This inspection took place over two days, 5 and 6 April 2016 and was a result of concerns raised to the Commission regarding staffing levels and the cleanliness of the premises. The inspection was unannounced. This meant that the provider and staff were not made aware of our inspection ahead of our visit. The service was last inspected 4 August 2015. The service was rated as good and no breaches of regulation were identified.The service provides residential care for up to 37 older people who may be living with a dementia. Glenholme Residential Care Home is a two storey converted townhouse with bedrooms located on both floors.
At the time of the inspection 31 people were living at the home, 19 of these people were living with a diagnosed dementia.
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.
Medication Administration Records (MAR) were not consistent. The service were using two differing MARs which had different codes for staff to use to determine whether a medicine had been given, refused or destroyed. Due to this we found conflicts in the coding system, it was unclear what medication had been administered. Medicines were not always disposed of in an appropriate and safe way. Liquid medicines were flushed down the sink.
The use of the dependency assessment tool, to determine staffing levels, was not effective in ensuring there were sufficient staff on duty, to meet the assessed needs of people who used the service. People who used the service were protected against other risks associated to their care and welfare by appropriate assessment and risk management measures being put in place.
People who used the service felt safe in the home and with the staff who supported and cared for them. Staff knew how to report any concerns about the safety and welfare of people who used the service. Robust recruitment procedures were in place and appropriate checks were carried out before people started work.
People were protected against the risks associated with the premises through appropriate legislative safety checks, in house safety checks and maintenance, such as portable appliance testing (PAT) and fire safety checks.
The home had not been adapted to meet the needs of people who are living with a dementia. The provider recognised the need for refurbishment to address this, but at the time of the inspection no work had been undertaken.
The service ensured that people were supported to have sufficient to eat, drink and maintain a balanced diet. Where people were identified as being at risk of malnutrition or dehydration the home did not monitor these needs effectively.
People were supported and had access to a range of healthcare professionals. This included GP's, opticians, dentists and chiropodists. The home included these professionals in the on-going care and treatment of people who used the service when necessary.
Consent to care and treatment was sought in line with legislation and guidance.
Positive and caring relationships were developed with people who used the service. The service had a stable staff team who knew people well. Staff knew and understood how people preferred to be cared for and supported.
Observations demonstrated that people were treat with kindness and compassion. People's privacy and dignity was respected and promoted. Staff were proactive in their approach to offering care and support discreetly to people who used the service.
People were supported to express their views and be actively involved in making decisions about their care, treatment and support.
People did not receive personalised care that was responsive to their needs. Planning and delivery of care and support was not person centred and did not always focus on assessed needs. People's needs were reviewed regularly to ensure care remained responsive to the needs and wishes of people who used the service.
The service had a complaints procedure in place that was accessible to people who used the service. The service listened and learnt from people's experiences, concerns and complaints but failed to record these investigations in line with their policy.
There were a lot of activities planned within the home to encourage stimulation and involvement from people who used the service. These activities not only met social needs but also captured cultural and religious needs.
The service promoted a positive culture that was open, inclusive and empowering. They ensured people who used the service and staff had opportunities to become involved and suggest ways in which the service could be improved.
The service could demonstrate that it had good management and leadership. The registered manager split her time between four days in the home and two half days in the adjourning day centre. In the weeks prior to the inspection we found that the registered manager had been heavily involved in offering support to another of the provider's service. From a review of documentation, discussions with staff and the management team it was identified that this had had a negative impact on the management of the service.
We saw the service had engaged with external stakeholders and worked in partnership with other agencies in the process of trying to deliver high quality care.