This inspection was carried out on 6 September 2017 and was unannounced. Glebe House Care Home (Nursing) provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 41 people. At the time of our inspection 30 people were living at the service. There were four other people living at the service that were under the care of the First Community Health Team and as such would be inspected separately.

There was a manager in post and present on the day of the inspection. They had submitted their application to become registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People said that they felt safe with staff. There were systems in place to ensure that people were protected against the risk of abuse. People, relatives and staff felt there were sufficient staff at the service. Staffing numbers at the service were adequate to meet the needs of people. People were protected from being cared for by unsuitable staff because robust recruitment was in place

Risks to people were minimised as there were appropriate measures in place to protect people. Incidents and accidents were reviewed and action taken to reduce these. People's medicines were managed appropriately.

People said that they enjoyed the meals at the service. People’s nutritional and hydration needs were being met and health care professionals were involved in their care.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). People told us that they were asked for consent by staff.

Staff received appropriate induction, training and supervision to undertake their role effectively.

People and relatives said that staff at the service were caring, attentive to their needs and treated them dignity and respect.

Staff understood the needs of people and people and the relatives were involved in the care planning.

There were adequate activities in place and people told us that they were not bored.

Care plans outlined individual's care and support and staff understood the care they needed to provide. Staff communicated changes to people’s care with each other.

Complaints and concerns reviewed and used as an opportunity to improve the service. People told us that they would know how to complain if they needed to. Compliments were received at the service and these were shared with staff.

People, relatives and staff felt the service was managed well. They felt that they were listened to and any concerns acted on.

The provider worked with external professionals to ensure the quality of care. Staff said that they felt valued and appreciated.

There were robust systems in place to ensure the quality of care. This included internal and external audits, surveys and feedback.

The manager had informed the CQC of significant events including significant incidents and safeguarding concerns. Records were accurate and kept securely. There was a contingency plan in place in the event of an emergency at the service.

This inspection was carried out on 6 September 2017 and was unannounced. Glebe House Care Home (Nursing) provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 41 people. At the time of our inspection 30 people were living at the service. There were four other people living at the service that were under the care of the First Community Health Team and as such would be inspected separately.

There was a manager in post and present on the day of the inspection. They had submitted their application to become registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People said that they felt safe with staff. There were systems in place to ensure that people were protected against the risk of abuse. People, relatives and staff felt there were sufficient staff at the service. Staffing numbers at the service were adequate to meet the needs of people. People were protected from being cared for by unsuitable staff because robust recruitment was in place

Risks to people were minimised as there were appropriate measures in place to protect people. Incidents and accidents were reviewed and action taken to reduce these. People's medicines were managed appropriately.

People said that they enjoyed the meals at the service. People’s nutritional and hydration needs were being met and health care professionals were involved in their care.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). People told us that they were asked for consent by staff.

Staff received appropriate induction, training and supervision to undertake their role effectively.

People and relatives said that staff at the service were caring, attentive to their needs and treated them dignity and respect.

Staff understood the needs of people and people and the relatives were involved in the care planning.

There were adequate activities in place and people told us that they were not bored.

Care plans outlined individual's care and support and staff understood the care they needed to provide. Staff communicated changes to people’s care with each other.

Complaints and concerns reviewed and used as an opportunity to improve the service. People told us that they would know how to complain if they needed to. Compliments were received at the service and these were shared with staff.

People, relatives and staff felt the service was managed well. They felt that they were listened to and any concerns acted on.

The provider worked with external professionals to ensure the quality of care. Staff said that they felt valued and appreciated.

There were robust systems in place to ensure the quality of care. This included internal and external audits, surveys and feedback.

The manager had informed the CQC of significant events including significant incidents and safeguarding concerns. Records were accurate and kept securely. There was a contingency plan in place in the event of an emergency at the service.

The last inspection report recorded a shortfall under outcome 20 (regulation 18) which was that although most types of notification were being sent to the Care Quality Commission, notifications referring to incidents that caused injuries which change the structure of a person’s body or require treatment, for example cuts resulting from falls were not being sent in and we set a compliance action to address this.

At this inspection we found that the shortfall had been met and the compliance action was closed. We therefore found that the registered person was notifying the Commission of incidents they are required to, and particularly those referring to incidents that cause injuries which change the structure of a person’s body or require treatment, for example cuts resulting from falls.

We therefore found people who use the service can be confident that all important events that affect their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken. This was because the registered person notified the Care Quality Commission about all the incidents that affect the health, safety and welfare of people who used the service.

We visited to follow up a recent finding made by the coroner regarding smoking and fire safety procedures at the Home.

We found that the home had responded to the Coroner’s findings and action had been taken by the home, in the first instance, by reviewing the smoking policy and ensuring people who used the service who smoked were supervised at all times . We noted that the service had brought in strict and effective smoking policies. We found that the recommendations of the Coroner had since been implemented and policies and practices had evolved and been strengthened further. There had been no further incidents relating to smoking and residents.

The main recommendation of the Coroner was that people who smoke should use fire retardant aprons designed for this purpose. We saw that the home had obtained fire retardant aprons and included them in its smoking policy. This ensured that people who were considering using the service knew they would have to wear the aprons, while smoking if they wished to smoke. Prospective service users were made aware of the strict smoking policy and procedures at the Home before making a decision about whether or not to start residing at the home. There were no people who used the service that smoked at the time of this inspection.

People who used the service told us that the staff were nice and they liked the food and their rooms.

A relative of a person who used the service told us they were very happy with the care their relative received. They said that the staff were always caring, they looked after their relative well and there were enough of them. They said they didn’t have to worry about their relatives care or safety and had never had a need to complain.

We saw that people’s needs were assessed and risk assessed and that care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

We saw that the home had contingency plans to continue safe, appropriate care in emergencies. For example, in the case of cold weather, fire, fire alarm failure, loss of land line or nurse call system, disruptions to the gas and electricity supply. They also had general and individual evacuation plans.

We also saw that there were also contingencies to provide a place of safety at an alternative location if the home was not usable for a period of time, so that safe appropriate care could continue in these circumstances too.

We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that people cannot be confident that all important events that affect their welfare, health and safety are reported to the Care Quality Commission so that, where needed, action can be taken. This is because the registered person did not notify the Care Quality Commission about all the incidents that affect the health, safety and welfare of people who used the service.

We saw there were enough qualified, skilled and experienced staff to meet people’s needs.

We had previous concerns about the safety of the physical environment and set compliance actions regarding these in our inspection on the 23rd of January 2013.

We inspected next on the 24rd of April 2013 and found that although the home had addressed a number of areas, they had not completed all the actions required and so remained non compliant in this area, leaving people still at risk.

We then received concerns from care managers that the lift was out of order and so some people had no access to bathrooms and people’s needs were not therefore being met, and action by the home to address this was taking an unreasonable length of time.

We visited and found that the work we identified as needed and the repairs to the lift had taken an unreasonable length of time. Some areas still remained unsuitable for appropriate and safe use, for example, the bathrooms and the sluice rooms.

We also found in all cases there was no planning or contingency planning. This would be needed to ensure the work was carried out in a risk assessed and prioritised fashion, with any delays and their consequences planned for and therefore managed.

We also found that people could not be confident that all of the types of important events that affect their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken. This was specifically the case for any environmental incidents or situations that are required to be reported to us.

People told us that they could go where they choose and do what they wanted. They said that they were treated with respect, that staff were nice to them and asked them about their care. They told us they liked their rooms and the home and felt safe there.

One person told us there were enough staff and they didn’t have to wait for them to support them. The said they looked after them well and treated them lovely.

Another person told us that they were aware of their care plan, that the staff understood their needs well and supported them to do what they want to do without delay. They said they had no complaints but knew how to make one and would if they did.

The provider had not taken sufficient steps to provide care in a home that was suitably designed and adequately maintained. Although the service had made much improvement in this area, people who use the service were not always protected from the risks of unsafe or unsuitable premises. This was due to staff ignoring warning signs and leaving doors to hazardous and unsafe areas open and accessible, so that people could be exposed to danger.

We saw that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found the home to be well maintained hygienic and clean. However, all safety doors we saw, such as those to lift machinery or electrical cupboards that are required to be locked to protect people, were unlocked with the keys left in the locks.

A visitor told us the building was always fresh and clean and that the staff welcomed visitors listened to their concerns and kept them informed. They also told us that they felt their friend was safe at the home and they were always relaxed and happy when staff came into the room and never looked worried or anxious.

People told us that they felt safe in the home, that staff were nice to them asked them about their care and they liked their rooms and the home.

All the people who used the service we spoke with and their relatives, said the food was always good and that they were offered choices with meals.

People also spoke about being able to choose what they wanted to do

People told us that they thought the staff were nice and knew their job.

Two people told us that they felt respected, were treated with dignity and they were involved in their care planning.

A relative told us that they had noticed the increase in staff training.

Two people we spoke with told us how they wanted to go out more in the garden and that there wasn’t enough staff to do that all the time, and especially at weekends. One person suggested that volunteers to allow for more individual activities would be helpful to facilitate this.

People were pleased or very pleased with the levels of care provided. They felt that staff treated residents with respect. People said the staff were caring and kept families informed about changes in their relatives' conditions. The local social services and the local General Practice both felt the service was safe.