Glenroyd nursing home is a purpose built home registered to provide residential and nursing care for up to 78 people. Glenroyd has three floors comprising of bedrooms, toilet and bathing facilities. All bedrooms have en-suite facilities. There are four separate units within the home for nursing, residential and people living with dementia. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There are communal lounge and dining rooms, a reception area, hairdressing salon and a large conservatory. A landscaped garden area is at the rear of the home with seating. Limited parking is available at the front and side of the building. At the time of the inspection 66 people lived at the home.

The inspection visit took place on 24 April 2018 and was unannounced.

At our last inspection we rated the service overall Good. The safe domain required improvement in relation to the number of safeguarding concerns and the safety of several window frames in the home. The window frames were replaced soon after that inspection. At this inspection we found although there had been a high level of safeguarding concerns up until the current registered manager, these had significantly reduced since her arrival. The service improved to good in the safe domain and remained good in the other four domains. We found the evidence continued to support the rating of overall good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was 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 we spoke with told us they felt safe and cared for by staff. One person told us, “I feel safe and well looked after. I rate the care very high.” A relative said, “Glenroyd is everything we hoped for.” There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place and kept under review. These provided guidance for staff in how to safely support people and reduced potential risks to people.

Staff had been recruited safely, trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. There were sufficient staffing levels in place to provide the support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people called for assistance.

Medicines were managed safely. They were ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. People told us they received their medicines when needed. One person said, “My tablets are organised for me. I don’t worry.” A relative commented, “[Family member’s] medication was reviewed and changed. This has made a big difference.

People told us they were supported in the way they wanted and staff provided care in a person centred way. They said staff provided care in a way that respected their dignity, privacy and independence. We saw staff were aware the importance of supporting and responding to people’s diverse needs and treated people with respect and care.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Relatives told us staff were welcoming to people’s families and friends. Peopl

This inspection took place on 10 February 2016 and was an unannounced inspection.

Glenroyd nursing home is a purpose built home registered to provide residential and nursing care for up to 78 people. Glenroyd has three floors comprising of bedrooms, toilet and bathing facilities. All bedrooms have en-suite facilities. There are four separate units within the home for nursing, residential and people living with dementia. There is a passenger lift for ease of access and the home is fully wheelchair accessible. There are communal lounge and dining rooms, a reception area, hairdressing salon and a large conservatory. A landscaped garden area is at the rear of the home with seating. Limited parking is available at the front and side of the building. At the time of the inspection 48 people lived at the home.

At the last inspection in April 2014. The service was meeting the requirements of the regulations that were inspected at that time.

There was 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 told us they felt safe living at Glenroyd nursing home and liked living there. Although people said they felt safe, there had been a significant number of safeguarding alerts about people’s care. Many of the alerts were substantiated and showed people had been placed at risk of harm or not protected from harm. The registered manager had reported safeguarding issues as required. This showed there were procedures in place and an open and transparent culture in the home. The management team had worked with the other professionals to improve care and reduce safeguarding concerns.

Risk assessments were in place and in most cases minimised risk. However there was some confusion with risk assessments for one person in relation to bed rails. This could have led to the person being unsafe.

We saw that two upstairs window frames were unsafe. The registered manager made arrangements for these to be made safe quickly. They were part of the rolling programme of refurbishment but were brought forward in response to the safety issue. The home was clean and hygienic when we visited. There were no unpleasant odours. The people we spoke with said they were pleased with the standard of hygiene in place. One person told us, “You cannot smell anything can you? This home is spotless.”

We looked at how the home was being staffed. We saw there were enough staff on shifts to provide safe care. People we spoke with were satisfied with staffing levels. One person said, “I think there are enough staff. Whenever I want something I just ask or press my buzzer.”

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the home. By doing this the management team reduced the risk of employing unsuitable people.

Staff managed medicines competently. They were given as prescribed and stored and disposed of correctly. People told us they felt staff gave them their medicines correctly and when they needed them.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. A member of staff told us, “The training has been good, really helpful.”

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). The registered manager showed us a sample of applications she had submitted. This showed us staff were working within the law to support people who may lack capacity to make their own decisions.

People were offered a choice of healthy and nutritious meals. Staff made sure people’s dietary and fluid intake was sufficient for good nutrition. People said the food was varied and tasty

The inspection was led by two inspectors. Information we gathered during the inspection helped answer our five 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, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. They told us they were receiving safe and appropriate care which was meeting their needs. They felt that staff were very good and that they received care and support when they wanted it. One person said, "The staff are great. They look after us really well and the food is excellent.”

The home had policies and procedures in relation to the Mental Capacity Act and best interests meetings had been carried out to assist with particular decisions. Staff were aware of Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and an application had recently been submitted. This meant that people would be safeguarded as required.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service was safe, clean and hygienic. Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained so people were safe.

The registered manager set the staff rotas. They had recently been increased and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Is the service effective?

People’s health and care needs were assessed and reviewed with them, and they were involved in developing their plans of care. This included the way each person's care was provided, their daily routines, health needs and their hopes and aspirations. We saw that care plans were up to date and reflected people’s current individual, dietary, cultural and religious needs.

People confirmed and records showed that they were able to see people in private and that friends and relatives could visit whenever they wished.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people. Good care practices were observed.

People told us that they were happy at Glenroyd nursing home. They said staff were caring and supportive. One person told us, “All the staff are kind and helpful. They are wonderful.” A relative told us, “Mum’s face lights up when staff walk into the room. Another relative told us, “The home is very nice. Staff are very friendly and welcoming. They are excellent at their jobs. I would definitely recommend the home. I have been happy with the care from day one as are the rest of the family.”

Care plans were person centred had been maintained, recording the care and support people were receiving. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People using the service, their relatives, friends and other professionals involved with the service had regular meetings to discuss the running of the home and completed satisfaction surveys. Where shortfalls or concerns were raised these were addressed. One relative said, “I attend the relatives meetings. I find the manager listens and follows through with any ideas or issues. I have no concerns about anything.”

Is the service responsive?

We were told staffing levels had increased and as a result care had improved. People told us that staff had more time to talk with them and they had more activities. One person told us, “I am very happy here. The staff are super and there is lots going on. We even have trips out in the minibus.” A relative said “We haven’t always been pleased with the care because of poor staffing levels but we are now. The staffing has really improved.

We found a range of meaningful social and leisure activities were organised to stimulate people and maintain skills. People said they enjoyed these and were enthusiastic about them. One person said, “I love the trips out, they are great.” Relatives said how much they benefitted their family members. One relative said, “The staff now have time to spend with residents and have smiles on their faces.”

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed promptly. Staff reflected on whether any incidents could have been managed more effectively or if lessons could be learnt. As a result of these measures the quality of the service was continuously improving

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Meetings were held regularly so everyone could discuss support needs and any changes in care or routines. Staff also received regular supervision and training to assist with their development. This helped to ensure that people received a good quality service at all times.

When we visited this home at the end of 2012, we had some concerns regarding staffing levels, the management situation and the care and welfare of people using the unit devoted to the care of people experiencing dementia related problems. During this inspection we found that staffing levels had been improved, and that the use of of agency staff had been significantly reduced. There is now a new manager and management team in place, who have undertaken to assess and evaluate the way the home operated, with a view to introducing changes and improvements as and when required. These changes have not been done without consulting people, but have been introduced in a managed way in order to minimise any stress and ensure the service continues to run smoothly.

We noted that people looked cared for, they told us they felt safe, and that they felt that staff were very helpful. We noticed people sitting in their wheelchairs for long periods of time, and recommend that the provider seeks advice on the risk factors related with prolonged wheelchair use, and if required, implement any changes to the ways in which people are supported.

CQC had received information and intelligence regarding Glenroyd, that raised concerns about the care and welfare of people who used the service, and staffing levels.

We spoke with people about their experience of the care they received, and they told us they experienced safe and appropriate care, treatment and support that met their needs. They told us that understood the care and support choices available to them, and they felt they could express their views, so far as they are able to do so, and were involved in making decisions about their care support. People told us they felt protected and safe, and also that they felt respected and cared about.

We found that the numbers of staff on duty throughout the building allowed for positive interactions to take place.The evidence we found indicated that people's health and care needs were being met. However, we have suggested the following: the monitoring of the systems and the actions the service needs to take to ensure people's needs are met, would provide assurance that the care being provided is safe and appropriate. The provider had a system to regularly assess and monitor the quality of service provided. We have suggested that the new service manager should give priority to understanding the risks associated with providing appropriate and safe care, and take appropriate action if necessary. This would assist in providing assurances to all parties that people receive a safe service that meet their needs.

We visited the home to look at what actions the provider had taken to comply with Outcome 4, care and welfare of people who use services. This was in accordance with Regulation 9 HSCA 2008 (Regulated Activities Regulations 2010). Outcome 7. safeguarding people who use services from abuse. This was in accordance with Regulation 11 HSCA 2008 (Regulated Activities Regulations 2010). Also, outcome 14, supporting workers. This was in accordance with Regulation 11 HSCA 2008 (Regulated Activities Regulations 2010).

As part of the inspection process we asked other organisations about this service. They told us Glenroyd was still being monitored in order to ensure improvements were being made for the benefit of people who lived and worked there.

People using the service displayed a range of dementia conditions. This impacted on the level of verbal communication people had with us. However, observations we made confirmed people living on the ‘Memory Lane Unit’ were able to move around without restriction. People were seen to interact with each other and also with staff. We saw some people focused on watching television, or took part in activities with staff members. Both the residential and nursing units were seen to be calm and organised.

We visited the home as part of this inspection process. We did this to look at what action the provider had taken to comply with Outcome 13 Staffing, This was in accordance with Regulation 22 HSCA 2008 (Regulated Activities Regulations 2010).

As part of the inspection process we asked other organisations about this service. They told us Glenroyd had improved how they staffed the service for the benefit of people who lived and worked there.

Prior to inspecting the service we received comments through the Care Quality Commissions (CQC) ‘Your experience’ survey. Comments included, “On a day to day basis the nursing home is improving and sorting its problems out.” Also, “I was looking to take my relative out of the home. I now feel at ease.”

We spoke with nine people who live in the home and nobody raised concerns about the way their medicines were handled although due to varying degrees of dementia we found it difficult to obtain their views.

We visited this home unannounced on Tuesday 1st May 2012. We spoke with the registered manager, two qualified members of the nursing team, three care staff, a visitor and made general observations of people using the service.

Our inspection focused on the memory lane unit of the service after receiving information relating to concerns in respect of staffing levels in this area of Glenroyd. An inspection of the service in December 2011 by the Care Quality Commission (CQC) highlighted non compliance issues around staffing. In addition Blackpool Social Services Contracts have been monitoring the service.

Some of the comments we received included:

“Staffing levels are constantly below par.”

“There were four members of staff besides the nurse, a carer rang in sick and was not replaced.”

Comments from people we spoke with during the inspection told us,

“I don’t think there are enough of them to give residents time to do any extras.”

“We are often stretched to get things done.”

We also received concerns in respect of medication being administered late due to insufficient staffing levels, care plans not being reviewed or completed, staff recruited without references being verified, and staff not receiving the support of supervision and induction. Comments included:

“Care plans on the nursing side are up to six months out of date.”

“Keeping the records up to date can be a bit difficult at times because we are so busy.”

“There are no procedures in place for nurse supervision.”

We spoke to people visiting the home about their relative’s experiences and the care they were receiving. They told us the staff team provided sensitive and flexible personal care support and they felt their relative was being well cared for.

People visiting the home told us they had concerns about staffing levels.

“The staff are lovely. There just aren’t enough of them in my opinion”.

“I am concerned about staffing levels. The girls are all lovely but they always seem so rushed and under pressure”.

“Overall I am happy with the care mum is receiving. The staff are very good with her. I visit every day and have never left feeling worried about mum”.

“I visit every day and I am always made welcome. The staff are very kind and friendly to my sister and me”.

We spoke with four people and a visiting relative about how medicines were handled. All said they thought medicines were given correctly.

We spoke to people about their experiences living in the home and were told the staff team provided sensitive and flexible personal care support and they felt well cared for.

“My carers are very attentive and responsive when I need them. I am always treated with great care and dignity and would never consider living anywhere else”.

“I received a visit form the manager before I moved into the home to discuss my needs and how these could be met. I haven’t been disappointed. The staff who support me are all lovely and it’s a joy to be cared for by them”.

“As an ex healthcare professional I have never seen or heard anything that has caused me concern regarding the care of others. It’s a lovely place to live”.

“The care is second to none they really look after mum. I cannot sing their praises enough”.

“The manager and her staff are so supportive”.

“Mum is always spotless and clean when I visit. I have often overheard carers with mum when I arrive for my visits and they are so patient with her. I have never had any concerns about my mum’s care they have my complete trust”.