About the service:

Glendale Residential Care Home is a ‘care home’ which accommodates up to 20 people in one adapted building. 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. At the time of our inspection there were 14 people living at the service.

Rating at last inspection: Inadequate (Published 6 September 2018). The service was placed in special measures.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We previously inspected Glendale in July 2018 where the service was rated ‘Inadequate’ and placed in special measures. This was because we found that since our inspection in March 2017 where the service was rated ‘Requires Improvement’ there had been a deterioration in the quality of care with a continued lack of action to reduce the risk of harm to people who used the service. There was a continued breach of Regulations 12 and further breaches of Regulations 9, 10, 11, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People’s experience of using this service:

People’s medicines were managed safely. However, further work was needed to ensure accurate records of carry forward medicines from one month’s cycle to another were maintained.

People’s safety had been considered and risks had been reduced by the introduction of revised guidance, risk management systems and improved systems of auditing. This included improved systems to identify and actions to reduce the risk of harm including responding to safeguarding incidents. All staff had been provided with updated training in safeguarding people from the risk of abuse.

We have made a recommendation about the management of some of the medicines, use of good practice guidance for kitchen audits, and that people’s spiritual and cultural needs be reviewed.

Improvements had been made to provide staff with regular, planned supervision to enable them to discuss their work performance and identify any training and development needs.

All care plans had been reviewed and systems put in place to enable ongoing review with people’s changing needs updated in a timely manner.

People told us they were satisfied with the quality and variety of food they were provided with. Those at risk of inadequate food and fluid intake were monitored and referral for specialist support accessed when needed.

People told us staff treated them with kindness, dignity and were respectful of their choices.

The recent employment of an activities coordinator provided more group and one to one activities for people. However, further work was needed in planning to support people who wanted regular access to the community.

Systems to monitor the quality and safety of the service had improved. A range of regular checks had been carried out by the manager with actions and timescales recorded where improvements were needed. However, whilst we were told the registered manager visited the service on a regular basis, they did not record any formal monitoring of the service. Further work was needed to ensure effective oversight of the service with overall planning for improvement at all levels of the organisation.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received,

This unannounced, comprehensive inspection took place on the 17, 25 July and 1 August 2018.

This inspection took place following information of concern we received that people were at risk of not having their needs responded to in a safe and effective way. At this inspection we identified a number of concerns.

Following our inspection, we notified relevant stakeholders such as the local safeguarding authority and Essex Fire service of our findings.

At our previous inspections in March 2017 and February 2018, we found concerns in relation to ineffective governance of the service. This included a lack of effective management of risk to people’s health, welfare and safety as well as shortfalls in maintenance and management of the premises. Our inspection in March 2017 found people were not protected from the risks associated with unsuitable staff being employed as the provider did not operate safe recruitment practices, the risk of not receiving their medicines as prescribed, and environmental risks had not been identified and managed. We also found action had not been taken in a timely manner in response to safety concerns highlighted by visits from fire safety officers.

At our inspection in February 2018 inspection we found some improvements had been made. However, there was a continued failure to provide staff with the guidance they needed to provide safe care and treatment to people including insufficient planning and monitoring of people’s needs. Following our inspection, we wrote to the provider and requested an action plan which would tell us what they would do to ensure compliance with the law. The registered provider failed to respond to our request.

At this inspection, we found there had been further deterioration in the quality of care which meant the provider continued to be in breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, the need for consent, staffing, fit and proper persons employed, person centred care and good governance.

Glendale Residential Care Home is a ‘care home’ which accommodates up to 20 people in one adapted building. 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. At the time of our inspection there were 17 people living at the service.

The service had a registered manager who was also the registered provider of Glendale and another registered service. 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 were not protected from being cared for by unsuitable staff because safe recruitment systems were not in place and operated effectively. There were insufficient numbers of staff available at all times. This meant there weren’t enough staff to fully enhance people's quality of life. Whilst some staff were seen to be kind and caring, further work was needed to imbed a culture of caring throughout the service.

There were inadequate numbers of skilled and knowledgeable staff employed and available to meet people’s needs at all times. Staffing rotas did not always reflect the actual staff working.

People were not always supported by staff that had the necessary skills and knowledge to meet their health, welfare and safety needs. Staff had received a variety of training relevant to their roles. However, this learning was not always being put into practice, when supporting people living with dementia and when presented with distressed behaviours that were challenging to themselves or others.

Care plans failed to provide staff with guidance

Glendale Residential Care Home provides residential care for up to 20 people. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and we looked at both of these during this inspection. At the time of our inspection there were 15 people living in the service. The service was located in the village of Felsted, close to local shops and other community amenities.

This unannounced inspection took place on 21 and 27 February 2018.

The service had 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. The previous registered manager had left since our last inspection. The provider, who was also the owner of the service, was now the registered manager and there was also a new deputy manager in post.

We had previously inspected Glendale Residential Home on 12 April 2017, when the service was under a different registration. We found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There had been a number of changes at the service since our last visit and a high turnover of staff. The provider had recruited a new deputy manager and the service and staff team were now more settled. The new management team had addressed the concerns found in our last inspection and the support people received was safer and more personalised. Some of the changes had only recently been implemented and more time was needed to measure whether they were sustainable. This included new measures to check on the quality and safety of the service.

Since our last inspection, the provider had concentrated on minimising risk to the safety and we found people received safe support when they arrived at the service. However, planned improvements to the pre-admission assessment process had not been implemented prior to our return to the service. We found the provider had admitted new people to the service without an adequate assessment of their needs and potential risk, leading to unnecessary disruption on their arrival.

The provider and deputy manager were visible and hands-on and promoted an open culture for people, families and staff.

The building work at the property was completed and people benefited from the new décor and furniture. The service was more ordered, which improved the safety of people receiving medicines and minimised the risk of infection.

People had personalised risk assessments and care plans tailored to their individual needs and preferences. There were improved measures to ensure the safe evacuation of people in an emergency. There were sufficient, safely recruited staff to meet people’s needs. Staff knew how to support people who were at risk of abuse.

Staff skills had increased, in particular in the area of dementia. Staff were well supported by the management team and worked well together. Staff worked alongside outside professionals to meet people’s health and social care needs.

The provider met their responsibility under the Mental Capacity Act 2005 (MCA). Where people did not have capacity to make decisions, the provider ensured decisions were made in the person’s best interest.

People had enough to drink and eat. The provider had employed a new activities coordinator to support people to remain active and stimulated. People and their families felt able to complain and be confident their feedback would make a difference. The provider ensured people were consulted about decisions at the service, including menu choices.

Staff knew people well and supported them with kindness. People were treated with respect and dignity. Staf