This was an unannounced inspection which took place on 30 August 2017.

At the last inspection in April 2016 the service was not meeting all of the legal requirements with regard to governance. At this inspection we found improvements had been made and the service was no longer in breach of these requirements.

Glenholme Residential Care Home is registered to provide accommodation for personal care to a maximum of 37 older people, some who may live with dementia. Nursing care is not provided. At the time of inspection 31 people were living at the home.

A manager was in place who was in the process of applying to become registered with the Care Quality 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 said they felt safe and they could speak to staff as they were approachable. We considered there were sufficient staff on duty to provide safe care and support to people.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. However, we have made a recommendation that volunteers who spend time in the home should also be vetted.

People told us their privacy, dignity and confidentiality were maintained. Staff understood the needs of people and care plans and associated documentation were clear and person centred. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. People received a varied and balanced diet to meet their nutritional needs. People told us staff were kind and caring and they felt comfortable with all the staff who supported them

Appropriate training was provided and staff were supervised and supported. People were able to make choices about aspects of their daily lives. They 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.

People and staff spoke well of the manager and management team. There were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided. These methods included feedback from people receiving care.

This inspection took place over two days, 5 and 6 April 2016 and was a result of concerns raised to the Commission regarding staffing levels and the cleanliness of the premises. The inspection was unannounced. This meant that the provider and staff were not made aware of our inspection ahead of our visit. The service was last inspected 4 August 2015. The service was rated as good and no breaches of regulation were identified.

The service provides residential care for up to 37 older people who may be living with a dementia. Glenholme Residential Care Home is a two storey converted townhouse with bedrooms located on both floors.

At the time of the inspection 31 people were living at the home, 19 of these people were living with a diagnosed dementia.

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.

Medication Administration Records (MAR) were not consistent. The service were using two differing MARs which had different codes for staff to use to determine whether a medicine had been given, refused or destroyed. Due to this we found conflicts in the coding system, it was unclear what medication had been administered. Medicines were not always disposed of in an appropriate and safe way. Liquid medicines were flushed down the sink.

The use of the dependency assessment tool, to determine staffing levels, was not effective in ensuring there were sufficient staff on duty, to meet the assessed needs of people who used the service. People who used the service were protected against other risks associated to their care and welfare by appropriate assessment and risk management measures being put in place.

People who used the service felt safe in the home and with the staff who supported and cared for them. Staff knew how to report any concerns about the safety and welfare of people who used the service. Robust recruitment procedures were in place and appropriate checks were carried out before people started work.

People were protected against the risks associated with the premises through appropriate legislative safety checks, in house safety checks and maintenance, such as portable appliance testing (PAT) and fire safety checks.

The home had not been adapted to meet the needs of people who are living with a dementia. The provider recognised the need for refurbishment to address this, but at the time of the inspection no work had been undertaken.

The service ensured that people were supported to have sufficient to eat, drink and maintain a balanced diet. Where people were identified as being at risk of malnutrition or dehydration the home did not monitor these needs effectively.

People were supported and had access to a range of healthcare professionals. This included GP's, opticians, dentists and chiropodists. The home included these professionals in the on-going care and treatment of people who used the service when necessary.

Consent to care and treatment was sought in line with legislation and guidance.

Positive and caring relationships were developed with people who used the service. The service had a stable staff team who knew people well. Staff knew and understood how people preferred to be cared for and supported.

Observations demonstrated that people were treat with kindness and compassion. People's privacy and dignity was respected and promoted. Staff were proactive in their approach to offering care and support discreetly to people who used the service.

People were supported to express their views and be actively involved in making decisions about their care, treatment and support.

People did not receive personalised care that was responsive to their needs. Planning and delivery of care an

Due to the physical and mental health needs of the people living at the home it was not possible to obtain some people’s views. However we used a number of different methods to help us understand the experiences of the people using the service including Short Observational Framework for Inspection (SOFI) exercise. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

We spoke with three relatives who were positive about the care their relatives received. One said, staff were “Very good”. Another said “I cannot fault the staff here” and another said her relative is “Happy here”. They all felt their relative was safe.

We found people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights. People who used the service were protected from the risk of abuse and people were cared for by suitably qualified, skilled and experienced staff. The provider had an effective system to regularly assess and monitor the quality of service that people received.

People we spoke with told us they were consulted about the care they received. Two people who used the service told us about giving consent to the content of their care plans. One person told us, “I know what is in my care plan and I agree with it”. A relative told us, ”They also tell us what is happening with mom, and I have been at the review to discuss her care”.

We saw appointments with dentists, chiropodists, psychiatrists, community psychiatric nurses, opticians and other health related activities. Details of contacts with healthcare professionals were recorded on each person’s file. This showed that people received appropriate care and support from the NHS. Comments from the people who used the service included; “I am very happy with the care I get here”; “The doctors and nurses come to see their patients all the time”; “The care here is excellent and I have no regrets coming here”.

The service users said that the staff often talk to them about their care plans and are told what is in their care plans. One service user said that her daughter often talks to the manager about her care needs and also her care plans. She stated that her daughter is kept informed about her care. We also spoke with two visitors and they both stated that although they were friends to the people they were visiting, the staff often told them how their friends were doing. One relative described how the staff often informed her about doctor’s visits and any changes in her relative’s condition.

The service users were complementary about the meals and said that there is always plenty to eat. Some of the comments included:

“The food is lovely here”.

“There is always plenty to eat and drink”.

“I enjoy my food, and I like the choice we are given”.

A visiting relative commented on the “home cooking” and said that her friend who is a resident in the home has always been complementary about the food and the choices available to them.

Other comment by the service users included:

“I am here for a short stay but I think I will stay permanently. I like it so much here and the staff are very caring”.

“I can’t complain about anything. We are well looked after”.

“You couldn’t fault the staff or the care here. I am happy here”.

“I know of the home’s complaints procedure and would know what to do if I am not happy with anything”.

“I can’t complain. The staff are very kind and caring”.

“ I am very happy with the home and everywhere is nice and clean”.

This inspection took place on 4 August 2015 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 5 August 2015 and was announced. The service was last inspected in May 2013. At that time it met all of the standards that we inspected against.

Glenholme Residential Care Home provides care for up to 37 people some of whom have nursing care needs. The service is based in a two-storey converted Victorian townhouse, and bedrooms are located on both floors. There is a separate day centre adjoining the building.

At the time of the inspection there were 33 people using the service. 22 people had general nursing needs. Eight people were living with dementia.

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.

The accommodation was not specifically adapted for people living with dementia, even though the home provided this support.

People said they felt safe and comfortable at the home. Staff knew how to recognise and report any suspicions of abuse. Staff told us they would report any concerns to make sure people were protected. Potential risks to people’s safety were assessed and managed. People’s medicines were managed in a safe way although the security of the storage could be improved.

People told us there were enough staff to meet their care needs. Care professionals told us it was a “very good” service and staff were familiar with each person’s individual needs. Staff attended quickly when people needed assistance. Staff were recruited in a safe way so that only suitable staff were employed.

The registered manager and staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. Staff asked for permission before carrying out care tasks. People told us they made their own choices over their own daily lifestyle.

Staff were knowledgeable about people’s individual care needs and how they wanted to be assisted. People were supported to eat and drink enough and they had choices about their meals.

Health care professionals said the home responded quickly to any changes in people’s well-being.

We saw that people were treated with dignity and respect. People were positive about the service, and were happy with the care that they received. Staff were well liked by people and their families. We saw that people were treated in a caring way. People were involved in decisions about their care and support.

The service did not advertise the role of advocates. No-one at the service required an advocate but we made a recommendation about this.

Care plans were comprehensive and gave a good insight into people’s needs and how they would like them to be met. People’s needs were assessed in detail, and were reviewed regularly. The plans contained details of personalised care, and we saw that staff were able to use these to deliver the care that people wanted.

The service employed an activities co-ordinator and we saw that people enjoyed the activities on offer. People and their families were able to give feedback on activities, and this was acted on. However, we saw that carers did not always have the time to join in with activities.

People knew how to raise complaints, and we saw that where this had happened they had been quickly and appropriately responded to.

Resident and family meetings were arranged regularly which gave people the opportunity to provide any feedback or share ideas, though we saw that these were not advertised within the service. The registered manager also sent people an annual questionnaire, and we saw that this had been used to improve the service. People and staff told us that issues they raised were sorted out quickly.