The inspection took place on 19 March 2018 and was unannounced. The last inspection was undertaken on 22 September 2015 and the service was rated Good at that inspection.

Glenbank 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.

Glenbank Care Home accommodates 24 people in one adapted building. Accommodation is provided on three floors, each having bathroom and toilet facilities. A passenger lift provides access to all floors.

The home is situated on a bus route providing access to Bolton and Horwich town centres. There is a large enclosed garden, and the home overlooks a lodge and conservation area.

There was a registered manager at the home. 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 at the home. The service had an appropriate safeguarding policy and staff had undertaken safeguarding training.

Health and safety records were in place and regular checks undertaken. Accidents and incidents were recorded and there were individual and general risk assessments in place.

Staffing levels were consistent and flexible and staff recruitment was robust.

Medicines systems were safe and staff had undertaken appropriate training in medicines administration.

Care files included a range of information about people’s health needs and monitoring charts, where required, were in place and up to date.

There was a thorough induction in place for new staff and training was on-going. Systems were in place to ensure staff had regular supervisions and annual appraisals.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff were respectful, friendly and kind when interacting with people who used the service. People who used the service were well presented and looked happy and content.

People were included in their care planning and reviews and residents’ and relatives’ meetings were held regularly. Relevant information about the service was available for people to read.

People told us the service was responsive to their needs. Staff went out of their way to assist people. Care plans were person-centred, regularly reviewed and included information about people’s likes and dislikes. There were a number of activities and outings on offer at the home.

There were advanced care plans which outlined people’s wishes for when they were nearing the end of their lives. Some staff had undertaken end of life care training.

There was an appropriate complaints procedure which was displayed around the home. There had been no recent complaints received.

The service had a registered manager who demonstrated a commitment to ensuring people’s experience of the service was positive. Staff we spoke with told us they were well supported by management and each other.

The registered manager/provider was involved with a number of initiatives and meetings within the local area including taking a lead role within the local Care Home Excellence programme, being part of a task and finish group and taking part in a falls prevention pilot scheme.

A quality assurance tool was used to gather information from people who used the service and there were a number of audits in evidence. All audits were analysed for patterns and trends and informed continual improvement to service delivery.

The unannounced inspection took place on 22 September 2015. At the previous inspection in May 2014 the service were found to be meeting all the regulations inspected. Glenbank Care Home provides personal care in three shared and 21 single rooms. Accommodation is provided on three floors, each having bathroom and toilet facilities. A passenger lift provides access to all floors. On the day of the inspection there were 26 people residing at the home.

The service had 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.

We saw that the service had appropriate health and safety measures in place. Environmental and equipment checks and maintenance were undertaken as required. Emergency procedures and individual risk assessments were in place.

Recruitment at the service was robust and the staffing levels were sufficient to meet the needs of the people who used the service.

The service had an appropriate safeguarding policy and procedures were in place for staff to follow, but local authority contacts needed to be added to give staff a further support. Staff we spoke with demonstrated a good working knowledge of safeguarding issues.

Robust systems were in place for the ordering, storage, administration and disposal of medicines. Infection control procedures were in place and were followed as required.

We looked at four care plans and saw that they included a range of health and personal information. The files were clear and easy to follow.

People’s nutrition and hydration requirements were addressed and people were given sufficient nutritious food and choices of meals. The dining experience was calm and efficient with everyone’s needs being met appropriately.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was sought were appropriate and signed consent forms were in evidence within the care files.

There was a thorough and robust induction programme for staff and training was on-going.

People who used the service, and their relatives, told us the staff were kind and caring. We saw that dignity and privacy was respected at all times.

People who used the service and their relatives where appropriate, were involved in planning and reviewing their care delivery.

Comprehensive information was given to prospective users of the service. Regular district nurse meetings with relatives were facilitated at the home to provide a forum for them to raise issues or concerns.

Care plans were person centred and included information about people’s preferences, likes and dislikes, background and interests.

A range of activities was on offer, both in the home and outside and the home had a dedicated activities coordinator. The service linked in with the local community to offer a wider range of activities.

Suggestions made via themed quality assurance questionnaires had been responded to by the service.

The service had an appropriate complaints procedure which was displayed around the premises.

There was a registered manager at the service and the management team were visible within the home. People who used the service, relatives and staff felt they were approachable.

Staff supervisions and appraisals were regularly undertaken.

A number of quality audits were carried out on a three monthly basis. Issues identified were followed up appropriately.

The registered manager participated in local groups and meetings to ensure her knowledge and skills with regard to best practice were kept current and up to date.

During this inspection the Inspector gathered evidence to help answer 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?

During the inspection we looked at respect and involvement, care, safeguarding, staffing and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking with professional visitors to the service and looking at records:

Is the service caring?

During the visit we saw care being offered to people who used the service in a friendly and polite manner. Staff administered care with patience and kindness and ensured people’s dignity and privacy were preserved.

The home ensured that people who used the service were able to offer suggestions and raise concerns via regular questionnaires. The results of these were analysed and any issues addressed in a timely way. People who used the service and their relatives were encouraged to speak with staff members or the home manager at any time if they wished to.

There were a number of activities on offer, such as trips out, exercises, games and entertainment. This helped give people a focus and provided things to look forward to.

We spoke with three people who used the service and two visitors. They all emphasised the friendliness of the staff and the homeliness of the establishment.

Is the service responsive?

We spoke with two visitors to the service who told us communication was excellent between the staff and themselves. They were contacted immediately if there was any issue with their relatives and kept informed of all developments.

One visitor told us that staff responded very quickly to summons by buzzer from people who used the service. We spoke with people who used the service who confirmed they were attended to very quickly, except on the odd occasion when an incident or accident had occurred.

We spoke with a District Nurse who was a regular visitor to the service. They told us appropriate referrals were made to their service, advice was sought when necessary and instructions were followed well by staff. Documentation was completed accurately by staff.

People’s individual care needs were assessed and care delivered in as personal and individual a way as possible. Religious services were arranged for those who wished to attend and efforts were made to link in with the community to ensure people’s interests were responded to where possible.

We saw evidence of the consideration of mental capacity and decisions being made in people’s best interests, with the input of relevant professionals, family and friends.

Is the service safe?

There were sufficient numbers of staff on duty at the home on the day of the visit. Rotas evidenced this was usually the case, which was confirmed by staff, people who used the service and their relatives.

Training records indicated that staff had undertaken all mandatory training and that training was on-going and regularly refreshed and updated. Staff with whom we spoke were able to give examples of how they would follow the safeguarding policy and procedure at the home and demonstrated a good knowledge and understanding of safeguarding issues.

Risk assessments, such as falls, nutrition and moving and handling were in place in the care records and were reviewed and updated regularly to ensure people’s needs were met safely.

Although no one was currently subject to a Deprivation of Liberty Safeguards (DoLS) authorisation the manager had a good understanding of the process. They were aware of the correct people to contact and how to do this.

All the people who used the service had a Personal Evacuation Plan (PEEP) so that staff were aware of the level of support required by each person in the event of an emergency.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities.

Care plans we looked at included factual and up to date information about people’s health and personal backgrounds, likes, dislikes, interests and hobbies. This helped ensure care was delivered in an individual way.

Recent questionnaires filled in by people who used the service indicated a high level of satisfaction and some suggestions for improvements had been made and responded to. Relatives felt the staff and management were approachable and would address any concerns or issues raised in a timely manner.

The people who used the service with whom we spoke felt the care provided was effective and appropriate. We spoke with two visitors who agreed that their relatives were cared for appropriately and well.

Is the service well-led?

The home had an appropriately registered manager in place at the home.

The manager actively participated in a number of local groups, such as the local Healthwatch, to help drive improvements to services in general and their own service in particular.

A significant number of audits and checks were in place at the home to help ensure consistent standards of care within the home.

Questionnaires were regularly completed with people who used the service, to gain their opinions and suggestions and gauge their level of satisfaction. Results were analysed and used to inform continual improvement to the service.

Glenbank care Home refer to people using their service as residents we will use this term in the report.

We found that Glenbank care Home was currently undergoing alterations to the front of the building, this did not effect the care being delivered to the residents.

We found care was planned following an indepth assessment of need, residents had signed their agreement to the care packages in place.We saw three monthly updates of care plans and risk assessments had been completed and plans updated as required.

When reviewing care files we saw nutritional assessments were completed as required. We noted residents were weighed monthly or more frequently if any weight loss was noted. We found that referrals to GP and dieticians were made when appropriate. We found meal times were social events for the ladies.

Residents were cared for by staff who had received appropriate training for their roles.

Glenbank Care Home had a robust process in place to monitor the quality of the care provided to residents within the home. The manager showed us documentary evidence to support an ongoing audit programme within the environment. We saw evidence of a comprehensive complaints policy although there were no ongoing complaints.

Residents told us; "I love it here they really care for us". "I can still do the things I did in my own home like have my X visit and play games with him. Staff will take me shopping if I ask them to, nothing is too much trouble for them".

We found a large well maintained property where people told us they felt well cared for and safe. The home currently has 5 shared rooms and 14 single rooms across 3 floors. People we spoke with were happy with the care and support offered and said they got on well together.

We were told there were always activities going on and you joined in if you wanted to. Frequent days out were organised and a Christmas meal was planned for early December in Cleveleys.

People told us: "I love it here they look after me well". "I have been here for 4 years and as my needs change they change my care". "I come and go as I please if my family take me out I just let the manager know. I enjoy going out on the organised days too we have such a good time". "My grandson comes here and spends time with me he enjoys himself too". "I have made some good friends here and we laugh all the time".

People told us "We do very well here" and "I wouldn't change anything". We heard "We can do what we like as long as we tell someone what we're doing".

The people we spoke with described the activities that they could join in with, and one person said "There's always something going on, especially if it's a dull day". We were told about trips that people had been on, including going on the Mersey ferry, and going for meals in a local restaurant.

People told us that they were happy with the care they received and were involved in the planning of their care. We heard that people felt they were treated with dignity. We were told "I'm surprised I enjoy it so much" and "I've nothing bad to say about it here. I love it".