Glen Arun Care Home

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

Risks were monitored and assessments had been updated. We saw people’s medicines were stored and administered safely. There were enough staff to ensure people got the help and support they needed. All feedback regarding staff was positive and included they are “kind” and “caring.” Recruitment systems were robust and ensured the right staff were recruited to support people safely.

There were effective systems in place to assess the quality of the service provided. Actions were implemented to improve the quality of the service. The service was well led and had a positive culture that was person centred, open and inclusive. Staff understood their role and responsibilities, were motivated and had confidence in the registered manager. Staff told us the registered manger was approachable and supportive.

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.

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 good, published 31 May 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the time since it was last inspected.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

There was an appropriate COVID-19 testing regime in-line with current government guidelines, this included lateral flow testing for all visitors to the service. There was a safe system in place for people’s visitors, which included a booking system to stagger visitors and visiting times to minimise visitor numbers. All visitors were screened for symptoms, had their temperature checked before entering the service and were provided with appropriate personal protective equipment (PPE).

There were appropriate policies and procedures for infection prevention and control (IPC), which were understood and followed by staff. Staff were wearing PPE in-line with government guidelines. There was adequate supply available to staff throughout the home. Staff had completed IPC training which included the safe use of PPE. Staff had regular competency checks for effective handwashing and the donning and doffing of PPE.

The service was clean and tidy. Cleaning tasks were consistently completed. Areas which were regularly touched, including door handles and hand rails were frequently disinfected. Communal areas were arranged to encourage social distancing, there was appropriate spacing between people.

Risk assessments for people living at the service and staff had been completed to promote their safety.

Glen Arun Care Home was last inspected in December 2016. We found that there were insufficient numbers of suitably qualified, skilled and experienced staff deployed to peoples' needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At this inspection we found that improvements had been made and the provider had taken the action required to meet this regulation.

Glen Arun Care Home is registered to provide accommodation, nursing care and support for up to 36 older people. At the time of our visit there were 34 people at the service. The service has a wide range of communal areas and well maintained accessible gardens.

The service had 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.

People were protected from risks to their health and wellbeing. Up to date plans were in place to manage risks, without unduly restricting people’s independence.

People said they felt safe at the service and knew who they would speak to if they had concerns. The service followed the West Sussex safeguarding procedure, which was available to staff. Staff knew what their responsibilities were in reporting any suspicion of abuse.

People were treated with respect and their privacy was promoted. Staff were caring and responsive to the needs of the people they supported. People's health and well-being was assessed and measures put in place to ensure people's needs were met in an individualised way.

People’s medicines were managed safely. People had enough to eat and drink throughout the day and night. The mealtime was an inclusive experience.

There was an open and friendly culture combined with a dedication to providing the best possible care to people. Staff at all levels were approachable and keen to talk about their work and committed to the on-going development of the service. The atmosphere in the service was happy and calm. People were engaged and occupied; they interacted and chatted with each other. Every person we spoke to was complimentary about the caring nature of the management and staff.

Staff received training to enable them to do their jobs safely and to a good standard. They felt the support received helped them to do their jobs well.

There were enough staff on duty to support people with their assessed needs. The registered manager considered people’s support needs when completing the staffing rota and staffing levels were calculated appropriately. The registered manager followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People benefited from receiving a service from staff who worked well together as a team. The registered manager and the staff team took pride in their work. Staff were confident they could take any concerns to the management and these would be taken seriously. People were aware of how to raise a concern and were confident appropriate action would be taken.

The premises and gardens were well maintained. All maintenance and servicing checks were carried out, keeping people safe. People were empowered to contribute to improve the service. People had opportunities to feedback their views about the service and quality of the care they received.

We carried out an unannounced comprehensive inspection on 5 November 2014. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 23 June 2015 we carried out a focused inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection we found that significant improvements had been made and all previous areas of concern had been addressed.

This inspection took place on 19 December 2016 and was unannounced. It was brought forward following concerns that had been raised with us in relation to staffing levels and timely access to care to meet peoples’ needs. At the inspection we spoke to people, relatives and staff. Following the inspection we spoke to a healthcare professional. All of whom told us that there was sometimes insufficient staffing to meet peoples’ care needs and some of our observations confirmed this. Comments from people included, “Well you have to accept that with so many people to be seen you have to wait your turn”, “They do tell you that if two of them are doing something for someone else you have to wait” and “ I have to wait to get up in the morning, you have to fit into their rota”.

People received their medicines from registered nurses and were happy with the support they received, one person told us, “They asked me if I wanted to be in charge of my own medication but I was happy for them to do all that for me so I don’t have to worry about forgetting it and yes I get my tablets regularly”. There were good systems in place to inform staff of when to offer people medicines on an ‘as and when required’ basis and systems ensured that the storage, administration and disposal of medicines were safe. However, there were concerns regarding peoples’ access to prescribed medicines. A healthcare professional told us about several occasions when medicines had been prescribed but people had not received their medicines for several days. Measures had been taken to ensure that this was less likely to occur in the future as the manager had changed the pharmacy that delivered the medicines, however, there were still concerns regarding staffs’ intervention to ensure medicines were provided to people in a timely manner.

Staff had demonstrated good practice by identifying and acting on concerns in relation to a pressure wound for one person. However, there were a lack of notifications to CQC about the deterioration of this and in relation to safeguarding investigations that had been conducted by the local authority. Notifications enable us to have oversight and to ensure that appropriate actions had been taken to ensure peoples' safety and well-being. Although this had improved since the new manager had been in post, this needed to be fully embedded in practice. Quality assurance audits were in place, however these were not always sufficient and although there were plans to improve these, the current provision did not ensure that the systems and processes used within the home were effective to ensure people received safe and effective care at all times. Records, to document peoples’ care and nursing needs, as well as the monitoring of the care they received on a day-to-day basis, were not always in place or completed sufficiently. When this was fed back to the manager immediate action was taken to address this, however this needs to be fully embedded in practice.

The home had been without a registered manager for over a year, however, there had been a number of managers that had managed the home during that time who had started the process of applying for registration before leaving. The management team consisted of two providers and a manager, who had been in post for several months and who was applying to be 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. There was a warm, homely and relaxed atmosphere and people told us that they were comfortable and felt at home. People were complimentary about the home and told us they would happily recommend it to others. A relative told us, “As soon as we walked in I knew my relative would be happy here”.

People were protected from harm and abuse. Staff had undertaken the necessary training to meet peoples’ needs as well as to enable them to recognise concerns and respond appropriately. People were able to take risks in accordance with risk assessments that had been devised and implemented. People told us that they felt safe. Infection prevention and control was maintained, the environment was clean and people told us that they were happy with the cleanliness of the home.

People were asked their consent before being assisted and there were measures in place to ensure that relevant people had been involved in decisions about peoples’ care needs. The management team were aware of the legislative requirements in relation to making decisions on behalf of people who lacked capacity and were in the process of seeking further advice and clarification from the local authority with regard to the deprivation of liberty safeguards (DoLS). People were involved in the running of the home as well as the care they received. Regular resident meetings as well as care plan reviews and regular surreys took place to enable people and relatives to make their opinions and wishes known. One person told us, “It’s very friendly and they don’t mind if you suggest trying something new. They listen to you and are happy to try it a new way”. People were aware of their right to make a complaint and those that had been made had been dealt with appropriately.

People were cared for by staff that were kind and caring. One person told us, “They tell me, don’t be afraid to tell me what you need. They are very helpful”. Another person told us, “I call them angels, they do so much for us”. Peoples’ health needs were assessed and met by registered nurses who made referrals to external healthcare professionals when required. There were person-centred care plans in place, that on the whole, provided staff with information about peoples’ needs, these were reviewed regularly and provided staff with guidance as to how to support people according to their preferences. Peoples’ privacy and dignity was respected and maintained, observations showed staff knocking on peoples’ doors before entering. People had a positive dining experience and told us that they were happy with the food. Comments included, “The food is great and there’s always plenty. I’ve put on a bit of weight it’s so tasty”, “ The food is first class, beautiful, fit for a Queen” and “The Sunday lunch is a proper Sunday lunch and you get a glass of sherry if you want one”.

People were supported to stay at the home until the end of their lives. A relative told us that they were happy with the care their loved one had received, they told us, “It was a big decision as to where X should be and we were very nervous but they have come up to the mark and we are quite a demanding family. The whole staff group are patient-orientated. They always speak to X when they come in and they are making sure X is comfortable. They do it so nicely and provide everything X needs at this time”.

People, relatives, staff and healthcare professionals were complimentary about the leadership and management of the home. One person told us, “Oh yes we can speak up and we do here. You could talk to anyone really and the manager is very helpful”. A healthcare professional told us, ‘The new manager has established good communication and appears keen to improve the service and establish good communication with us, the residents and relatives”.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the providers to take at the back of the full version of the report.

We saw that people's consent was sought, wherever possible, before care and support was provided. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the providers policy. We noted that there were enough skilled and experienced staff to do this and to deliver effective care. We also found that systems were in place to make a complaint about the service if people needed to and that complaints were managed in an effective and timely manner.

People who used the service were positive about the care they receive. Each person commented that they were treated with respect and that they could exercise individual choices in their care and treatment. One person told us that they found the manager very approachable and they could talk to them about any suggestions or concerns. People told us that they found the care good and had no complaints.

We observed that the staff were respectful and caring and demonstrated an understanding of individual needs in the planning of care and treatment.

People we spoke with told us that they felt safe at the home and that their needs were met. One person told us that they were regularly checked by staff to ensure that they were comfortable and safe.

We saw that people were involved in regular meetings about the home and services provided and that they were informed and consulted about activities and changes.

We spoke to three staff. They said they felt supported by the manager and that they listened to their views on the service. One told us that "this is the best place I've ever worked in" and another said that the manager's "door is always open" for them to talk to.

We found that there was a good system of quality control in place, with people, visitors and staff being surveyed for their opinions on the care provided.