Archived: Glen Rose

Updated 27 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We also checked to see if the improvements required following our last inspection had been made.

This was an unannounced inspection which took place over three days on 10, 13 and 24 September 2018. On the first two days, the inspection team consisted of two inspectors and a specialist nurse advisor. On the third day the inspection was completed by a one inspector.

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, such as what the service does well and improvements they plan to make. We also reviewed the information that had been provided to us by the service over the past year. This included information such as staffing rotas and the nature and number of incidents which had occurred within the service. We used this information to help us decide what areas to focus on during our inspection.

During the inspection we spoke with four people who used the service and nine relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with the registered manager, the director of operations, three registered nurses, seven care workers, the activities lead, the maintenance person, cook and laundry person. We reviewed the care records of eleven people. We also looked at the records for three staff that had been recruited since our last inspection and other records relating to the management of the service such as audits, policies and staff rotas.

Prior to the inspection, we sought feedback from five health and social care professionals about the care provided at Glen Rose and from a further three following the inspection.

Updated 27 October 2018

Glen Rose is a care home with nursing. People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Glen Rose provides accommodation for up to 47 older people. The accommodation is arranged over two floors. At the time of the inspection there were 19 people using the service. Many of these people were living with dementia.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Our last inspection had identified concerns regarding the deployment of staff, the management of risks to people and of medicines. People’s dignity had not always been respected and care had not always been designed to meet people’s individual needs. The quality assurance systems were not being effective at assessing and monitoring the quality and safety of care. Due to the nature of our concerns and the provider’s poor track record with compliance with the Regulations, we took enforcement action and placed conditions on the provider’s registration. We required them to submit a range of information to the Care Quality Commission (CQC) on a weekly and monthly basis. We used this information to monitor how the service was performing. In addition, the local authority and clinical commissioning group began to support the service via their quality improvement frameworks. The provider also voluntarily agreed to not take any new admissions to the home to support this process. This continued until May 2018, when due to increasing concerns about the safety and effectiveness of care provided, the local authority placed the service under their safeguarding framework and initiated a large-scale enquiry into the service. Two specific incidents are part of an ongoing safeguarding investigation by the local safeguarding team.

This inspection continued to find some areas where the service was not meeting the fundamental standards.

Staff were not always following risk management plans or guidance. Calls bells had not always been left in reach. Pressure relieving mattresses had not always been set correctly limited their effectiveness as a pressure relieving aid.

Whilst systems were in place to assess and monitor the safety of the service, these were not being fully effective as we continued to find instances where the safety and quality of the service provided had been compromised.

Insufficient action had been taken to monitor people’s nutritional needs.

Despite being made available; the registered nurses were not undertaking additional training relevant to their role and to enhance their clinical skills.

Some local health and social care professionals continued to express concerns about the clinical care provided. They lacked confidence in the leadership team to drive improvements. However, the provider had introduced measures to try and address these concerns and to improve partnership working.

Improvements were needed to ensure that following incidents and accidents, post falls protocols were always followed. In one case, the records did not provide a satisfactory explanation as to how the incident of unexplained bruising had occurred.

Whilst there were still some aspects of the dining experience that needed to improve, where people needed support to eat and drink, this was provided in a way that was dignified and respectful of the individual.

Improvements had been made to ensure the safety of the premises and of some of the equipment within it.

Improvements had been made to ensure that staff were deployed in a manner that helped to ensure people’s safety.

Improvements were needed to ensure that people cared for in their rooms had regular opportunities for meaningful interaction. Despite the home only having 19 people, their needs were very diverse and we were concerned that the provision of 21 hours of dedicated activity time was not sufficient to ensure that each person received regular and meaningful activities.

Overall medicines were being managed safely, although further improvements were needed to ensure that the application of topical creams was documented effectively. Individualised risk assessment and care planning was needed to identify and protect people from accidentally ingesting thickener.

Staff were receiving more regular supervision and felt generally well supported.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. The provider had appropriate policies and procedures which ensured staff had clear guidance about what they must do if they suspected abuse was taking place.

Overall the home was clean and we did not find any malodours. We observed that staff used appropriate personal protective equipment (PPE) and they were aware of how to appropriately handle and dispose of infectious waste.

Where there was doubt about a person’s capacity to make decisions regarding their care and treatment, staff had completed mental capacity assessments which were well documented.

The premises were generally suitable to people’s needs, although we have made a recommendation that the provider continue to explore evidence based practice guidance on how environments can be designed effectively to meet the needs of people living with dementia.

Staff referred to people in a respectful and dignified way and care was provided in a discreet manner.

Staff spoke fondly about the people they supported and it was clear that the permanent staff and longer-term agency staff had developed meaningful relationships with people.

People were encouraged and supported to make decisions about their care and support.

Care plans had improved and now recorded people’s individual preferences about how they liked their care to be delivered. There remained some areas where care plans could be developed further to ensure that staff were able to be responsive to people’s individual needs.

Staff were observed to be attentive to people and engaged with them in a person centred rather than neutral manner.

Information about how to complain was available within the service and the provider maintained a record of the complaints that had been received and how these had been responded to.

We have made a recommendation that the service consider ways in which information about people’s end of life needs and wishes are assessed and documented.

The registered manager was passionate about their role and to driving improvements within the service. Staff were generally positive about the registered manager and most felt supported in their roles. They told us morale was improving.

This is the third consecutive time the service has been rated Requires Improvement. The service is not yet consistently providing good care. We will meet with the provider to discuss the findings of this report and consider the most appropriate regulatory response. We will publish actions we have taken at a later date.