Glencairn Residential Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 8 Quality Statements in this key question. We identified 5 breaches of legal regulations. We found the service did not have safe systems and practice in place to keep people safe and needed to significantly improve medicines management. There were insufficient risk assessments completed and peoples care records lacked assessments and care plans. Care was not provided in line with best practice guidance and referrals for healthcare advice were not always happening as needed. People did not all have personal emergency egress plans, PEEPS in place, and you were not able to locate those that had been completed. Staff lacked adequate support, we found no evidence of 1-to-1 supervision sessions with senior staff.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives and people told us they felt safe, and we saw people cared for in a respectful and caring manner. We did not receive any feedback as to whether people believed learning was taken from issues.

Staff did not give any specific feedback about a culture of learning in the service. They did tell us about people arriving to the service with no assessments or draft care plans in place and having to learn about them and share what they had learned about providing care to them with colleagues to ensure support was consistent. We did not see any formalised learning in meeting minutes or handovers.

Systems were not in place to ensure learning was taken from all scenarios. We were not able to view a safeguarding or accident and incident log and there was no evidence of investigations and learning from these events. The local safeguarding authority had supplied copies of all alerts from October 2023 however these had just been filed without review or analysis. Due to staff members not working in the same way when using the eCare system, accidents and incidents had been recorded in different areas of the system meaning reports were not providing complete information for analysis.

A person told us they had enquired about availability of a bed at Glencairn and were told they would be called when one became vacant. When a vacancy opened up, they were told to bring their things for admission. They told us no assessment or home visit had taken place.

Staff confirmed a lack of available information, telling us a second person, admitted with no assessment, had complex family dynamics and there were now concerns others may have too much influence over them. Staff had needed to find out this with no previous understanding of the persons needs, and without knowing if this admission was for respite care or a permanent bed.

We did not receive feedback from partners about this area.

Pre-admission information for more recent admissions was brief or had not been completed at all. One person admitted had no preadmission information and within a short period of time significant high risks were noted by staff. Staff were not prepared for new admissions as a result of poor preadmissions information, having to learn peoples needs as they met and got to know them. Staff told us they didn’t know if people admitted to the service were there for permanent placements or for respite care, or even if they needed any personal care. We saw records for people who had lived in the service for several years and the preadmission information collection was far better, but this had significantly deteriorated over time. Essential information was available on the eCare system for some people to share with healthcare professionals. As with most information, more recent admissions had little recorded information available.

Relatives were satisfied their family members were safe and believed this was because staff were aware of their needs, and knew them well. They told us they were confident in the skill base and delivery of care alongside. People also told us they felt safe and were respected by staff.

Staff members understood how they should report all concerns of suspected and actual abuse to senior staff at the earliest opportunity. They understood they could also go to outside agencies such as the local authority with their concerns. Staff were certain the acting manager would follow up on their concerns and refer the matter to safeguarding.

We spent time in the communal lounge and completed a SOFI observation. The Short Observational Framework for Inspection (SOFI) is a Framework for directly observing and reporting on the quality of care experienced by people who may not be able to describe this themselves. It is used in the inspection of care homes and hospitals. There was a period of 1 hour and 10 minutes when there was no allocated staff presence in the main communal lounge despite there being a person present who had recently absconded from the service. Staff had accessed the area for brief periods to give medicines and to collect washing up, and while they were in the room interacted with people, however there was no oversight of people in this area for a prolonged period. When people were with staff, we saw them providing appropriate support, moving and handling was safely and respectfully completed, and staff spoke with people constantly.

We were not able to review a safeguarding log as was no one in place. The registered manager of the second of the providers services, who was briefly the interim manager at Glencairn, had contacted the local authority safeguarding team who had supplied copies of all alerts made by Glencairn since October 2023. There were copies of each referral form on file. No records or log were found for any alerts prior to that point. There were no investigations to review, or evidence collected for any of the incidents. No learning was taken from incidents to inform the future care of individuals.

We spoke with people and their relatives however no one specifically commented on risk management. No one mentioned they felt at risk, and everyone who commented believed the care was good.

Staff members understood risk assessments should take place for all aspects of service provision, the environment and activities. However, staff also told us there were few risk assessments for people and in reviewing care records we found this to be the case. Staff had to continually consider risks when supporting people in the absence of risk assessments.

We saw staff supporting people in a caring and person-centred way. People received appropriate support with care, meals and drinks and reassurance when needed. However we also saw the communal area not staffed for prolonged periods of time meaning individual, environmental and general risks were not mitigated, and risks of incidents such as people absconding from the service potentially increased.

Risk assessments had been completed for some people at Glencairn who had lived there for a considerable time. More recent admissions had no risk assessments or plans to mitigate risks available to review in their care records. Staff had supported people having received no information about them, therefore completely unaware of any associated risks. Applications for urgent DoLS had been made by the interim manager of the service. Unfortunately, these had expired and there were no records to confirm if an application for a longer term DoLS had been made. The acting manager had contacted the local authority and assured us verbally there were applications in place. There were safety devices such as coded door locks and pressure mats in use. We saw a person had a pressure mat by their room door to alert staff to them moving about the premises. There was no signed consent for its use, and we found no MCA assessment and BI decision to support its use. There was a current risk assessment policy that gave clear guidance about what risks needed to be assessed and how to mitigate identified risks however, this was not consistently followed to ensure peoples safety.

People did not feedback about the environment of the home however they appeared to be comfortable in their rooms and the communal areas of the premises.

The acting manager told us there were ongoing improvements being made through refurbishment of the premises. In particular, a new medicines storage room had been identified and works were underway to fully fit the room with appropriate and safe storage.

The premises were clean and well presented. However, we saw unlocked doors to the laundry and there was an unlocked cupboard on the first floor that held cleaning chemicals. Gloves for use by staff were in racks around the service however there was no risk assessment in place for storage in this manner. There have been cases where people living with advanced dementia have been harmed due to ingesting non-edible items including latex or vinyl gloves and cleaning tablets. The provider should take appropriate measures to mitigate these risks.

There was a lack of oversight of the environment due to there being no completed audits of them. However, we saw external surveys and assessments completed that ensured areas of concern such as poorly fitting fire doors had been identified and addressed. Since the current provider took over the service, they had engaged a care consultant who had provided audits of the service at regular intervals. The last audit completed by them noted some areas of non-compliance such as water hygiene flushing not taking place regularly, insufficient fire drills and some safety certificates were not available. They also noted several positive areas including PAT testing and lift servicing being completed. There was no evidence found to indicate these shortfalls had been addressed. We have not been able to assure ourselves that all monitoring and service checks were taking place due to almost all records being missing from the premises. On our second day at the service, more records were missing that the provider was certain had been available the previous day.

People told us they received support when they needed it, for example, a person had fallen and it took less than a minute for staff to attend to them. People were concerned the management team were on extended leave and that staff with long service were leaving, however, had positive feedback about the agency staff booked to cover. One person felt the newer staff did not know them well.

Staff noted some shifts had more staff available than others and at times there was no cover provided. We reviewed rotas, and found there were usually the correct number of staff available however, if staff called in late to say they were not attending, agency staff could not always be booked.

We saw staff supporting people effectively, however there were long periods when communal areas were not supervised, leaving people at increased risk of harm. Care staff were also responsible for laundry in the service so in addition to caring duties were often away from the 'floor' completing other tasks.

The registered manager had lacked oversight of staff annual leave, and a significant amount of annual leave had been agreed leaving the service short of staff. This meant the provider was using agency staff regularly to cover the rota and maintain safety. The agency supplied regular staff members and during our inspection, a senior care assistant was shadowing a permanent senior care assistant. They shadowed them for 5 days before they were able to work in the role without support. The most recent staff recruitment record held all the necessary information and pre-employment checks needed to ensure safe recruitment. However, this staff member had been recruited at the providers sister home by their registered manager and would complete shifts in both services. A second recruitment record lacked proof of addresses for a person, a recent audit had identified this. We reviewed a third recruitment record and though the record was comprehensive, they had a Disclosure and Barring Service (DBS) check completed in 2011 which had not been repeated. There is no requirement to repeat DBS checks, however good practice guidance suggests providers should assess when rechecking may be of benefit and assure themselves staff had not been subject to police charges at any time. This could even be a signed, annual statement from staff of any criminal record. Recent staff files had no evidence of supervision meetings, or 1 to 1 meetings with senior colleagues. There had been supervision meetings with longer serving staff members, however these did not offer staff an opportunity to raise their own items. Staff completed a mix of face-to-face training courses and online courses. Several booked face-to-face training courses had been cancelled by their supplier and when we inspected, new courses were being identified and booked. There was clear oversight of staff training however some staff had been identified as having poor completion rates, there was not a plan in place to improve this.

Staff and leaders did not feedback specifically on this area, however when we asked staff about the types of PPE they might use in different situations, we were assured of their knowledge.

The premises were clean and there were no malodours. Throughout our inspection there were housekeepers working both in communal areas and in people’s rooms. Staff used personal protective equipment (PPE) appropriate to the task they were undertaking, for example, gloves when serving food, aprons and gloves when supporting people with care. The premises were clean and fresh.

There had been some oversight of infection prevention and control (IPC). There were only 2 monthly IPC audits available for our review, these were for September and October 2023. The content in each was the same, they had not been photocopied. For example, the training provider was added to both rather than summarizing the training statistics, and both stated there was no longer a need to wear face masks. This had been the case since December 2022 so was not a relevant entry to the audits almost a year later. There were no identified actions or an ongoing improvement plans in place to help the provider maintain standards in IPC. We were not assured the IPC audits contributed to improving IPC in the service.

Relatives assumed people received their medicines as prescribed. We were concerned as one relative told us their family member tended to hide their medicines and they were not certain if staff were aware of this. A second relative told us staff left medicines for their family member to take later when they had a drink. We will share this information with the provider so they may act upon it. There was no adequate assessment of a person’s ability to store and self-administer their medicines. One person had signed a form to agree they would self-administer however, staff had not observed them or ensured medicines were being taken as prescribed.

The acting manager was open about medicines management not being safe when they commenced at the service and told us about some of the problems they had dealt with so far. This included spending 6 hours clearing the garage of medicines, many of which were for people who had died, all of which should have been disposed of. The medicines audits we saw, completed by the registered manager, stated all medicines had been safely returned to the dispensing pharmacy however, this was clearly not the case, calling into doubt accuracy of the rest of the audits. The acting manager also told us of the improvements underway. All staff have been retrained in medicines and those who participate in administering medicines are being checked for competency. We saw staff administering medicines. Staff practice was safe and covered the 7 rights of medicines. They identified the correct person, medicine, dose, route, time, documentation and reason before administering. They told people what the medicines were and asked them if they would take them.

Medicines were not managed safely, and we have issued a warning notice covering the shortfalls in practice. Medicines were not safely stored, temperature records reflected the temperature of storage was often at the high end of the safe range and did not show any actions taken. Staff told us they would tell the owner should the temperature exceed safe levels; however, the owner was not aware of this plan. There was no specific escalation plan or agreed ways to mitigate the risk should temperatures exceed the safe level. Liquid medicines had not always been labelled with their opening date. The registered manager had instructed staff not to label medicines when opened, and we found pain relief in solution form without a date and eye drops supplied in mid-January that were not dated when opened. Medicine administration records (MAR) were not always accurately completed with information about doses and specific risks omitted. MARs did not always reflect if medicines were administered, omitted or if signatures had been forgotten. Specific medicines were not always managed safely. For example, a person who needed Fentanyl patches for pain relief did not have their new patch applied as prescribed due to there being no stock of the item. We highlighted this to staff, however the patch was not changed as stock did not arrive on time. Immediate cessation of opioid medicines may cause the person to experience unpleasant side effects. People receiving blood thinning medicines had no specific risk assessments or ‘flags’ on care records to alert staff and visiting healthcare professionals of the additional precautions needed should they fall for example. Changes in peoples medicine requirements had not been escalated to healthcare professionals. There was no policy for homely remedies and staff had been given inaccurate information by the registered manager about administering homely remedies, including not recording the time paracetamol was administered.