• Care Home
  • Care home

Archived: Preston Glades Care Home

Overall: Good read more about inspection ratings

196 Miller Road, Ribbleton, Preston, Lancashire, PR2 6NH (01772) 651484

Provided and run by:
Four Seasons Health Care (England) Limited

Important: The provider of this service changed. See new profile

All Inspections

14 December 2021

During an inspection looking at part of the service

About the service

Preston Glades Care Home is a residential care home registered to accommodate up 65 people in need of nursing and personal care. Accommodation is provided over two floors with single rooms. All rooms have en-suite facilities. On the days of the inspection there were 56 people living at the home.

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

Recruitment processes needed to be reviewed as some pre-employment checks were missing. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

The service made appropriate notifications to us and other authorities of safety incidents.

Medicines were safely administered and people received their medicines as prescribed from well trained staff.

Infection prevention control measures were robust and safe visiting processes were in place to ensure people could see their visitors safely.

People told us they felt safe and were happy with the service they received. We noted good interactions between people, management and staff.

Staff understood how to protect people from abuse and there were enough staff to meet people's needs and to ensure their safety. Staff told us they had received training and support relevant to their roles and when they commenced employment.

Care plan records provided a guide to enable people to retain their independence and receive support with minimum risk to themselves or others. People's care and support needs were assessed prior to them using the service to ensure their needs could be met. Where people's needs could not be met, the home worked well with others to ensure people were appropriately supported.

Quality assurance systems, audits and checks were robust and embedded within the service. We did not find any shortfalls around care planning and record keeping. This assisted in ensuring people received proper and safe care.

People, staff and health care professionals were happy with the way the service was managed. Staff felt valued and enjoyed working at the home. People's views and opinions of the service were sought and acted on.

Staff supported people to have access to health professionals and specialist support and the service worked well with external 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 13 October 2020).

Why we inspected

We received some concerns regarding staffing and oversight of the service. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only. 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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Preston Glades 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.

17 November 2020

During an inspection looking at part of the service

Preston Glades Care Home is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 65 people.

We found the following examples of good practice.

Staff had received infection prevention and control training and were regularly supported to update their knowledge and skills in relation to best practice standards. We observed staff carry out safe practices when putting on their personal protective equipment (PPE). However, staff did not always safely dispose of their PPE because the clinical waste bins were not consistently stored in a safe place. The registered manager acted on this during the inspection.

People were supported to stay connected with their relatives and friends. During the inspection people were starting to come out of a period of 14 days isolation and we saw they safely used communal areas by social distancing.

Staffing levels had been maintained during the outbreak and staff were only deployed to one unit to reduce the risk of further transmission. The registered manager had worked as a designated nurse at the service throughout the outbreak to reduce footfall of agency staff.

The environment was clean and domestic workers demonstrated good understanding of best practice standards for cleaning and decontamination.

The provider had risk assessed and implemented contingency plans to ensure an outbreak of Covid-19 was effectively managed. People and staff affected by Covid-19 were individually risk assessed.

People were tested before admission and asked to isolate for a period of 14 days.

Further information is in the detailed findings below.

30 July 2020

During an inspection looking at part of the service

About the service

Preston Glades Care Home is a residential care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 65 people. Preston Glades Care Home is a purpose-built home based over two floors and the home is divided into three units. At the time of the inspection, only two units were open. One unit specialises in providing care to people living with dementia.

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

People who lived at the home told us they felt safe. Risk was appropriately managed. People said they received their medicines on time and as stated. We found improvements had been made to ensure medicines were managed safely and in line with good practice. However, these had not been fully embedded. We have made a recommendation about this. Infection control processes were not consistently implemented. Staff did not always follow good practice guidance when wearing face coverings. We have made a recommendation about this.

Although some improvements within the service had been made, concerns with the quality of documentation remained and we could not be assured people always received safe care and treatment due to conflicting and inaccurate paperwork. This meant the registered provider continued to be in breach of regulations and once again had failed to meet all the fundamental standards. Although some improvements had been made to auditing processes, we found once again these were not always fully effective and had not picked up concerns we identified during the inspection process. Although we identified continued shortfalls, people praised the way in which the home was managed and told us it was a nice place to live. The registered provider had recruited a new registered manager since the last inspection and all staff we spoke with agreed the new registered manager had had a positive effect upon the service.

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 13 February 2020). Following the inspection visit, we wrote to the registered provider and asked them to tell us how they intended to make improvements to ensure compliance with the regulations. At this inspection we found some, but not enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service between 06 and 13 January 2020. Breaches of legal requirements were found. The provider completed an improvement plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. In addition, the registered provider sent us copies of results of medicines audits on a monthly basis to show us how medicines were being managed.

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.

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 remained the same. 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 Preston Glades 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.

Whilst we found some improvements have taken place, we have identified continued breaches in relation to good governance.

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

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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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 the 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.

6 January 2020

During a routine inspection

About the service

Preston Glades Care Home is a care home registered to provide personal and nursing care for older people, people living with dementia or a mental health condition. At the time of the inspection 32 people lived at the home. The care home accommodates 65 people in one building which is divided into three units. Each unit has separate adapted facilities. At the time of inspection, one unit was closed. One unit specialised in providing care to people living with dementia.

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

Although some improvements were noted in relation to the safe management of medicines, medicines continued to be a concern. Risk assessments addressed risks to people and the environment, but risk was not consistently managed. We have made a recommendation about this. People and staff told us deployment of staffing was not always appropriate to meet people’s needs. We have made a recommendation about this. Staff were aware of processes to follow should they be concerned people were being mistreated.

Auditing systems for overseeing the safe management of medicines had improved but were not fully embedded. We received conflicting information about staff morale within the home. There was no registered manager in post, however the registered provider had acted to ensure there was oversight and leadership within the home. We saw evidence of multi-disciplinary working.

People told us they were happy with the quality and quantity of food provided. We observed the meal time experience for people and saw this was inconsistent. We have made a recommendation about this. People told us they had access to health professionals when needed. Good practice guidance was considered when planning and supporting people with personal care.

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. Good practice guidance was followed to ensure the processes of the Mental Capacity Act (MCA) were followed.

People and relatives told us on the whole staff were kind and caring. We observed staff enquiring about people’s comfort and welfare throughout the visit. Observations made during the inspection confirmed people were treated with dignity and respect.

People were sometimes supported by staff who knew them well. The registered provider encouraged people to remain active. We observed social activities taking place. The registered provider understood the importance of providing high-quality, end of life care. We saw complaints were handled professionally and in a timely manner.

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 inadequate (published 5th October 2019). We took enforcement action against the registered provider and imposed conditions upon the registration. At this inspection we found some, but not all improvement had been made and the provider was still in breach of regulations. We have used the previous rating and enforcement action taken to inform planning and decisions about the rating at this inspection. The service has been in special measures since May 2018. The service remains inadequate in the well led key area and remains in special measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 in 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 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.

4 June 2019

During a routine inspection

About the service

Preston Glades Care Home is a care home which is registered to provide personal and nursing care for up to 65 people. At the time of the inspection the home was providing care and support to 33 people.

Preston Glades Care Home is a purpose built building, which has two separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia.

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

At the last inspection visit carried out in December 2018, we identified concerns related to the storage and administration of medicines. At this inspection, although people told us they felt safe, we found systems and processes for the safe management of medicines had not been improved to ensure they met with good practice. We could not therefore, be assured people were receiving their medicines safely as directed. This was a continued breach of Regulation 12 of the Health and Social Care Act 2014, (Safe care and treatment.)

We found management and oversight of the home continued to be inconsistent. Auditing systems within the home continued to be ineffective and had failed to address key concerns regarding the safe management of medicines. Documentation to support the safe use of medicines was sometimes inaccurate and incomplete. This was a continued breach of Regulation 17 of the Health and Social Care Act 2014, (Good governance.)

Although we identified continued concerns around the safe management of medicines and good governance, we identified other key areas in which improvements had been embedded and sustained. We saw that recommendations made at the last inspection had been considered and acted upon. Professionals and staff all agreed there were noted improvements within the home.

We saw risk was sometimes appropriately addressed and managed. Staffing levels had improved and a staff deployment system had been introduced to improve staff responsiveness at the home. We were told people were much happier since staffing levels had improved. Systems and processes for reporting and responding to abuse continued to be embedded within the service.

People told us they had access to a GP whenever they required. We saw evidence of multi-disciplinary working to meet people’s health needs. 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. We saw processes were in place to ensure consent was achieved before providing care and support.

People described staff as kind and caring. Observations made throughout the inspection confirmed this was the case. We saw staff treated people sensitively and compassionately with dignity and respect.

There was a vibrant atmosphere within the home. People told us they were able to make choices about their care and support and said they received care tailored to their need. One person told us they had freedom within the home to make their own choices. We observed activities taking place within the home to keep people occupied and active.

People were positive about their experiences of being supported by staff from Preston Glades Care Home. We saw that concerns were dealt with seriously and formal complaints were addressed in line with the providers procedures.

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 01 January 2019) and we identified continued breaches to 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 not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections and has been in special measures for the last two inspections.

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

We discussed the findings with the provider, who provided us with assurances they would take action to make the required improvements to mitigate any risk.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Preston Glades Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to the safe management of medicines and good governance of the service.

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 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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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 the 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.

10 December 2018

During a routine inspection

This unannounced inspection took place on 10 and 11 December 2018.

Preston Glades Care Home is a purpose-built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in three units. The two first floor units provide services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. At the time of the inspection visit 45 people were receiving care and support at the home.

Preston Glades Care Home is a 'care home'. 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 the inspection visit there was a registered manager in place. However, the registered manager was absent at the time of the inspection, so the service was being supported by several people from the senior management team. 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 service was last inspected on the 14, 16 and 18 May 2018. The registered provider did not meet the requirements of the regulations during that inspection as multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to person centred care, safe care and treatment, safeguarding people from abuse, diet and nutrition, staffing, fit and proper person’s and good governance. Additionally, we found a breach to Regulation 18 of the Care Quality Commission Registration Regulations as the registered provider had failed to notify the Care Quality Commission, (CQC) of all reportable incidents. At the May 2018 inspection, the service was placed in special measures by the CQC.

At this inspection visit carried out in December 2018, we found the registered provider had worked hard to make improvements but not all required improvements had been made. We found not all improvements had been made to ensure people received their medicines safely. Good practice guidance had not been consistently implemented to ensure the safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014, Safe Care and Treatment. Additionally, we identified a continued breach to Regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014, as the service had failed once again to ensure systems were operated to ensure compliance with the Regulations.

Following the May 2018 inspection, support had been provided to the home from the Care Service Support team. The Care Service’s Support team were an internal team which offered support to locations who required additional support to provide a high quality effective service. Improvements had been made to ensure risk was suitably managed. The Care Service Support team had started auditing people’s care records to ensure risk was identified and appropriately managed. Care plans and risk assessments for people who lived at the home had been reviewed and updated to ensure they reflected their needs. We found no information of concern within any of the files we reviewed. Although we found improvements within care records we noted one incident when naturally occurring risk had not been appropriately managed. We have made a recommendation about this.

Auditing systems had been reviewed to ensure audits carried out reflected what was happening at the home so effective action plans could be developed and maintained. Oversight at the home from senior managers had increased to ensure the service was well-led. Lessons had been learned from the previous inspection visit. Staff told us they had seen an improvement in how the home had been managed since the last inspection visit.

The Care Service Support team had liaised with their internal human resources team to conduct a full audit of all personnel files. Personnel files had been reviewed to ensure all the required information was in place to ensure only fit and proper persons were employed at the home. Although an audit had taken place, we identified some concerns in one staff members file that had not been identified. We have made a recommendation about this.

We saw person-centred care was delivered to people who lived at the home. Staff were aware of people’s likes and dislikes. However, we noted people’s preferences were not consistently met when a person lacked capacity. We have made a recommendation about this.

We found deployment of staffing had improved. People had access to call bells to summon help and assistance and they told us staff responded in a timely manner. Staff were suitably deployed to meet peoples individual support needs throughout the day. However, staff responses were sometimes inconsistent. We have made a recommendation about this.

People we spoke with told us they felt safe living at the home. The registered provider had started to make improvements to ensure people who lived at the home were protected from harassment and abuse.

Training had been provided to ensure staff were equipped with the necessary skills required to carry out their role. We saw staff working appropriately and putting their skills in practice.

The registered provider had acted upon recommendations to improve infection prevention and control processes within people’s bedrooms. However, an external local authority inspection of the kitchen had identified concerns within staff practice. We saw immediate action had been taken to support the kitchen staff to make improvements.

People told us they were happy with the choice and quality of food provided. Improvements had been made to enhance the dining experience for people who lived at the home. Additionally, the registered provider had acted to ensure people’s dietary needs were consistently met. Support was given in a respectful manner if people required support at meal times.

The mental capacity and consent of all people who lived at the home had been reviewed. We saw evidence best practice guidelines were followed when people were assessed as not have capacity. Advocates had been sought for people without families to assist people with decision making.

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.

When people made requests for assistance we saw their needs were promptly addressed. People who lived at the home spoke highly of the staff and their attitude. We noted staff were patient and respectful with people.

We looked at how complaints were managed and addressed by the service. At the time of the inspection no one had any complaints about how the service was delivered. We saw evidence that when complaints were raised they were dealt with professionally and in a timely manner.

Although this service had improved since the last inspection we still need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

The overall rating for this service is ‘Requires Improvement’. The service remains in ‘special measures’ as one of the key questions remains inadequate. 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. 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 have asked the provider to take in the main report.

14 May 2018

During a routine inspection

This unannounced inspection took place on 14, 16, and 18 May 2018.

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in three units. The two first floor units provide services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. At the time of the inspection visit 53 people were receiving care and support at the home.

Preston Glades is a 'care home'. 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 the inspection visit there was a registered manager in place. 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.

At the last inspection, carried out in January 2017 Preston Glades was rated as requires improvement. This was because we identified concerns related to the safe management of medicines, processes for ensuring consent was lawfully achieved and the way in which the service was managed. Following the inspection visit we asked the registered provider to submit an action plan to demonstrate how they intended to make the required improvements to meet the fundamental standards. The registered manager told us improvements would be in place by May 2017.

At this inspection visit carried out in May 2018, we found not all required improvements had been made. Breaches were identified to Regulations, 9, 12, 13, 17, 18, and 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of the Care Quality Commission Registration Regulation 2009.

We found improvements had not been made to ensure people received their medicines safely. Good practice guidance had not been considered and implemented to ensure the safe management of medicines.

Auditing systems established and operated by the registered provider continued to be ineffective as they had failed to identify the concerns we found during the inspection process. For example, monthly audits had failed to identify safeguarding and medicines concerns we identified during the inspection visits.

Risk was not always suitably managed at the home. Risk assessments were not always completed in a timely manner to ensure all risk was suitably addressed. When people displayed behaviours which challenged the service we found risk management plans were not in place to direct staff to protect the person and other people who lived at the home. In addition, staff sometimes failed to ensure risk assessments were followed to protect people from harm.

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, processes were not always followed to ensure safeguarding concerns were consistently reported to the local authority safeguarding team for review. Processes to ensure people were safe from abuse were not consistently followed by the registered provider.

Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not suitably implemented as suitable checks had not been consistently applied in a timely manner.

Processes to ensure people’s nutritional needs were met were inconsistent. People did not always receive appropriate support to ensure their dietary needs as identified within their care plan were met.

We found deployment of staffing was not always effective to ensure the safe care of people. Staff were not always suitably allocated within roles to ensure people remained safe.

Care plans did not always have all the appropriate person centred information in them to promote individualised care being provided. Religious and cultural needs were not consistently addressed and met.

We noted documentation was not always accurate, accessible and fully complete. Of the eleven care records viewed, we identified concerns within the paperwork for five people. Individuals care plans were sometimes reviewed to accommodate peoples changing needs. Additionally, information relating to investigations into staff conduct were sometimes inaccessible.

The registered provider had failed to ensure notifications were submitted to the Care Quality Commission in a timely manner. During the inspection visit we identified three serious injuries and three safeguarding concerns which the registered provider had a responsibility of reporting to CQC but had not done so.

There were processes in place for managing infection prevention and control within the home. However these were not consistently followed. During the inspection visit we noted the kitchen was not suitably maintained to promote hygiene and we had to request this was deep cleaned. The registered provider took immediate action to ensure the kitchen was clean and suitable for purpose. In addition, there was no care plan in place for one person who had support needs which impacted upon the cleanliness and hygiene standards within the home. We have made a recommendation about this.

Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Whilst good practice guidelines were sometimes considered these were not consistently implemented to ensure all principles of the Mental Capacity Act (MCA) 2005, were lawfully respected. We have made a recommendation about this.

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

Staff told us they were happy with the training provided and said the registered manager encouraged staff to develop their skills. Whilst the registered provider had maintained high levels of training at the home, we identified clinical training deficits for qualified nursing staff. This sometime impacted upon the quality of care provided. The registered manager had already identified this training need and had commenced action to ensure training was provided. Following the inspection visit, we received confirmation this had been addressed.

During our inspection visit we observed some activities taking place. People told us activities took place on a regular basis.

People who lived at the home and their relatives told us they had no complaints about the way in which the home was managed. When people had complained they told us they were happy with the way in which the complaint was managed.

People who lived at the home told us they had good relationships with the staff. During the inspection visits we observed staff being patient and kind with people. However, during the first day of the inspection visit we saw that call bells to assist people to summon help had been removed in a high number of rooms across all units. The registered manager investigated why this had occurred but could not identify who had done this. Following the investigation the registered manager took swift action to prevent this from occurring again.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought from health professionals when appropriate. We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people.

End of life care had been discussed when appropriate with people and their relatives. Provisions were in place to promote a dignified and pain free death.

There was ongoing commitment by the registered manager to make the home pleasing for people. We noted refurbishments within the building were ongoing.

Feedback was routinely sought from people who lived at the home. People told us residents meetings took place. Additionally we saw people had been consulted with regarding food quality and choice.

Staff praised the improvements made by the registered manager who was registered with the Care Quality Commission in May 2017. They told us morale and staff turnover had improved at the home since the new registered manager had been recruited.

The overall rating for this service is ‘Inadequate’ and the service is 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

19 January 2017

During a routine inspection

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who live with dementia.

All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are varieties of communal areas within the home where people can spend their time, including a room for people who smoke.

At the time of the inspection, there were 50 people who used the service.

The last inspection of this service took place on 28 April 2016. The service was awarded a rating of 'Requires Improvement.' The service was found to be in breach of the regulations relating to person centred care, dignity and respect, need for consent, safe care and treatment, good governance and staffing.

We were provided with an action plan following the inspection carried out in April 2016.

An unannounced inspection took place on 19 January 2016 and a follow up announced visit took place on 01 February 2016.

The manager of the service was present throughout our inspection; the manager is currently undergoing the registration process to become the registered manager. 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.

During this inspection we found that improvements had been made in medicines management and the service were working with other professionals to ensure that they were following best practice. However, we looked at how variable doses for medicines were recorded and found these were not always recorded accurately.

During our last inspection, we made a recommendation around recruitment processes due to staff personal files not always being complete. We looked at recruitment processes at this inspection and found that a full audit had taken place of the staff files. Prospective employees were asked to undertake checks prior to employment to help ensure they were not a risk to vulnerable people.

We found people were protected from risks associated with their care because the provider had completed risk assessments, which provided updated guidance for staff in order to keep people safe.

During our last inspection, we had found that staffing levels were not always adequate to meet the needs of people. During this inspection we found that, staffing levels were adequate to meet people’s needs.

During the last inspection, we found in some care files, consent forms had not been completed. We also found some examples where consent had been provided by people's family members, but there was no confirmation that the people who had provided consent had legal authority to do so.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found that mental capacity had been considered and written consent to various aspects of care and treatment was observed on some people's files. However, recording was not consistent throughout the service. We found that in two peoples care records consent had been signed by relatives. We saw evidence that best interest discussions had taken place, however the documentation was not always fully completed.

During the last inspection, we found that there were issues with staff training and induction. We checked the full training records of four staff and viewed the training matrix for the service. Training subjects included areas, which affected the wellbeing of people, such as safeguarding. We found that staff felt they received adequate training in order to care for people effectively.

We found that the service was pro-active in supporting people to have sufficient nutrition and hydration. We observed lunch being served, we saw some people who had difficulty cutting their food being offered support. We observed people eating in a relaxed manner and they seemed to enjoy their meals.

During the last inspection, we found that staff did not always have good knowledge of the people they supported. We noted that some people were not supported to be presented in a manner that promoted their dignity.

We observed staff as they went about their duties and provided care and support during this inspection. We observed staff speaking with people who lived at the home in a respectful and dignified manner. Staff appeared to understand the needs of people they supported and it was apparent that trusting relationships had been created.

People and their relatives told us staff communicated with them regularly to ensure they were aware of any matters affecting people's care. Staff respected people's dignity and privacy.

At the last inspection, we found issues relating to the process in place to carry out assessments of people's needs prior to offering them a place at the service and people's care plans, which contained confusing and conflicting information.

We looked at the improvements that had been made during this inspection. We saw care records were written in a person centred way and observed that staff followed the guidance in care records. Care records were regularly reviewed. This meant that people received personalised care, which met their changing needs.

We saw evidence in care files that the service was making necessary referrals and seeking support on how best to meet people’s needs.

During the last inspection, we found issues with complaints. Complaints were not always carefully recorded this meant it was not possible for an overview of concerns raised and there were no details to show any themes or trends to be learned from.

We looked at records of complaints during this inspection and found that there was a system was in place for recording any complaints received by the service. Complaints had been recorded along with any action taken.

During our last inspection at the service, we found that there were issues around good governance. There were systems in place designed to monitor quality and safety across the service but we found these had not been used effectively at times.

We looked at the improvements that had been made during this inspection. We found that the management team carried out audits and reviews of the quality of care. However, the audit process in place had not picked up some issues that we found during the inspection such as medicines documentation not being fully completed.

We observed the manager and deputy manager were visible within the service. People reacted positively to the management team and appeared to be comfortable in their presence.

We found a positive staff culture was reported by all the staff members we spoke with. We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

28 April 2016

During a routine inspection

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who live with dementia.

All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are a variety of communal areas within the home where people can spend their time, including a room for people who smoke.

At the time of the inspection there were 52 people who used the service.

At the time of the inspection there was a registered manager in post. However, they were not available during the inspection. Shortly, following the inspection we were informed that the registered manager would not be returning to their 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 last inspection of this service took place on 5 February 2015. The service was awarded a rating of ‘Requires Improvement.’ The service was found to be in breach of the regulation relating to record keeping. We were provided with an action plan following the inspection carried out in February 2015.

This inspection took place on 28 April 2016 and was unannounced. We found that standards at the service had not improved and we identified a number of concerns and new breaches of regulations.

Risks to the health, safety and well-being of people who used the service were not consistently well managed. Sometimes risks were not identified. In other examples we found that measures put in place following risk assessment, to help promote people’s safety were not followed.

We identified concerns about the way people’s medicines were managed. People’s medicines were not consistently managed in a safe way, which meant they were exposed to unnecessary risks to their health and wellbeing.

We found the provider did not have effective arrangements in place to ensure that adequate numbers of suitably qualified staff were effectively deployed at all times. This meant people were at risk of not receiving the care they needed in a timely manner.

The rights of people who used the service were not always protected because the service did not consistently work in accordance with the Mental Capacity Act 2005. We found a number of examples where the service had failed to gain legal consent for the provision of various aspects of care.

We found evidence that staff at the service did not always support people in a manner that promoted their privacy, dignity and autonomy. Examples were seen of people being left in undignified situations and their privacy being compromised.

We found that in some cases there had been a failure to adequately assess and plan for people’s needs. We also found that at times the service failed to recognise and respond to people’s changing needs.

The arrangements for monitoring the quality and safety of the service were found to be inadequate. We identified a number of concerns and breaches of regulations which has not been identified or acted upon by the registered manager.

PEEPs (Personalised Emergency Evacuation Plans) were in place, but required improvement to ensure they were more personalised. We made a recommendation about this.

More robust auditing of medicines management and consideration of the NICE guidance, ‘Managing Medicines in Care Home’ was recommended to help ensure improvements were made and sustained.

There were clear recruitment procedures in place which were designed to help ensure only people of suitable character were employed. However, these were not always consistently followed. We made a recommendation about this.

We found some examples of effective nutritional care which included the prompt involvement of external professionals when risks to people’s nutritional health was identified. However, this was not always the case and we also found some examples where people had experienced weight loss over several months before the appropriate referrals were made. We made a recommendation about this.

There was a training programme in place, which helped to ensure that staff had the appropriate skills to carry out their roles. However, a number of staff we spoke with felt they would benefit from the opportunity to take part in some classroom based learning as well as ‘e - learning.’ We made a recommendation about this.

We received some poor feedback about activities provided at the service. Some people felt that the provision of activities was of poor quality. We also noted that some people’s preferences in relation to activities were not recorded in their care plans. We made a recommendation about this.

We found evidence that complaints were not always properly recorded and that the complaints procedure was out of date. We made a recommendation about this.

The service had safeguarding procedures in place which provided staff with information and guidance about how to recognise and report any concerns about the safety or wellbeing of a person who used the service. Staff demonstrated a good understanding of the procedures and their responsibility to report any concerns immediately.

We identified some positive examples of joint working by staff at the home with community professionals, for example, community health professionals. We saw evidence of some good outcomes for people which had been achieved through this positive joint working.

A team of senior managers from the organisation had been deployed at the home to support improvements. At the time of the inspection they were able to provide evidence that they had identified a number of areas for improvement and were in the process of implementing action plans to address them. We received positive feedback from community professionals regarding the way the team had liaised with them. We noted that they had worked closely with the local authority safeguarding team and commissioners to ensure all such concerns were being investigated.

We found a number of breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, staffing, consent, dignity and respect, person centred care and good governance. You can see what action we have told the provider to take at the end of the full version of this report.

05/02/2015

During a routine inspection

Preston Glades is a purpose built care home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are a variety of communal areas within the home where people can spend their time, including a room for people who smoke.

The last inspection of the service took place on 5th September 2013. That inspection was carried out to ensure the service had made improvements and taken action to address non-compliance we had earlier identified. During that inspection the service was found to be fully compliant.

This inspection took place on 5th February 2015 and was unannounced.

At the time of the inspection the registered manager had just completed the process of registration with the Commission. 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 who used the service and their representatives expressed satisfaction with their care and felt confident that staff understood their needs. We found that staff worked positively with community professionals such as mental health workers to ensure that people’s needs were met. However, there were some gaps in care planning information that meant people were at risk of not receiving the care and support they needed.

We received mixed feedback about how people’s social care needs were addressed and the range of activities provided at the home. Trips out of the home were not routinely provided and some people felt the activities that were provided did not meet their personal preferences.

People told us they were treated with respect and dignity and described the staff team in ways such as, ‘kind’ and ‘caring’.

There were ample numbers of staff employed to meet the needs of people who used the service. The registered manager took people’s needs into account when determining necessary staffing levels on a day-to-day basis.

Staff were provided with a range of training to assist them in carrying out their roles. Over half of none-nursing staff held nationally recognised qualifications in care.

There were a variety of processes in place to assist the registered manager and the provider in monitoring quality across the service. As a result of their use, a number of developments were planned for the home, with an aim to constantly improve the service people received.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to records for people who used the service. You can see what action we told the provider to take at the back of the full version of this report.

5 September 2013

During an inspection looking at part of the service

This inspection was carried out to follow up concerns we previously identified in relation to the care and welfare of people who use services, medication management and the processes used to assess and monitor quality within the home.

During the inspection we spoke with seven people who lived at the home. Overall we received positive feedback from people. Their comments included;

'Staff are brilliant.'

'The dining room and meals have recently improved as it is better organised.'

'I like living here, things are fine.'

'Everyone of the staff, it doesn't matter who they are, are brilliant. I couldn't ask for better.'

'This home is top class.'

We found during this inspection, that the home had taken action to make the required improvements.

Overall, we found medicines were handled safely.

We found that people were provided with safe and effective care and that the provider had suitable arrangements to monitor quality and identify risks.

11, 16 April 2013

During a routine inspection

During this inspection we spoke with a number of people who lived at the home. We received very positive feedback from everyone we spoke with and people told us they were very satisfied with the service provided at Preston Glades.

Comments included:

'This is a good home. I like them all they are a good bunch.'

'They are very good to us.'

'The staff have an excellent attitude.'

'I feel completely safe here.'

At this inspection we looked at standards relating to people's care and welfare, nutrition and medication. We also assessed how the home supported people who did not have capacity to consent to some aspects of their care or treatment. Other standards we assessed included those related to staff training and how quality and safety within the home was monitored.

We found that the home had made some good improvements since their last inspection but identified some outstanding areas of concern.

3 December 2012

During a routine inspection

During our inspection we spoke with a number of people who lived at the home. We received some positive feedback and residents spoke highly of staff and managers.

Comments included:

'The staff are great!'

'They look after me well!'

'I find them all very good, they are a nice bunch.'

Prior to the inspection we liaised with a number of community health care professionals and a local authority contract officer. These professionals shared some concerns with us about some aspects of the service provided at the home.

During our inspection we assessed standards relating to people's care and welfare and how the home addressed their care needs. We also looked at how medicines were managed and how the home went about safeguarding people from abuse. Standards relating to staffing levels and training were also inspected. We identified a number of concerns and several areas where improvements were needed.

19 September 2011

During a routine inspection

People living at the home told us that the staff talk to them to find out how like to be supported and take account of their points of view. One person told us that the staff are aware of their dietary needs and always make sure they are met. Another person told us that the staff are very good at giving them information about their care needs and the best ways to supported. This person said that they found it very useful.

People gave the impression that there is a balance offered to them in relation to everyday events and activities, between the reasonable risks people want to take and their personal safety. People said that they felt safe and secure at the home, and felt that the care they received was always of a good standard. One person made it very clear that the care they received was based on their personal requirements. This made the person very happy.

People told us that they felt safe living at Preston Glades. One person told us "if there was anything strange going on, like abuse, then I'd go straight to the staff and tell them. They would sort it out and stop it, and report to those who need to know." Another person said that if they needed to report abuse then they know the staff and manager would respect and support them in doing that.