CQC report explained · a nursing home
What the CQC found at Gledholt
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured that infection prevention measures, PPE, testing, cleaning, visiting arrangements and vaccination requirements were being managed. They found that some care plans needed updating about isolation after a positive COVID-19 test.
- Effective?
- Good
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Good
- Is the home run well? The manager, the culture, how problems get found and fixed.
What inspectors found, February 2022
Inspected but not rated; inspectors found strong COVID-19 infection controls, with one care-plan update needed.
This was a targeted inspection on 3 February 2022. It looked at infection prevention and control, visiting arrangements and whether COVID-19 staffing pressures affected the home. The visit was announced with 24 hours' notice.
Inspectors found good infection control arrangements. Visitors were checked, staff used personal protective equipment correctly, testing was available and cleaning schedules were completed. The home also had ventilation, hand gel, supplies and infection control audits.
One shortfall was found. Some care plans needed updating to reflect the latest guidance on isolating after a positive COVID-19 test. The registered manager dealt with this after the inspection.
The home was inspected but not rated. This was not a full assessment of all five areas of care, so the report does not provide an overall quality rating.
Infection control
Staff used PPE correctly and the home had hand gel, hand-washing products, ventilation and regular cleaning of frequently touched surfaces.
“We observed staff wearing PPE correctly throughout the inspection.” from the report
Cleaning and audits
Cleaning schedules were complete, frequent-touch points were cleaned every two hours and infection control audits had led to actions and improvements.
“Cleaning schedules were fully completed and we observed domestic staff going around the home every two hours to keep frequent touch points clean.” from the report
Visiting arrangements
Visitors had to complete checks, including a negative lateral flow test, vaccination evidence, a temperature check and a COVID-19 questionnaire.
“Through checks were followed before visitors were allowed into the home.” from the report
Care plans needed updating
needs fixingSome care plans did not reflect the latest government guidance on isolating after a positive COVID-19 test. The registered manager dealt with this after the inspection.
“Care plans needed updating to reflect the latest government guidance on isolating after testing positive for COVID-19.” from the report
- 01What changes were made to care plans after the inspection about isolating following a positive COVID-19 test?
- 02How do you check that care plans continue to reflect current infection control guidance?
- 03What measures are currently in place if COVID-19 causes staffing pressures?
- 04How are visits managed now, including testing and vaccination requirements for visitors and professionals?
This was a targeted inspection of infection prevention and control, visiting arrangements and COVID-19 staffing pressures; it was not a full inspection and the service was inspected but not rated. This explanation was written from the published report of 16 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Gledholt rated Good; inspectors found safe, kind and personalised care, with some mental capacity and record-keeping gaps.
Inspectors visited on 17 and 18 December 2019. They spoke with people living at the home, a relative, staff and a healthcare professional. They observed care and checked care records, medicines, staff files, training and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and staff were kind, respectful and supportive. Inspectors found that people were encouraged to make choices, build independence, take part in activities and access healthcare.
There were some gaps in records. Not all decision-specific mental capacity assessments and best-interest decisions had been completed, and some care plan updates were still outstanding. The home had no registered manager at the time, but inspectors found alternative management arrangements were effective and a new manager had been appointed.
People felt safe
People told inspectors they felt safe, and staff understood safeguarding procedures and how to manage risks.
“People told us they felt safe.” from the report
Kind and respectful care
People and relatives gave positive feedback. Inspectors saw polite, relaxed and respectful interactions between staff and people.
“All of the people we spoke with told us staff were kind and caring.” from the report
Choice and independence
People were involved in care decisions and supported to develop daily living skills, go out and choose activities.
“People's independence, choice and control was promoted.” from the report
Good health support
Staff worked with healthcare professionals and followed advice about people's health needs, including choking risks.
“People were supported to live healthier lives through regular access to health care professionals such as their GP or psychologist.” from the report
Safe medicines practice
Medicines records showed people received medicines as prescribed. Inspectors found improvements since the previous inspection in checking medicines in and out of the home.
“Medicines were managed safely at the service.” from the report
Some mental capacity records were missing
needs fixingThe provider had not completed every decision-specific mental capacity assessment and related best-interest decision. Inspectors made a recommendation to improve this record keeping.
“We have made a recommendation for the provider to review and apply relevant guidance in this area.” from the report
Some care plans needed updating
needs fixingOne person's needs had changed, but the care plan had not yet been fully updated. Staff knew the required support, but the written record was behind.
“We reviewed the care plans for one person and noted that some areas needed updating; for example, the level of support they required with their medication.” from the report
The home is larger than current guidance suggests
minorThe home was registered for nine people and eight were living there. Inspectors noted that its size was larger than current best-practice guidance, although they found the design and location reduced the possible negative impact.
“The service was a large home, bigger than most domestic style properties.” from the report
No registered manager at the inspection
minorThere was no manager registered with the CQC during the visit. Inspectors found alternative arrangements were effective, and a new manager had recently been appointed.
“There was not a registered manager in place but alternative management arrangements were effective and a new manager had recently been appointed.” from the report
- 01Have all decision-specific mental capacity assessments and best-interest decisions now been completed, including those about medicines?
- 02Have the care plans that needed updating been brought up to date, and how are changes in people's needs recorded?
- 03Who is currently managing the home, and is the manager now registered with the CQC?
- 04How are medicines checked and administered now that team leaders are taking the lead instead of nursing staff?
- 05How does the home make sure its larger size does not limit people's choice, privacy or independence?
This was a planned inspection covering all five CQC questions, including the premises and care provided; the previous overall rating was Good, published on 9 June 2017. This explanation was written from the published report of 17 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Gledholt
2 rated inspections over 3 years: the service has held its Good rating throughout.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- January 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2017GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016
Registered with the Care Quality Commission on 25 April 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Kirklees
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 86 can care for a couple. 11 years' experience on average.
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“Primrose is a very kind and compassionate healthcare professional”
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