About the service:

Glentworth House 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. Glentworth House is registered to provide accommodation and nursing care for up to 33 people. At the time of the inspection there were 28 people living at the home.

What life is like for people using this service:

• People told us they felt safe living at Glentworth House. However, we found some improvement was needed to reduce the risk of cross infection between people, to ensure medicines were managed in accordance with best practice guidance and to ensure safe recruitment practices were followed consistently.

• Quality assurance processes were not always effective. They had not identified concerns we found during the inspection, relating to the management of medicines, infection control and recruitment practices. Updates identified during care plan reviews were not always completed.

• People’s needs were met in a personalised way by staff who were highly competent, kind and caring. Individual and environmental risks were managed appropriately.

• People’s rights and freedoms were upheld. Staff acted in the best interests of the people they supported.

• People were empowered to make their own choices and decisions. They were involved in the development of their personalised care plans.

• People felt listened to and knew how to raise concerns. They, and healthcare professionals told us they would recommend the home to others.

• Staff respected people’s privacy and protected their dignity.

• People and staff were engaged in the running of the home.

• The home experienced low levels of staff turnover, which enabled staff to develop meaningful relationships with people and a comprehensive understanding of their needs.

• Everyone we spoke with, including external professionals, had confidence in the management and felt the home was run well.

The service has been rated Requires improvement it met the characteristics for this rating in two of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

Rating at last inspection:

The service was rated Good overall at the last full comprehensive inspection, the report for which was published on 9 September 2016.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Glentworth House provides accommodation and nursing care for up to 33 people who have nursing needs, and other conditions such as dementia, diabetes and strokes. Glentworth House is owned by Whytecliffe Limited and has another home nearby. Accommodation was provided over two floors with a passenger lift that provided access to all parts of the home. People spoke well of the home and visitors confirmed they felt confident leaving their loved ones in the care of Glentworth House.

The home had a registered manager. A registered manager is a person who has registered with the 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 home is run.

Medicines were not managed safely and in accordance with current regulations and guidance. Systems in place had not ensured that medicines were administered appropriately or by nurses who had completed an annual competency assessment. We have identified these issues as areas of practice that needs improvement.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The home was applying these safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported in ways that were most appropriate for their needs and known wishes. A relative said, “There is a nice atmosphere here. The staff and management are nice and caring and concentrate on the residents. You can’t fault the quality of care which is provided.” There were sufficient numbers of staff available to meet people’s needs.

People’s healthcare needs were assessed and care was planned and delivered in a consistent way. Care plans gave information and guidance to staff about people’s health and care needs that was clear. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to help keep people safe.

Observations of interactions between staff and people, our conversations with people, their relatives and feedback from health and social care professionals found that people were cared for by staff who were kind and compassionate. Staff engaged and communicated with people in a way that respected their dignity. Social and daily activities provided met peoples individual needs. One visitor said, “The residents themselves always seem so peaceful and content and that is evidence of the fact that the staff and [registered manager] work so hard to pay attention to their needs as well as keeping them feeling happy and comfortable.”

People, their relatives and staff told us they felt able to approach any member of the management team. They said there was clear communication between the staff team and the management of the service. A visitor said, “I find Glentworth House to be extremely well managed and with a high calibre of both nursing staff and carers.” People were able to complain or raise concerns if they needed to. The provider regularly reviewed the performance of the home to ensure that standards were maintained and improvements were made. They sought the views from people using the service.

Our inspection team was made up of one inspector. We answered our question; Is the service safe?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff understood the signs of abuse and were able to raise this with the right person when those indications were given. We looked at a safeguarding referral made to the local authority after our last visit. We saw that the provider had held meetings with all staff to discuss safeguarding practice and procedures. A person who used the service told us, “I am very satisfied. Staff are very polite to me, they are fantastic given the difficult job they have to do.”

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected the issues identified in the assessment. These were sufficiently detailed to allow nursing and care staff to deliver safe and responsive care. A care worker said, “The care plans are useful, especially when we receive new people. They give you enough information to work confidently with that person.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke to a person who told us they did not always feel safe and comfortable with one member of staff. The person who told us this also said that they had informed a senior member of staff about their experiences and concerns two days before our visit. We looked at care records and found no entry relating to what we had been told. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to responding appropriately to any allegation of abuse.

Systems were in place to make sure that all staff learnt from events such as accidents and incidents, complaints or concerns. Feedback was sought from people and their relatives which helped the service develop and learn.

Is the service effective?

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that people or their representatives had been involved in their care assessments and reviews.

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person who used the service told us, “The staff here take care of all our needs. We are well looked after.” Staff had received training to meet the needs of the people receiving care.

Is the service caring?

People were supported by committed and attentive staff. We saw that care staff were patient and empathetic when supporting people. The relative of one person told us, “[My relative] has blossomed since being here. I am full of praise for all the carers.”

Is the service responsive?

People’s needs were continually assessed. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and treatment had been provided in accordance with people’s wishes. One person told us, “They [relative] were poorly at home and that led to them going into hospital. [My relative] came here and went from strength to strength. [My relative] is now walking once again, whereas before she wasn’t.”

Is the service well-led?

Staff had a good understanding of the ethos of Glentworth House which promoted in their literature its commitment to providing, ‘personalised individual care in a homely and friendly environment’ and quality assurance processes were in place to support this. People told us they were asked for their feedback on the service they received and they confirmed they had felt listened to.

During our inspection we spoke with five people who used the service and four of their family members. We spoke with seven staff members; these included the registered manager and care workers. We used different methods to help us understand the experiences of people who used the service. We took information from other sources to help us gain information, including meeting minutes and a review of documentation.

The people we spoke with told us they were happy with the care they had received and with the staff team. A person who used the service told us "It's a nice place to live". Another person told us "I do like it here. The staff are nice". Staff we spoke with had a good understanding of people's care needs. One member of staff we spoke with told us "I think we provide a good service to the residents”. A relative of a resident told us "The staff are kind and caring."

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service. The home appeared clean and well maintained. We saw that they had appropriate systems and policies in place in respect to cleanliness and infection control.

We found people were protected from the risks of inadequate nutrition and dehydration.

The staff we spoke with during our inspection told us that they felt valued and supported. We saw that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.

During our visit, we found that people living in the home appeared settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that, in accordance with their identified wishes and individual support plans, people were encouraged and enabled, as far as practicable, to make choices about their daily lives.