Glenthorne No2 Care Home Limited

We found the following examples of good practice.

• People received support to maintain their relationships with their families and friends.

• Visitors use entry doors nearest people’s room to minimise contact with others.

• Visits were by appointment and visitors were COVID-19 tested prior to entry into the home.

• Testing for COVID-19 for people and staff had occurred and was ongoing on a regular basis.

• People and staff had been supported to receive COVID-19 vaccinations.

• We observed prominent signage to guide staff on the use of protective personal equipment (PPE).

• Processes were in place for staff to put on, take off and dispose of PPE when entering and leaving the building.

• The use of PPE was in accordance with current government guidelines. We observed staff wearing PPE appropriately.

• Electronic messaging services were used to share best practice between homes and to liaise with relatives.

We found the following examples of good practice.

• Visiting at Glenthorne No2 Care Home was restricted. All visitors were temperature checked before admission. Visitors were required to follow best practice guidance and wear appropriate PPE. Their visiting policy and restrictions had been discussed with people, their families and friends.

• People who had returned from hospital were risk assessed and their immediate care and support followed government guidance. This included people having to isolate in their bedrooms.

• Testing for Covid-19 for people and staff had occurred and was ongoing on a regular basis. The registered manager had initiated zoning of the home and cohorting of people to minimise the risk of transmission.

• We observed prominent signage to guide staff on the use of protective personal equipment (PPE). Processes were in place for staff to put on, take off and dispose of PPE when entering and leaving the building. Additional PPE measures were in place when supporting people who had tested positive for Covid-19. We observed staff wearing PPE appropriately.

• We observed the home looked clean and hygienic. Staff told us high touch areas such as handles, and switches received additional cleaning daily. Environmental, coronavirus and infection control policies, procedures and audits were in place to ensure infection prevention procedures were robust and ongoing.

• People received support to maintain their relationships with their families and friends. This was achieved through telephone calls, video calls and the use of social media.

Further information is in the detailed findings below.

Glenthorne No2 Care Home Limited is a detached property close to local amenities in Thornton-Cleveleys. The home provides personal care for up to 15 people. Bedrooms are on the ground and first floor. All bedroom accommodation is for single occupancy. Communal space consists of a lounge, a separate dining room, and a small conservatory which is also used as a smoking room. At the time of our inspection visit on 31 January 2019 there were 15 people who lived at the home.

Glenthorne No2 Care Home Limited is a 'care home.' People in care homes receive accommodation and nursing or personal care as 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.

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 on 07 and 13 December 2017 we made a recommendation for the provider to carry out frequent risk assessments during the renovation work being undertaken at the home. This was because we identified risks such as raised plank/uneven flooring in the hall had not been noted as a possible trip hazard. These were rectified when brought to the attention of the management team. During the inspection on 31 January 2019 we found risk assessments had been developed to minimise the potential risk of harm to people when renovation work was to be undertaken.

At the last inspection on 07 and 13 December 2017 we made a recommendation for the provider to further develop people's care records including care plans and risk assessments. During the inspection on 31 January 2019 we found care plans were well maintained and informative about people’s care provision. We saw people had consented to their care and treatment and where appropriate family members who had the legal authority to do so.

People who lived at the home told us they were happy with the care provided and staff were caring and compassionate. They told us staff were kind and attentive and spent time with them. Comments received included, “I am very happy here. There is lots of laughter.” And, “I am happy here and I do feel safe.”

Relatives spoken with during the inspection told us they were happy with the care provided and had no concerns about their family members safety. One person visiting the home said, “The staff are lovely. They are kind to my [relative].”

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Staff had been recruited safely, appropriately trained and supported.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We observed the daily routines and practices within the home and found people were treated equally and their human rights were constantly being respected.

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.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People received their medicines as prescribed and when needed and appropriate records had been completed.

We looked around the building and found substantial improvements in the homes environment had continued to be made. These were ongoing and further work was scheduled for updating bedrooms and the downstairs bathroom which are in need of improvement.

The design of the building and facilities provided were appropriate for the care and support provided. People had access to an enclosed rear garden to enjoy during the better weather.

The service had safe infection control procedures in place. People who lived at the home told us they were happy with the standard of hygiene in place.

We received mixed reviews about the meals provided with some people saying they would like more choices. This was discussed with the registered provider.

Although the service provided social activities some people spoken with said they would like these to be organised more often. The registered manager told us this was something he would address.

The service had a complaints procedure which was made available to people and their family when they commenced using the service. The people we spoke with told us they were happy with the service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided.

Further information is in the detailed findings below.

Glenthorne No2 Care Home Limited is a detached property close to local amenities in Thornton-Cleveleys. The home provides personal care for up to 15 people. Bedrooms are on the ground and first floor. All bedroom accommodation is for single occupancy. Communal space consists of a lounge, a separate dining room, and a small conservatory which is also used as a smoking room.

At the time of the inspection visit 15 people lived at the home.

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.

This is the first inspection for Glenthorne No2 Care Home Limited since it was registered with the Care Quality Commission (CQC) on 21 July 2017. Prior to Glenthorne No2 Care Home Limited taking over the home, the service was owned by another registered provider. At that time it was not meeting regulations and needed significant improvements. The new service provider Glenthorne No2 Care Home Limited had made substantial improvements in the homes environment and documentation. However further work was needed. The director of Glenthorne No2 Care Home Limited was the nominated individual and temporary registered manager. They assured us the improvements were continuing and has kept us informed of further improvements. Most of the staff team had remained in the home’s employment. This meant they had knowledge of the home and people who lived there and people were cared for by staff who were familiar to them.

When the new registered provider took over the home, the environment was in a poor state of repair and maintenance. The building needed refurbishment to make it a pleasant place to live in. Since then there had been substantial work carried out with new floorboards and other urgent remedial work needed to make the home safe. Significant improvement had been made to the décor and furnishings in the home. People told us the refurbishment had made the home much nicer to live in. One person said, “It’s so much better. It’s lovely.” A relative commented, “What a difference in a short time. I am so pleased.”

Although the staff team attempted to keep people safe during the renovation work and many risks were minimised, we found others were not. We found risks such as raised plank/uneven flooring in the hall had not been noted as a possible trip hazard. When we informed the management team of this they immediately rectified it and during the inspection carried out a visual risk assessment of the whole property to check for hazards. They then prioritised these. The major renovations in the home had caused some disruption but the management team were attempting to keep this to a minimum.

We made a recommendation to carry out frequent risk assessments during the renovation work.

The home had recently had a food safety inspection, an infection control inspection and a fire safety inspection. All had highlighted a number of issues. Many related to the fabric of the building such as old and dated kitchens and bathrooms and furnishing such as chairs, fire systems and call bells. The management team told us many of the issues highlighted had been rectified and this had reduced the risks. There were plans to remove and fully refurbish the kitchen and to renovate one of the bathrooms by early 2018. These measures would improve inspection control in the home.

Staff had received infection control training and were pleased with the improvements already made and positive about those planned. On the first day of the inspection we noted several commodes and toilet frames were in poor condition. By the second day of the inspection these had been replaced with new ones. This meant the risk of infection was reduced.

Documentation had been poor before Glenthorne No2 Care Home Ltd took over the home. The nominated individual of Glenthorne No2 had introduced a new system of care records. Staff had started to complete these. The management team acknowledged that these would benefit from further development and completion. Risk assessments prior to the change of ownership had also been very basic. Staff had since completed risk assessments for each person to assist in keeping people safe. Although they provided guidance for staff when they gave people care and support to people, the risk controls were not always detailed.

We looked at a person whose behaviour challenged the service. Although staff knew how to support the person, on the first day of the inspection there were no written management strategies in place to assist staff. When we carried out the second day of the inspection the management team had recorded the measures used to defuse situations or distract the person from behaviour that challenged.

We have made a recommendation to further develop people’s care records including care plans and risk assessments.

The management team had started to make regular checks to govern, assess and monitor the quality of the service and the staff. These had not yet had time to become embedded into the governance structure when we inspected.

People told us they felt safe at Glenthorne No2. We observed staff provided safe, patient and sensitive care during the inspection. The service had procedures to protect people from abuse and unsafe care. Staff were familiar with these and had received training in safeguarding adults. They told us they would take prompt action to ensure people’s safety where they became aware of or suspected a safeguarding concern. At the time of the inspection a safeguarding alert was being investigated. The management team were co-operating with the investigation.

People we spoke with told us they were happy and supported by staff who cared for them and treated them well. One person said, “I am looked after very well I am happy with my care.” A visiting relative said, “The staff are really kind and patient. They have made such a difference.”

People said staff supported them to remain as independent as they could be. They told us staff were caring and respectful, listened to them and assisted them promptly. They said staff were familiar with their care needs and preferences.

The service had sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people required their help.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

People spoken with and care plans seen, confirmed staff requested consent from people and involved them in decision making about their care.

We looked at accidents and incidents to check the registered manager evaluated these for any lessons learnt. We saw they checked for triggers to, or patterns in the accidents or incidents. This enabled staff to review where risks could be reduced while still supporting people to be as independent as possible.

People had been 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.

People told us they were offered a variety of meals and were complimentary about the food provided. Drinks were offered to people throughout the day and their dietary and fluid intake was sufficient for good nutrition.

We saw there was an emphasis on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered personalised care. Care plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.

We saw people who lived at the home had access to healthcare professionals. People we spoke with said their health needs were met promptly and care records reflected this.

People visiting the home told us they were made welcome by friendly and caring staff and had unrestricted access to their relatives. They told us they were happy with the care provided and had no concerns about their relatives safety.

People told us they knew how to raise a concern or to make a complaint if they were unhappy with something. They said staff were approachable and listened if they had a concern.

This is the first time the service has been rated as ‘Requires Improvement.’