Archived: Glendale Residential Care Home

Glendale Residential Care Home provides accommodation and personal care support for up to 20 older people who require 24 hour care and support including people living with dementia. On the day of our inspection there were 15 people living at the service.

The service had employed a manager and who had been registered since 2010. 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.

Visits from environmental health inspectors and a fire officer highlighted a number of areas where action was required by the provider to improve the safety of the environment and protect people from the risk of harm. Fire doors were wedged open. Food and hygiene safe practices were not followed to safeguard people from the risk of harm.

People’s medicines were not managed safely and effectively. We were not assured that people received their medicines as prescribed. Improvements were needed in the way that people were supported with their medicines and how this was recorded and monitored.

We found a lack of sufficient measures in place to ensure the safety of people during procedures where staff were required to support people with their moving and handling transfers.

The provider did not operate a safe and robust system when recruiting staff. Checks on the suitability of staff including Disclosure and Barring (DBS) checks had not been carried out on all staff prior to their starting employment.

Staff were not to be provided with the full range of training required, relevant to their roles which would provide them with the skills and knowledge to keep people safe. This failure to consider, plan and provide for the range of skills required put people at risk of their health, welfare and safety needs not being met.

There was a lack of nationally recognised assessment tools in place to monitor people at risk of malnutrition. People’s weight was not always effectively monitored and where people had lost significant amounts of weight, referrals to a GP or dietician for specialist advice and support had not been actioned. This placed people at risk.

The majority of interactions we saw were respectful and supported people's dignity; however improvements were required to provide privacy and dignity for people when using the upstairs shower. People were not always involved in making decisions about their care.

People were being put at risk of not having their welfare and safety needs met as there was a failure to ensure that people were protected from the risks associated with improper operation of the premises. The provider had failed to respond fully to improve the safety of the environment to protect people from the risk of harm in response to fire officer visits.

The quality of the internal assurance systems in place were not robust enough to identify the shortfalls that we identified at this inspection. The provider failed to identify and mitigate the potential risks to people’s health, welfare and safety.

The provider had a system in place to respond to complaints. However, complaints had been logged but the provider did not provide an audit trail of any response with a record of the steps taken to resolve complaints in a timely manner to the complainant’s satisfaction.

During this inspection we identified a number of breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This is the summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff.

People told us that they felt safe. The service had appropriate policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although currently no applications had needed to be submitted.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

We saw the staff rota which confirmed that the service ensured there were sufficient numbers of staff to meet people's needs. People who used the service, care staff and visitors all told us that they considered staff were available when they needed them. Two people told us that staff always responded to their call bells promptly.

Is the service effective?

People's health and care needs were assessed in consultation with either the person themselves, relatives or their advocate. All care plans seen had been signed. People had a plan of care in place that reflected their healthcare needs in conjunction with support from outside professionals, where required. Care plans should include a method of assessing and monitoring people's dietary and nutritional needs in order to ensure that people are protected from malnutrition.

People's mobility and other needs were taken into account in relation to signage and building adaptation, which enabled people to move around the service freely and safely.

Is the service caring?

People were supported by staff who were kind, caring and respectful. Care workers supported people with patience and genuine affection, assisting people who required additional support in a dignified manner and at their own pace.

People commented 'All the staff are very kind here, even when I am having a bad day, there is always a smiling face to greet me.' 'I love the entertainment when we all have a sing a long, just like the old days.'

Is it responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, this included doctors and district nurses.

People were involved in participating in a range of activities both within the service and were also offered regular visits from outside entertainers.

People knew how to make a complaint if they were unhappy.

People's preferences, interests and choices had been recorded and the care and support offered in accordance with people's wishes.

People using the service, relatives and friends involved in the service had completed an annual satisfaction survey and issues raised had been addressed and an action plan completed.

Is the service well led?

Not all staff we spoke with had a good understanding of the whistle blowing policy but all were aware that the service had one. All staff spoken with stated that if they witnessed poor practice they would report their concerns.

The service had a quality assurance system but records seen showed us that not all areas of the service were monitored or reviewed regularly. There were shortfalls in staff management, the auditing of medication and the auditing of care plans

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to line management support and guidance.

We found evidence that medication was not handled as safely as it could be and evidence to show that falls and risk of falls were not being managed as effectively as they could be. Therefore the safety of people was being compromised.

All five people we spoke with said that they felt well and safe. We looked at three care plans as part of this inspection and saw that these had been signed by the person who used the service or their representative which confirmed that were happy with the content.

When we inspected the service in September 2012 we found issues with regard to care planning, safeguarding, staff training and quality assurance. We have re-inspected the service in January 2013 and found improvements across all areas.

We found that daily records and district nurse records were all now completed, staff had received training in safeguarding, dementia, deprivation of liberty safeguards and Mental Capacity Act training since September 2012. There were some improvements in the services quality monitoring system but this still provided limited information regarding the actions they were planning or had taken in relation to the shortfalls they had identified.