered manager said she would look into this, as the dentist did see people regularly.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

The service had a programme of organised activities, and an activity organiser was employed two days a week. These activities included activities such as board games, singing, drawing, bingo and baking. The activities organiser also spent individual time with people in their rooms. Some external entertainers such as musicians and singers visited. People went out on occasional outings.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, “The food is very good,” “and people said they had a choice. People said they received enough support when they needed help with eating or drinking.

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told. “The manager is really relaxed and supportive.” Staff told us the new owner was “Extremely approachable” and had “Done an awful lot for the home since they purchased it,” and made staff “Feel appreciated.” There were satisfactory systems in place to monitor the quality of the service.