A comprehensive inspection of Gledhow, took place on 9 and 11 January 2019. This inspection was unannounced.

Gledhow is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gledhow is registered to provide accommodation for people who require personal and nursing care and people living with dementia. During our inspection there were 41 people living in the home. At our last inspection the service was rated as good. At this inspection, we found the service deteriorated to requires improvement.

There was no registered manager in post at the time of our inspection. Two managers from other homes with the providers organisation were currently supporting the home. There was an area manager who had oversight of the home and told us they were planning to become the registered manager to promote consistency. They were also in the process of recruiting a new manager. A registered manager is a person who has registered with the CQC 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.

Systems were not always in place to assess, monitor and improve the quality of the service to identify shortfalls and there was a lack of accurate and robust care records. Audits had not been consistently carried out to ensure continuous monitoring of the service. Temperatures of medicines in people’s rooms had not been recorded, some care plans lacked details about people’s history and relevant checks. We also found some incidents and accidents that had not been recorded accurately.

Medicines were not always managed safely. We found a medicine that had been signed as given. However, this was still in its box when we checked this. There had been medicine errors and a missed signature for a medicine. We found medicines had not always been stored correctly and temperature checks to ensure medicines were stored at the correct temperature had not always been recorded. We have made a recommendation around medicines management.

The provider followed their legal obligations under the Mental Capacity Act 2005 (MCA) and implemented best practice guidance relating to capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications were made. However, we found some best interest decisions had been made by only one person and some reviews that needed to be updated to reflect people’s current needs. We have made a recommendation around best interest decisions.

The provider had robust systems and procedures in place to keep people safe. Staff were competent in their knowledge of what constituted abuse and how to safeguard people. There was a whistleblowing policy in place and staff knew how to raise concerns should this be required.

Risk assessments had been completed and reviewed regularly. Accidents and incidents were managed effectively and action taken to prevent future risks. However, we found some incidents had not been recorded accurately to determine the risk.

Staffing levels were sufficient to meet people's needs and robust recruitment processes were in place to ensure people were of suitable character. We received mixed views about staff levels. The provider was in the process of recruiting staff and used regular agency staff to ensure consistency in the meantime. Staff carried out training to ensure they had adequate skills and knowledge to meet people's needs. Staff were supported with regular supervisions and appraisals.

The home was clean and tidy. Health and safety checks were completed regularly and staff followed the providers procedures for infection control.

Staff were aware of people's nutritional needs and we found people were offered choices

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 mana

Our inspection was unannounced and took place on 26 February 2015.

Gledhow is a purpose built property. The home is located in a residential area close to local amenities and public transport. 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 ensuite bedrooms. There are several lounge and dining rooms located throughout the home.

The service had 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.

We looked at staffing levels for the service which were adequate however, through our observations and from speaking with people who used the service and their relatives we found people were being put at risk because they were being left unattended in lounges and dining rooms.

On arrival at the home we were allowed access to the building by a contractor who did not check our identity. We were then able to move freely around the building without challenge; this put people who use the service at risk.

The home was being refurbished and new windows had been fitted in some areas of the home, we found the new windows did not have window restrictors which complied with Health and Safety Executive guidance (HSE). We also found some restrictors on the old windows were unlocked and therefore unsafe.

We found most staff had checks for their suitability to work with vulnerable people. We looked at some staff records and we were unable to ascertain if staff had received supervisions or appraisals. We found the majority of staff training was up to date and they had received a comprehensive induction on commencing employment.

From records we reviewed and through our observations we found the home was not appropriately assessing people’s capacity to make certain decisions.

People were very complimentary about the attitude of staff and the care we observed demonstrated this. We saw staff spoke with people respectfully and treated them with dignity; staff knocked on people’s doors and waited before entering their rooms. We observed staff ensuring people’s dignity was respected when they transferred moving people using hoists.

People told us there were some activities but not many.

We saw care plans were comprehensive and had been reviewed regularly. We saw where people’s needs had changed these were documented. In one person’s file we saw they had fallen and their mobility and dexterity plan had been updated.

The registered manager carried out audits of the home although these were not always effective as the manager had been assisting some of the providers other services which meant time spent at Gledhow was reduced. People who used the service and their relatives had filled in satisfaction surveys and we found their responses were mainly positive.

Staff who worked at the home told us the management team were approachable and they thought as a staff team they worked well together.

We found the home was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which has since changed to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

Staff we spoke with were aware of the procedures for protecting vulnerable people and told us they would report any concerns to the manager. We spoke with the manager about the Deprivation of Liberty Safeguards (DoLS) and we were told there was not anyone currently living at Gledhow who was subject to a DoLS.

People and their relatives told us they had developed a good relationship with the staff and felt safe living at the home. Relatives told us they were confident their relatives were very well cared for. One relative we spoke with said, "I feel my relative (person's name) is very safe here."

Gledhow were in the process of upgrading their care plans. We were told this was a long process which they had hoped would have been completed by the end of 2013. We found the transition from the 'old' care plans to the 'new' was causing inconsistencies in how people were cared for.

There were effective recruitment and selection processes in place. The manager showed us the recruitment procedures and confirmed that checks were carried out prior to employees starting work. We looked at three recently recruited staff records to assess the recruitment process that the provider had in place. We saw the recruitment procedures were followed in order to ensure no person was employed without the necessary checks.

Is the service effective?

Generally people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at six people's care plans and saw each person received an assessment before entering the service. Care needs were identified and the plans were written to support the person's needs. A relative of a person who lived at Gledhow told us, "They went through everything with us when my relative (person's name) first came here."

Is the service caring?

We spoke with two relatives of people who used the service, one person said, "They always keep me updated, the care here is very professional and they are very friendly."

People confirmed they were given choices about their daily activities and staff supported them as needed. One person who used the service told us, "I decide when I want to get up, and where I eat my meals. I normally have breakfast in my room and then lunch and dinner in the dining room. Today I decided to eat all my meals in my room."

Is the service responsive?

We saw the activities programme which people could choose to be involved with. During a week's programme we saw, a sherry morning with nibbles, 'name that tune and musical sparkle', bible studies and a film afternoon with ice cream and nibbles. We saw a piano in one of the lounges, a person who used the service told us they played the piano for people.

We were told by the manager there was a resident survey conducted annually. We saw the results of the 2013 survey. The results of this survey were positive in some areas and less so in others.

The provider took account of complaints and comments to improve the service. The home had a complaints procedure, which was displayed in the entrance hall to the home. We asked the manager about any complaints the home had received. We were told they had received one complaint which was currently being investigated.

Is the service well led?

We asked the manager about how the home monitors the quality of service provided. We were told there were formal systems in place to audit and monitor the quality of the service provided on a regular basis. They were able to demonstrate improvements had been made as a result of the surveys and audits carried out. We saw there were several areas of the home that had been refurbished, including some of the bathrooms, the entrance area, both lounge areas and the bistros on each floor.

There was evidence learning from incidents took place and appropriate changes were implemented. We saw in the home’s accident report file that they recorded any accidents or incidents. Staff told us they were told during the daily handover if there had been any incidents of concern and where this had resulted in changes had being made.

We observed staff treating people with respect, being polite and courteous. People who used the service and/or their families had contributed their opinions and preferences in relation to how care was delivered. One person told us, “I can tell staff if I want something different, staff listen.”

People had detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported that ensured their needs were met. We spoke with nine people who used the service and they told us they were happy with the care and treatment they received. One person told us, “I am looked after very well. I am very surprised how good it is.”

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us they had no concerns with the cleanliness of the home. One person said, “Hygiene is very good and they always clean my room.”

We found people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People who used the service we spoke with told us there were always enough staff to help them when they needed support. One person said, “There are always people to help me.”

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided an overview of the quality of the service’s provided.

People told us that staff explained all procedures and treatments to them and respected their decisions about care. People who used the service told us they were happy living at the home and they were well looked after.

Three people told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything. The also told us that if they had any concerns or complaints they would discuss them with members of staff or the manager.

People told us that they were happy with the care provided. They told us that they had been involved in making decisions about their care and how the home is run. They also told us that they could choose what time to get up.

We had received concerns that people were being made to get up very early; 4.30am. However people told us they could choose what time to get up. One person told us that they liked to get up early as they enjoyed the company of the staff and felt lonely in their room. They also told us that getting up early is something which they had always done.

People told us that they felt safe when they were moved using either the hoist or stand aide.

People were complimentary of the staff. One person told us, "when they leave it's like losing one of your family."

People told us that they knew how to complain and felt their complaint would be taken seriously.