We undertook an unannounced focused inspection of Glebefields Care Home on 31 January 2019 This inspection was carried out in part, following concerns that had been raised by the public surrounding clinical practices within Glebefields Care Home. We also wanted to check that improvements to meet legal requirements planned by the provider after our June 2018 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because the service was not meeting some legal requirements and the concerns raised to us related to safety and leadership within the service.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

When we completed our previous inspection on 13 June 2018 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). These failings related to staffing levels and the systems in place designed to improve the service. At this inspection we found the service had made improvements in these areas. However, we identified a further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014), relating to the safe management of medicines.

Glebefields Care Home is a ‘care home’ near Banbury. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Glebefields Care Home accommodates 48 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection 39 were using the service.

At the time of our inspection the service did not have a 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. However, the home manager had applied to become the registered manager.

What life is like for people using this service:

The provider did not always ensure that people received safe care and treatment. This was because people did not always receive their medicines as prescribed. Medicines were not always stored in line with the manufacturers guidance. The service did not always seek guidance from professionals when administering medicines covertly.

People complimented the continuity of care provided by the right level and mixture of skilled and competent staff. Risks to people's well-being were assessed, recorded and updated when people's circumstances changed. The staff ensured any lessons learnt were reflected to improve the service delivery. However, the systems designed to improve the quality of the service were not always effective.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

This inspection took place on 13 and 19 June 2018 and was an unannounced inspection.

Glebefields is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Glebefields accommodates up to 48 people in one adapted building. At the time of the inspection there were 39 people living at the service.

There was not a registered manager in post. 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 not always sufficient staff to meet people's needs. There was not an effective system in place to monitor call bell response times. The provider’s procedures to formally assess, review and monitor the quality of the service were not always effective.

People were supported by staff who had been trained in the MCA. However staff did not always apply the principles of the Act in their work. Staff did not always follow the recommendations made by healthcare professionals. Records relating to people’s care did not always capture person centred information; and care records were not always clear and concise.

People were supported appropriately to eat and drink sufficient amounts to help maintain their health and well-being. However, people gave a varied response about the choice of food at Glebefields.

People told us they were safe living at Glebefields. Staff demonstrated they understood how to keep people safe and we noted that risks to people's safety and well-being were managed through a risk management process.

People were very complimentary about the staff and management at the home. They told us staff were kind, caring and compassionate. Visitors were welcomed at all times and people were supported to maintain family relationships.

People's health care needs were met and they had access to a range of healthcare professionals. Where required, appropriate referrals were made to external health professionals, such as GP’s or therapists.

The provider had systems in place to receive feedback from people who used the service, their relatives and staff members about the service provided. People were encouraged and supported to raise any concerns with staff or management and were confident they would be listened to and things would be addressed.

Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager) and yearly appraisals. The provider had safe recruitment processes in place, which helped to ensure that staff employed were of good character and suited to the roles they were employed for. People's medicines were managed safely and kept under regular review. Infection control measures were in place to help reduce the risks of cross infection.

We inspected this service on 8 February 2016. This was an unannounced inspection.

Glebefields is a nursing home providing nursing care for up to 48 people. At the time of our visit there were 43 people living at the service. The service is divided into two units. One of the units is called Willow lane and is designed to meet the needs of people living with dementia. People who require nursing care live in the other unit.

The home 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, relatives and staff were complimentary about the registered manager and the management team. The registered manager sought feedback from people and their relatives and was continually striving to improve the quality of the service. There was an open culture where people and staff were confident they could raise any concerns and these would be dealt with promptly.

There was a warm and friendly atmosphere at the service. People felt safe, enjoyed living at the service and felt valued as individuals. Staff knew the people they cared for and what was important to them. People felt involved in their care and their choices and wishes were respected and recorded in their care records.

People enjoyed the many activities on offer and told us there was always something to do. However, we have asked the service to make improvements to the activity provision for people who are living with dementia. This was because people living on Willow Lane did not always benefit from the activities on offer.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. People were assessed regularly and care plans were detailed. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met. However, we have asked the service to make some improvements to peoples care records. This was because some care records were not written in a legible way and not all capacity assessments were individualised.

Where required staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.

People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People were supported with specialist diets.

There were enough staff to meet people’s needs. People felt cared for by competent staff. Staff felt supported, understood the values and ethos of the service and were motivated to improve the quality of care. Staff benefitted from regular supervision, team meetings and training to help them meet the needs of the people they were caring for.

Medicines were stored and administered safely.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way.

We have made a recommendation about the activity provision for people who are living with dementia.

On the day of our visit 43 people were using the service. They were supported by a combination of nine care workers and three nurses. We spoke with ten people who used the service and eight relatives. We also spoke with two nurses, four care workers, a chef and the registered manager. An inspector and an expert by experience carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was safe. People told us that they felt safe. Staff had received safeguarding training. Staff discussed the action they would take if they had identified safeguarding concerns.

People were protected from the risk of malnutrition and dehydration. Care staff completed food and fluid charts where they had concerns over people’s well-being. Care plans had also been updated to reduce the risk of people receiving inappropriate care and treatment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit we noted that the registered manager and staff had awareness of DoLS. We spoke with the manager about the recent high court judgement around DoLS. They told us that they had awareness of this decision and would be attending local training regarding the issue.

Is the service effective?

The service was effective. People told us they enjoyed being at the home and felt well cared for. People we spoke with told us they felt respected.

People’s views and experiences were taken into account in the way the service was provided and delivered. For example, we noted that people and their representatives could suggest changes to the service and these were acted upon.

Staff were supported and trained to carry out their roles. We saw training records for staff at the home and saw that staff were trained to meet the needs of people. Staff felt supported and told us they had access to supervision.

Is the service caring?

The service was caring. People we spoke with were complementary about the home. One person said, "I’m very happy here.” Another said, “The staff are very responsive.” A relative told us "I always find that the staff have time to help.” Another relative said, “It’s great here. Their [relatives] needs are met.” We spoke to a GP who was visiting the home. They told us, “The nurses communicate well. They are very good at telling us about people’s needs and what’s going on.”

Care workers had a good awareness of people’s needs. We observed staff assist someone who can become agitated in a loud environment. We saw that staff did this with dignity and respect.

We observed that people were involved in a range of activities which included music and movement and an entertainer. We conducted a Short Observation Framework for Inspection (SOFI) observation. SOFI is used to capture the experiences of any person who may have cognitive or communication impairments and cannot verbally give their opinions on the services they receive. We observed that people benefitted from positive and caring interactions with staff.

Is the service responsive?

We found that the service was responsive. For example, we saw that where people’s needs had changed staff took appropriate action. We noted that the service had sought the advice of dieticians to ensure that people were protected from the risks of malnutrition.

We noticed that incident and accident records noted that the service took appropriate action to manage the risks associated with incidents and accidents and ensure the health and welfare of people living at Glebefields Care Home.

Is the service well led?

We found that the service was well led. The service had a registered manager. Staff we spoke with felt they had clear leadership from the registered manager who always had their door open and would listen to any concerns.

Robust systems were in place to monitor the quality and safety of the service. Systems were in place to protect people from the risk of malnutrition and ensure incidents and accidents were learnt from.

Where issues were identified appropriate action was taken. We noted that the registered manager had identified concerns about medicine practices. The manager met with nurses and an extra nurse was allocated on morning shifts.