Glenmuir House Residential Care Home

Glenmuir House Residential Care Home provides accommodation and personal care for up to 20 older people with increasing physical frailty, diabetes, strokes and those approaching end of life. There were also people who were living with dementia. There were 15 people living at the home at the time of the inspection.

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

The manager and provider had systems and processes to safely assess and manage risks to people, including their medicines and the environment. However, these had not identified some of the shortfalls we found. The audits for care plans and risk assessments had not identified that there was no guidance to manage diabetes and administration of insulin, placing people at possible risk of health complications.

The premises was not always maintained to a good standard. Improvements were required throughout the building, such as in relation to fire doors, radiator covers and hot water temperatures, which the registered manager and provider were prioritising and actioning. The cleaning of the premises needed to improve to ensure all areas of the home were clean and hygienic for people.

We have made a recommendation about the procedures of giving medicines.

People received safe care and support by enough numbers of staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. As identified in the report however the lack of a dedicated house keeper had impacted on the cleanliness of the premises. One person said, “I like it here.” Most peoples care plans and risk assessments meant peoples’ safety and well-being were protected. Medicines were stored, administered and disposed of safely.

Staff had all received essential training to meet peoples support and care needs. There was an induction programme to introduce new staff to the service and during this process they got to know people and their needs well. Staff told us that they felt the induction had been a good introduction to the home. People's dietary needs were assessed, and people were provided with a choice of cooked meals each day, including breakfast. Feedback about the food was positive and people said they enjoyed the meals. People’s health needs were consistently met with involvement from a variety of health and social care professionals.

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 caring in their approach to the people they supported and at this inspection we saw people were treated with respect, humour and dignity. People and visitors to the service were consistent in their views that staff were caring and supportive. People were relaxed, comfortable and happy in the company of staff and engaged with in a positive way.

People told us they felt involved in planning their care. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

Complaints made by people were taken seriously and investigated.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Staff said the leadership was positive, “It’s a good place to work, the residents are family.”

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 Good (published 20 October 2017)

The overall rating for the service has changed to Requires Improvement. This is based on the findings at this inspection.

Why we inspected:

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Enforcement and Recommendations:

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 monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection. This was related to the maintenance and cleanliness of the service and records relating to people’s care.

Please see the action we have told the provider to take at the end of this report.

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.

Glenmuir House Residential Care Home provides accommodation and personal care for up to 20 older people with increasing physical frailty, diabetes, strokes and those approaching end of life. There were also people who were living with dementia. There were 15 people living at the home care at the time of the inspection.

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

We found the following examples of good practice.

People were supported by staff to have visits from their friends and family in various ways throughout the pandemic. When face to face visits had not been possible, people had had window/door visits and visits in the garden. The garden was able to be accessed through a separate entrance. People receiving end of life support were able to have visitors throughout the pandemic.

People also used phone and video calls to keep in touch with their loved ones. The staff have a booking system to ensure people received their visitors safely. All people had a COVID-19 visitor risk assessment in place that was reviewed regularly. Staff provided people and their relatives with updates to keep them informed of what’s happening at the home and any changes to visiting.

Peoples mental health and well being was monitored and staff devised ways of celebrating with people and families whist following government guidance about keeping people safe.

People were supported to go out safely and were encouraged to wear a mask and wash their hands when they returned to the home. The layout of the home meant that in the event of an outbreak, people could be supported to safely isolate in small zones around their bedrooms.

The home was clean and hygienic. Cleaning schedules showed how staff had included high traffic contact areas to ensure thorough cleaning. Personal protective equipment (PPE) stations had been placed throughout the home for staff to access easily.

Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following

correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

Regular testing for people and staff was taking place. All staff have a weekly PCR and three lateral flow device test (LFD) weekly.

The premises has a variety of communal rooms and people who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been arranged to allow more space between people.

At the last inspection in November 2015, the service was rated Good; at this inspection we found the service remained Good but requires improvement in well-led.

There was a registered manager who registered with CQC in October 2017. Registered managers 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 provider had not correctly displayed their CQC rating on their website. The provider informed us that this was due to an encoding issue that prevented them from accessing their website. The website has been taken down until rectified. This was identified and rectified during the inspection process.

We recommend the provider ensures that they understand all legislation in respect of providing care and treatment.

The provider and registered manager continually assessed, monitored and evaluated the quality of the service; however we found that whilst audits had identified issues, actions were not always progressed in a timely manner. Areas of essential maintenance were outstanding for up to two months, such as extractor fans and call bells.

The service continued to provide safe care. Staff understood their responsibilities for safeguarding people from harm and followed the provider's policies to support people in taking their prescribed medicines safely. There were enough suitably skilled staff to meet people's needs. Staff had been recruited using safe recruitment practices.

Staff sought people's consent before providing care and people's mental capacity was assessed in line with the Mental Capacity Act 2005. The registered manager understood their responsibilities and referred people appropriately for assessment under the Deprivation of Liberty Safeguards. People received care from staff who had received training to meet people's specific needs, and had supervision to assist them to carry out their roles. People were supported to access healthcare professionals and staff were prompt in referring people to health services when required. Staff understood people’s dietary needs and people received a balanced diet which they enjoyed.

Staff treated people with respect and helped to maintain their dignity. People received care from staff they knew, which helped them to forge positive relationships. Staff supported people emotionally and practically to maintain their independence and well-being.

Care plans were updated regularly and people and their relatives were involved in their care planning where possible. Risks to people’s health and well-being were assessed and staff had followed plans that were centred on the person as an individual. People were supported to pursue their hobbies and interests and continue to celebrate special days.

We found that people we spoke with felt they were treated with dignity and respect. One person told us, 'I am looked after very well, the staff are lovely and it feels like home.'

We found that the meals were varied, balanced and nutritious and people had access to a choice of drinks. One person told us, 'The food is always very nice, they always find something that I like.'

We saw that the premises were safe and suitable for the people who lived there. One person told us, 'I love my room, lots of space and comfortable.'

We looked at three staff files. We found that the home had effective recruitment processes in place. Staff we spoke with felt supported by the management.

We found that the home had a clear complaints policy which was accessible to visitors and people who lived there. One person told us, 'I haven't made a complaint but I would know who to contact if I did.'