This unannounced inspection took place on 10 and 11 December 2018.

Preston Glades Care Home is a purpose-built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in three units. The two first floor units provide services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. At the time of the inspection visit 45 people were receiving care and support at the home.

Preston Glades Care Home 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.

At the time of the inspection visit there was a registered manager in place. However, the registered manager was absent at the time of the inspection, so the service was being supported by several people from the senior management team. 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 service was last inspected on the 14, 16 and 18 May 2018. The registered provider did not meet the requirements of the regulations during that inspection as multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to person centred care, safe care and treatment, safeguarding people from abuse, diet and nutrition, staffing, fit and proper person’s and good governance. Additionally, we found a breach to Regulation 18 of the Care Quality Commission Registration Regulations as the registered provider had failed to notify the Care Quality Commission, (CQC) of all reportable incidents. At the May 2018 inspection, the service was placed in special measures by the CQC.

At this inspection visit carried out in December 2018, we found the registered provider had worked hard to make improvements but not all required improvements had been made. We found not all improvements had been made to ensure people received their medicines safely. Good practice guidance had not been consistently implemented to ensure the safe management of medicines. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014, Safe Care and Treatment. Additionally, we identified a continued breach to Regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014, as the service had failed once again to ensure systems were operated to ensure compliance with the Regulations.

Following the May 2018 inspection, support had been provided to the home from the Care Service Support team. The Care Service’s Support team were an internal team which offered support to locations who required additional support to provide a high quality effective service. Improvements had been made to ensure risk was suitably managed. The Care Service Support team had started auditing people’s care records to ensure risk was identified and appropriately managed. Care plans and risk assessments for people who lived at the home had been reviewed and updated to ensure they reflected their needs. We found no information of concern within any of the files we reviewed. Although we found improvements within care records we noted one incident when naturally occurring risk had not been appropriately managed. We have made a recommendation about this.

Auditing systems had been reviewed to ensure audits carried out reflected what was happening at the home so effective action plans could be developed and maintained. Oversight at the home from senior managers had increased to ensure the service was well-led. Lessons h

This unannounced inspection took place on 14, 16, and 18 May 2018.

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in three units. The two first floor units provide services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. At the time of the inspection visit 53 people were receiving care and support at the home.

Preston Glades 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.

At the time of the inspection visit 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.

At the last inspection, carried out in January 2017 Preston Glades was rated as requires improvement. This was because we identified concerns related to the safe management of medicines, processes for ensuring consent was lawfully achieved and the way in which the service was managed. Following the inspection visit we asked the registered provider to submit an action plan to demonstrate how they intended to make the required improvements to meet the fundamental standards. The registered manager told us improvements would be in place by May 2017.

At this inspection visit carried out in May 2018, we found not all required improvements had been made. Breaches were identified to Regulations, 9, 12, 13, 17, 18, and 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of the Care Quality Commission Registration Regulation 2009.

We found improvements had not been made to ensure people received their medicines safely. Good practice guidance had not been considered and implemented to ensure the safe management of medicines.

Auditing systems established and operated by the registered provider continued to be ineffective as they had failed to identify the concerns we found during the inspection process. For example, monthly audits had failed to identify safeguarding and medicines concerns we identified during the inspection visits.

Risk was not always suitably managed at the home. Risk assessments were not always completed in a timely manner to ensure all risk was suitably addressed. When people displayed behaviours which challenged the service we found risk management plans were not in place to direct staff to protect the person and other people who lived at the home. In addition, staff sometimes failed to ensure risk assessments were followed to protect people from harm.

People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, processes were not always followed to ensure safeguarding concerns were consistently reported to the local authority safeguarding team for review. Processes to ensure people were safe from abuse were not consistently followed by the registered provider.

Recruitment processes for ensuring staff were suitably qualified to work with people who may be vulnerable were not suitably implemented as suitable checks had not been consistently applied in a timely manner.

Processes to ensure people’s nutritional needs were met were inconsistent. People did not always receive appropriate support to ensure their dietary needs as identified within their care plan were met.

We found deployment of staffing was not always effective to ensure

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who live with dementia.

All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are varieties of communal areas within the home where people can spend their time, including a room for people who smoke.

At the time of the inspection, there were 50 people who used the service.

The last inspection of this service took place on 28 April 2016. The service was awarded a rating of 'Requires Improvement.' The service was found to be in breach of the regulations relating to person centred care, dignity and respect, need for consent, safe care and treatment, good governance and staffing.

We were provided with an action plan following the inspection carried out in April 2016.

An unannounced inspection took place on 19 January 2016 and a follow up announced visit took place on 01 February 2016.

The manager of the service was present throughout our inspection; the manager is currently undergoing the registration process to become the 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.

During this inspection we found that improvements had been made in medicines management and the service were working with other professionals to ensure that they were following best practice. However, we looked at how variable doses for medicines were recorded and found these were not always recorded accurately.

During our last inspection, we made a recommendation around recruitment processes due to staff personal files not always being complete. We looked at recruitment processes at this inspection and found that a full audit had taken place of the staff files. Prospective employees were asked to undertake checks prior to employment to help ensure they were not a risk to vulnerable people.

We found people were protected from risks associated with their care because the provider had completed risk assessments, which provided updated guidance for staff in order to keep people safe.

During our last inspection, we had found that staffing levels were not always adequate to meet the needs of people. During this inspection we found that, staffing levels were adequate to meet people’s needs.

During the last inspection, we found in some care files, consent forms had not been completed. We also found some examples where consent had been provided by people's family members, but there was no confirmation that the people who had provided consent had legal authority to do so.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found that mental capacity had been considered and written consent to various aspects of care and treatment was observed on some people's files. However, recording was not consistent throughout the service. We found that in two peoples care records consent had been signed by relatives. We saw evidence that best interest discussions had taken place, however the documentation was not always fully completed.

During the last inspection, we found that there were issues with staff training and induction. We checked the full training records of four staff and viewed the training matrix for the service. Training subjects included areas, which affected the wellbeing of people, such as safeguarding. We found that staff felt they received adequate training in order to care for people effectively.

We found that the service was pro-active in supportin

Preston Glades is a purpose built home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who live with dementia.

All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are a variety of communal areas within the home where people can spend their time, including a room for people who smoke.

At the time of the inspection there were 52 people who used the service.

At the time of the inspection there was a registered manager in post. However, they were not available during the inspection. Shortly, following the inspection we were informed that the registered manager would not be returning to their 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 last inspection of this service took place on 5 February 2015. The service was awarded a rating of ‘Requires Improvement.’ The service was found to be in breach of the regulation relating to record keeping. We were provided with an action plan following the inspection carried out in February 2015.

This inspection took place on 28 April 2016 and was unannounced. We found that standards at the service had not improved and we identified a number of concerns and new breaches of regulations.

Risks to the health, safety and well-being of people who used the service were not consistently well managed. Sometimes risks were not identified. In other examples we found that measures put in place following risk assessment, to help promote people’s safety were not followed.

We identified concerns about the way people’s medicines were managed. People’s medicines were not consistently managed in a safe way, which meant they were exposed to unnecessary risks to their health and wellbeing.

We found the provider did not have effective arrangements in place to ensure that adequate numbers of suitably qualified staff were effectively deployed at all times. This meant people were at risk of not receiving the care they needed in a timely manner.

The rights of people who used the service were not always protected because the service did not consistently work in accordance with the Mental Capacity Act 2005. We found a number of examples where the service had failed to gain legal consent for the provision of various aspects of care.

We found evidence that staff at the service did not always support people in a manner that promoted their privacy, dignity and autonomy. Examples were seen of people being left in undignified situations and their privacy being compromised.

We found that in some cases there had been a failure to adequately assess and plan for people’s needs. We also found that at times the service failed to recognise and respond to people’s changing needs.

The arrangements for monitoring the quality and safety of the service were found to be inadequate. We identified a number of concerns and breaches of regulations which has not been identified or acted upon by the registered manager.

PEEPs (Personalised Emergency Evacuation Plans) were in place, but required improvement to ensure they were more personalised. We made a recommendation about this.

More robust auditing of medicines management and consideration of the NICE guidance, ‘Managing Medicines in Care Home’ was recommended to help ensure improvements were made and sustained.

There were clear recruitment procedures in place which were designed to help ensure only people of suitable character were employed. However, these were not always consistently followed. We made a recommendation about this.

We found some examples of effective nutritional ca

Preston Glades is a purpose built care home, registered to provide accommodation for up to 65 people who require nursing or personal care. The home is arranged in two units. The first floor unit provides services for people who are living with dementia. All accommodation is provided on a single room basis, with the majority of rooms having en-suite facilities. There are a variety of communal areas within the home where people can spend their time, including a room for people who smoke.

The last inspection of the service took place on 5th September 2013. That inspection was carried out to ensure the service had made improvements and taken action to address non-compliance we had earlier identified. During that inspection the service was found to be fully compliant.

This inspection took place on 5th February 2015 and was unannounced.

At the time of the inspection the registered manager had just completed the process of registration with the Commission. 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 who used the service and their representatives expressed satisfaction with their care and felt confident that staff understood their needs. We found that staff worked positively with community professionals such as mental health workers to ensure that people’s needs were met. However, there were some gaps in care planning information that meant people were at risk of not receiving the care and support they needed.

We received mixed feedback about how people’s social care needs were addressed and the range of activities provided at the home. Trips out of the home were not routinely provided and some people felt the activities that were provided did not meet their personal preferences.

People told us they were treated with respect and dignity and described the staff team in ways such as, ‘kind’ and ‘caring’.

There were ample numbers of staff employed to meet the needs of people who used the service. The registered manager took people’s needs into account when determining necessary staffing levels on a day-to-day basis.

Staff were provided with a range of training to assist them in carrying out their roles. Over half of none-nursing staff held nationally recognised qualifications in care.

There were a variety of processes in place to assist the registered manager and the provider in monitoring quality across the service. As a result of their use, a number of developments were planned for the home, with an aim to constantly improve the service people received.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to records for people who used the service. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was carried out to follow up concerns we previously identified in relation to the care and welfare of people who use services, medication management and the processes used to assess and monitor quality within the home.

During the inspection we spoke with seven people who lived at the home. Overall we received positive feedback from people. Their comments included;

‘’Staff are brilliant.’’

‘‘The dining room and meals have recently improved as it is better organised.’’

‘’I like living here, things are fine.’’

‘’Everyone of the staff, it doesn’t matter who they are, are brilliant. I couldn’t ask for better.’’

‘’This home is top class.’’

We found during this inspection, that the home had taken action to make the required improvements.

Overall, we found medicines were handled safely.

We found that people were provided with safe and effective care and that the provider had suitable arrangements to monitor quality and identify risks.

During our inspection we spoke with a number of people who lived at the home. We received some positive feedback and residents spoke highly of staff and managers.

Comments included:

‘’The staff are great!’’

‘’They look after me well!’’

‘’I find them all very good, they are a nice bunch.’’

Prior to the inspection we liaised with a number of community health care professionals and a local authority contract officer. These professionals shared some concerns with us about some aspects of the service provided at the home.

During our inspection we assessed standards relating to people’s care and welfare and how the home addressed their care needs. We also looked at how medicines were managed and how the home went about safeguarding people from abuse. Standards relating to staffing levels and training were also inspected. We identified a number of concerns and several areas where improvements were needed.

People living at the home told us that the staff talk to them to find out how like to be supported and take account of their points of view. One person told us that the staff are aware of their dietary needs and always make sure they are met. Another person told us that the staff are very good at giving them information about their care needs and the best ways to supported. This person said that they found it very useful.

People gave the impression that there is a balance offered to them in relation to everyday events and activities, between the reasonable risks people want to take and their personal safety. People said that they felt safe and secure at the home, and felt that the care they received was always of a good standard. One person made it very clear that the care they received was based on their personal requirements. This made the person very happy.

People told us that they felt safe living at Preston Glades. One person told us "if there was anything strange going on, like abuse, then I'd go straight to the staff and tell them. They would sort it out and stop it, and report to those who need to know." Another person said that if they needed to report abuse then they know the staff and manager would respect and support them in doing that.

During this inspection we spoke with a number of people who lived at the home. We received very positive feedback from everyone we spoke with and people told us they were very satisfied with the service provided at Preston Glades.

Comments included:

‘’This is a good home. I like them all they are a good bunch.’’

‘’They are very good to us.’’

‘’The staff have an excellent attitude.’’

‘’I feel completely safe here.’’

At this inspection we looked at standards relating to people’s care and welfare, nutrition and medication. We also assessed how the home supported people who did not have capacity to consent to some aspects of their care or treatment. Other standards we assessed included those related to staff training and how quality and safety within the home was monitored.

We found that the home had made some good improvements since their last inspection but identified some outstanding areas of concern.