Our inspection took place on 24 May 2016 and was unannounced. At our last inspection on 26 February 2015 we rated the service as requires improvement and identified breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not acted in accordance with the Mental Capacity Act 2005 in assessing people’s capacity to make decisions. We also found there were insufficient suitable staff deployed, and staff were not supported to enable them to be effective in their duties. We asked the provider to send an action plan showing how these regulations would be met. At this inspection we found the provider had taken action and was now meeting these legal requirements. Gledhow Care Home is a purpose built property. The home is located in a residential area close to local amenities and public transport. There are car parking facilities. There are gardens surrounding the home that are accessible to the people who live there. The accommodation is on two floors with a passenger lift connecting the two. There are 51 single en suite bedrooms. There are several lounge and dining rooms located throughout the home. On the day of our inspection there were 46 people using the service.
There was a registered manager in post on the day of our inspection. 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 told us they felt safe living at Gledhow and were confident in staff’s abilities. We saw the provider was thorough in ensuring full background checks were undertaken before new staff commenced working with people, and staff understood how to look for signs of potential abuse and how to report these in a timely way.
We found staff were present in sufficient numbers to provide safe care and support. We saw people received assistance in a timely way when it was needed, and people told us this was usually the case.
Risks associated with people’s care needs were well assessed and documented in care plans, meaning staff had access to information which helped them minimise these risks or take appropriate action to help keep people safe. Medicines were managed safely and where people were able to do this independently they were appropriately supported to do so.
Newly appointed staff received a thorough induction which ensured they were given the skills to be effective in their role. On-going support was given through regular supervision, appraisal and refresher training.
We saw people were supported to access a range of health professionals when needed, including GPs, specialist nurses and falls teams. Care plans contained appropriate assessments of people’s capacity to make decisions and staff understood how the Mental Capacity Act 2005 impacted on the care and support they provided. People told us how they were able to make choices in their daily lives and we saw evidence of consents recorded in their care plans. The provider had made applications for Deprivation of Liberty Safeguards for people where appropriate.
People gave us good feedback about the meals they were served, and we saw they were consulted at regular intervals about menus. We observed the lunchtime meal during out inspection and saw it was a relaxed and sociable occasion, with people receiving patient support from staff when this was needed.
People and visiting relatives gave excellent feedback about the staff and said they would recommend Gledhow to others. We observed a high level of positive interactions between staff and people, and saw people who chose to spend time in their rooms were regularly visited by staff.
People were regularly involved in making decisions about the design and décor in the home, supporting the registered manager’s ambition for the service to reflect somewhere homely rather than a care setting wherever possible. Individual units within the service had been named to reflect a more homely feel and support people’s dignity and sense of independence.
There were a number of initiatives undertaken to ensure people’s lives at Gledhow were fulfilling. People were encouraged to think about ambitions for ways in which they spent their time or things they had felt unable to do for some time, and staff worked to find ways to help people have these experiences.
We saw evidence people and their families were involved in the processes of writing and review of their care plans. Plans contained information about important people and events in people’s lives as well as likes, dislikes and preferences.
The provider had robust systems in place to ensure complaints and concerns were recorded, investigated and responded to in a consistent manner. We saw feedback had been received confirming complaints had been resolved to people’s satisfaction. In addition we saw the provider received regular compliments about the service.
People had access to a good range of activities, and were given a weekly programme in advance to help them choose what they wanted to participate in. People who preferred to stay in their rooms were visited by the activities coordinator to engage in one to one rather than group activities. Records kept about people’s involvement were comprehensive but the information was not fully utilised.
People, visitors and staff were complimentary about the registered manager’s leadership and we saw they were a visible and well-known presence in the service. Staff told us the management team were approachable and felt they were given opportunities to contribute to the running of the home.
The registered manager held regular meetings with both staff and people who used the service and their relatives. We saw these were well documented and showed how feedback was used to generate action plans to help improve the quality of the service. Annual surveys were also used to check opinion and identify actions that could be taken to drive further improvements.
The registered manager oversaw a regular programme of audit activities to ensure various aspects of performance in the service were checked and action taken where needed. These included analysis of events such as accidents and falls to ensure emerging trends were identified and action taken to reduce risk.