This was an unannounced inspection which took place on 29 and 31 October 2018. The last inspection was in May 2016 when the service was rated as ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The Glade is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The Glade is a residential care service which offers support for up to 25 older adults. It is a converted Edwardian residential property set over four floors. A passenger lift provides access to all areas of the building. Accommodation comprises of bedrooms which have a wash basin facility and a small proportion of bedrooms have an en-suite. There is a dining area situated on the ground floor and a spacious lounge which overlooks a large enclosed garden. The property is both decorated and furnished to a high standard. The service is conveniently situated near to bus routes and local amenities. At the time our inspection there were 19 people living at the service.

The service had a registered manager in post. A registered manager is a person who has registered with 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.

Staff had received training in safeguarding and were knowledgeable in both how to identify and how to report abuse. We found that staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken. People told us staff were caring and kind.

Staff had received training which equipped them with the knowledge and skills to ensure people received adequate support. The majority of staff had completed National Vocation Qualifications (NVQs). NVQs are nationally recognised qualifications achieved through training and assessment which help to ensure that staff are competent to carry out their job role to the required standard.

Medication was managed safely and was administered by staff who were competent to do so.

Appropriate arrangements were in place for checking the environment was safe. For example, health and safety checks and audits were completed on a regular basis and accidents and incidents were reported and recorded appropriately. People told us they felt safe living at The Glade.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the rights of people to make their own decisions.

People were involved in their care and there was evidence in their care records to show that they had been consulted about decisions. Care records contained detailed information to identify people’s requirements, preferences and routines in relation to their care and support.

Appropriate risk assessments were carried out and recorded which helped to keep people safe. People were referred to external health professionals appropriately, this helped to promote people's well-being. People told us they were supported by staff to attend health appointments.

There was no set daily routine at the service and people told us they had a choice in what activities they participated in each day. The service had its own mini bus and people enjoyed weekly trips out.

Effective quality assurance processes were in place to seek the views of people using the service and t

This unannounced inspection of The Glade Residential Care Home took place on 19 May 2016.

The Glade Residential Care Home is registered to accommodate and provide personal care for up to 25 people. It is located in a residential area and is close to local facilities in Birkdale Village. The home provides accommodation over four floors and has lift access. The shared areas consist of a dining room and a lounge. There is a large garden to the back of the building.

There were 25 people living at the home when we carried out the inspection.

A registered manager was not in post as they had recently left the service. 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 secure living at the home and were supported in a safe way by staff. Visitors to the home that we spoke with also told us they thought The Glade was a safe place to live.

The staff could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. Staff confirmed they had received adult safeguarding training.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People living at the home and staff told us there was sufficient numbers of staff on duty at all times.

Staff told us they were well supported through the induction process, regular supervision and appraisal. They said they were up-to-date with the training they were required by the provider (owner) to undertake for the job.

A range of risk assessments had been completed depending on people’s individual needs. Care plans were well completed and they reflected people’s current needs. Risk assessments and care plans were reviewed on a monthly basis.

People told us they received their medication at a time when they needed it. Checks were in place to ensure medicines were managed in a safe way.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment and equipment.

People said their individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

People living at the home were satisfied with the meals and said they could have snacks and drinks between meals and at night. A food audit had been conducted shortly before our inspection to seek feedback on the food.

People, families and staff described the manager as effective and approachable. Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home and staff throughout the inspection. A full and varied programme of recreational activities was available for people to participate in.

Records regarding Deprivation of Liberty Safeguards (DoLS) and how mental capacity assessments were completed suggested management and staff were unclear about how to apply the principles of the Mental Capacity Act (2005). We made a recommendation regarding this.

The culture within the service was and open and transparent. They said they felt listened to and involved in the running of the home. People we spoke with told us the registered manager and staff communicated well and kept them informed of any changes.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities, such as staff meetings were in place to address lessons learnt from the outcome of incidents and complaints.

A procedure was established for managing complaints and people living at the home and their families were aware of what to do should they have a concern o

This inspection was to follow up on a previous inspection in August 2014. At that time the home had failed to meet requirements with respect to staff training, quality assurance and record keeping. This inspection was to check on progress and improvements made.

We found at this inspection that improvements had been made. Staff were supported with appropriate training to deliver care effectively. Systems were in place to assess and monitor the quality of the service. This included the completion of care audits to help assure the care provision. Records seen were up to date to help protect people from the risks of unsafe or inappropriate care and treatment.

Prior to our inspection we received some information of concern regarding the management of people’s medical conditions and people not receiving support and advice from external health care professionals at the appropriate time. We therefore carried out an unannounced inspection of The Glade.

The inspection helped answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they had access to their GP and other health care professionals for medical conditions that needed monitoring or to be followed up. They told us appointments were made for them at the appropriate time. A person told us "They [the staff] ring the doctor pretty quickly." People told us they felt safe living at the home.

Systems were in place to ensure the manager and staff learnt from events such as accidents and incidents. This helped to reduce the risks to people and for the service to continually improve.

People told us that there were sufficient numbers of staff on duty to support them.

There was little recorded evidence to show how people were involved in making decisions about the care and support they needed. People however told us they received the support they needed. The manager showed an understanding of the Mental Capacity Act [2005] which is the legislative framework for the decision making process regarding people who may lack mental capacity.

We found that a number or care records lacked detail or had not been updated to reflect a change in people’s needs and the current care provision. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people’s records accurately record their care needs to ensure their safety and well-being.

Is the service effective?

People had a plan of care, risk assessments and other supporting care documents for their assessed needs. Aids to assist people with their mobility were recorded to help improve people’s independence.

Staff told us they had access to mandatory/statutory training to help them with their job role. The training plan showed that the staff required moving and handling training as the current certificate has expired. There were no planned dates to deliver this staff training. We have asked to provider to tell us what they are going to do to meet the requirements of the law for the staff to be properly supported to provide care and support to people who live at the home.

Is the service caring?

People who lived at the home told us they were treated with respect and dignity by the staff. People also said they were satisfied with the standard of care and support they received. Their comments included, “Very kind staff”, I think I am OK and get help from the girls”, “There are enough staff on duty to help me” and “The staff are around to help us.”

We observed staff supporting people with various aspects of personal care. Their approach was kind and helpful. Staff communicated well with the people they supported and were attentive to people’s needs.

Is the service responsive?

The home provided a social activities programme in and outside of the home to meet people's needs and wishes. A minibus was used to help people be involved with the local community.

People told us they knew who to speak with if unhappy about the home. A complaints procedure was available should people wish to raise a complaint.

Is the service well-led?

The service had a quality assurance system. This included a number of audits [checks] on how the service was operating. We found monitoring systems and some audits were not as robust as they could be to help assure the service provision. We have asked to provider to tell us what they are going to do to meet the requirements of the law ensure the home is assessed and monitored effectively to ensure the safety of people who live at the home.

Formal feedback from people who lived at the home was limited. There had been no recent satisfaction surveys sent to people to gain their views about the home and how it was run. People told us however they had confidence in how the service was managed.

We visited the Glade to review our findings of non-compliance in one outcome at our inspection in September 2013.

At this unannounced inspection we spoke with the Registered Manager about the changes that had been made since the last inspection in September 2013.

We made a thorough inspection of the home and looked at the improvements that had been made.

We looked at the homes policies and procedures relating to infection control. We looked at the audits (checks) carried out to ensure the home was kept clean and hygienic.

During our inspection we spent time with people who lived at the home and a visitor. We invited them to share with us their views and experiences of living at The Glade.

People we spoke with were positive about the care and support they received. Their comments included, “I am happy living here” and “I get the help I need and enjoy going out with my family as well.” People had a plan of care and this recorded information to enable the staff to provide the care and support people needed. Staff interviewed were knowledgeable about people's needs and wishes. A person said, "Everyone (the staff) knows me well and that is important to me."

People were satisfied with the quality of meals served to them. They told us they had plenty to eat and drinks at different times of the day.

We looked at standards of infection control and found a lack of cleanliness and hygiene. This meant people were placed at risk of poor standards of infection control.

We looked at different areas of the environment. Some areas required attention in respect of decoration and maintenance to ensure people's safety and well-being. The home has a refurbishment, decoration and maintenance plan. This evidenced work to be completed by September 2013 to ensure people lived in a safe well maintained environment.

People told us they received prompt attention from the staff. There was however no formal risk assessment to help determine staffing levels in accordance with people's assessed needs.

During this planned review, we spent time with people who used the service, their relatives and staff. We also followed up two compliance actions issued at our last visit to the service.

People and their relatives were positive about the standard of care and support provided at The Glade. They told us that staff were respectful, helpful and that they felt listened to. People knew how to make their views known if they were not happy with the service and told us about ‘residents meetings’ and surveys. Comments included:

“The staff are really caring – they must be well trained”.

“I’ve got no problems – I’d let the girls know if I did!”

“I’m happy here”.

People told us there were lots of activities available at the home, including regular trips out to local places of interest. People who used the service were also positive about the food on offer at the home and told us there was always plenty of choice available at mealtimes.

Our observations indicated staff were polite and respectful to the people using the

service. Staff were also observed to be caring and attentive.

We spoke with four people using the service. They all said that the staff respected their wishes and feelings and treated them with dignity. They said that their requests and preferences were listened to and acted upon.

The people using the service that we spoke to were happy with the service provided and the care they were receiving. Some comments made were;

" I'm happy here. The staff look after me very well. The food is nice. We go for trips out on the mini-bus."

"I'm well looked after. The staff provide the support I need. My visitors are always welcomed."

" I'm happy. The staff are attentive and helpful. There is plenty of good humour about the place."

"The staff are nice. The home is kept clean and the food is good."

Relatives spoken with said that the staff were friendly and helpful. They descrbed the home as clean and comfortable and said they were kept informed about their relatives well-being. Relatives reported that people got the care that they need.

Sefton Council's Contracts Monitoring Team reported that they have visited the home twice this year following safeguarding issues being reported to them by the manager. They last visited in October 2011 and have asked the manager to provide a detailed response to issues identified around record keeping, communication and training. Further information is currently being sought from the manager around the improvements made.