About the service: Glenesk is a care home that provides personal care for up to 22 people in one adapted building. It is registered to provide a service to older people who may be living with dementia or physical disability. At the time of the inspection 20 people lived at the home.

People’s experience of using this service: People were placed at risk of harm as medicines were not managed safely. There had been a failure to learn from incidents. Improvements were required to ensure the home was clean and well maintained. There were not always enough, adequately trained staff available to meet people’s needs. Action had not always been taken to protect people from improper treatment and abuse. Risks associated with people’s care and support were managed safely. Overall, safe recruitment practices were followed.

Further work was needed to ensure people’s rights under the Mental Capacity Act 2015 were protected. Staff required more effective training and support to enable them to provide high quality care. Mealtimes were positive experiences; however, more work was needed to ensure risks were managed safely. People had access to a range of health care professionals. Overall, the home was adapted to meet people’s needs, but some areas were in a poor state of repair and there was limited private space.

People were supported by kind and caring staff. Staff upheld people’s right to privacy and treated them with respect. People were enabled to have control over their lives and were supported to be as independent as possible.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. People and their families were given an opportunity to discuss their wishes for the end of their lives. People were offered opportunities for meaningful activity. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

Systems to ensure the safety and quality of the service were not fully effective. Where issues had been identified, improvements had not always been made or sustained. This failure to identify and address issues had a negative impact on the quality of the service provided at Glenesk. Sensitive personal information was not stored securely. The management team were responsive to feedback and took swift action to address issues identified in this inspection. There was positive partnership working with health professionals.

The service met the characteristics of Requires Improvement in most areas; more information is in the full report

Rating at last inspection: Requires Improvement (report published on 17 October 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: During our inspection we requested evidence of improvements made in in relation to medicines management. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on the 13 September 2017 and was unannounced. This was the first comprehensive inspection following the change of ownership of the home in February 2015.

Glenesk Care Home provides accommodation for older people requiring support with their personal care. The service can accommodate up to 22 older people. At the time of our inspection there were 21 people living at the home.

The service had a 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. However, the registered manager only worked part time and the provider had been unable to sustain a full time manager to manage the day to day running of the home. This had impacted on the general day to day oversight of the home.

There was not always sufficient staff to meet people’s needs in a timely and safe way. Staff interactions with people were good but task focussed. Outside of the interaction staff had with people when providing their direct care there was little positive engagement.

There was no area, a part for a person’s bedroom, for people to meet with their family and friends privately. There was a potential for people’s confidentiality to be breached as there was no separate area for the managers’ and staff to complete records and hold staff handover briefings.

The systems in place to monitor the quality of the service did not effectively pick up on the overall experience of people living in the home.

Staff were supported but the level of induction for new staff needed to be improved and staff supervisions needed to be more consistent. Staff did undertake training which helped them to understand the needs of the people they were supporting.

People received care from staff that were kind, compassionate and respectful. Their needs were assessed prior to coming to the home and individualised care plans were in place which were kept under review.

Staff protected people’s dignity and demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were 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.

Care plans detailed people’s preferences, likes and dislikes and the plans were regularly reviewed to ensure they remained relevant to meeting people’s needs.

People were encouraged to follow their interests and there was a variety of activities that people could take part in if they wished. Families were welcomed and encouraged to take part in events with their loved ones.

People’s nutritional needs were being met and people were given a choice as to what they ate and where they ate. Support was available if needed and staff sat with people to help encourage people to eat.

Staff knew how to protect people and recruitment practices ensured that people were cared for by staff that were suitable and safe to support them. People could be assured that they were protected from any avoidable harm or abuse.

There were opportunities for people and their fami