Gorsefield Residential Home

People’s experience of using this service:

People were not consistently supported by enough staff. People were not consistently receiving responsive care and support.

The systems in place to monitor the quality of care were not always effective and actions were not consistently driving improvements.

People felt safe and they were protected from the risk of abuse. Peoples risk assessments were followed and risks associated to the environment had been mitigated. Staff were safely recruited. Staff were trained and able to support people’s needs.

People were treated with kindness by staff who knew them well. People’s privacy and dignity was respected and their independence was encouraged. People could choose for themselves.

People were listened to and had their views sought about the care they received. There was a positive culture and learning and partnership working were encouraged.

The service met the characteristics of Requires Improvement in most areas.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 governance. Details of action we have asked the provider to take can be found at the end of this report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 7 February 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The location has previously been rated as Requires Improvement. At this inspection the provider had made improvements to those areas, but other areas were found to require improvement. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

Follow up: 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.

The service was last inspected on 4 April 2016, when it was given an overall rating of Requires Improvement. At our last inspection, we found there was not always sufficient numbers of staff deployed to meet people's needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found the provider was now meeting the requirements of Regulation 18, although there was a need for a more systematic approach to the assessment and adaptation of staffing arrangements in line with people’s changing needs.

Gorsefield Residential Home 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.

Gorsefield Residential Home accommodates for up to 16 older people some of whom are living with dementia in one adapted building. At the time of the inspection, nine people were living at the home.

The service is required to have a registered manager and there was a registered manager in post. 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 registered manager and provider did not work in partnership to assess, monitor and improve the quality and safety of the service provided. As a result, the provider’s quality assurance was not as effective as it needed to be.

Staff did not always follow good practice when handling and administering people’s medicines. Further measures needed to be taken to protect people, staff and visitors from the risk of infection. Staff had received training in, and understood, how to recognise and report abuse. The risks associated with people’s care and support had been assessed, recorded and plans were in place to manage these. The safety and accessibility of the home’s back garden needed to be improved.

People’s rights under the Mental Capacity Act 2005 were not always fully promoted. People had enough to eat and drink and any risks or specific needs associated with their nutrition or hydration were assessed, recorded and managed. The provider needed to do more to make the care home environment more dementia-friendly. Staff received induction, training and ongoing support from management to help them fulfil their job roles. Staff monitored people’s general health and supported them in accessing healthcare services as required.

We have made a recommendation about adapting the care home environment to meet the needs of people living with dementia.

The provider needed to do more to protect people’s confidential information. Staff knew people well and treated them with kindness and compassion. People were supported to express their views and be involved in decision-making that affected them.

People did not receive consistent support to take part in activities they found enjoyable and stimulating. People and their relatives were involved in care planning and reviews. Care plans were individual to people and included information about what was important to people. People and their relatives understood how to raise complaints or concerns about the service, and felt comfortable doing so.

The registered understood the responsibilities associated with their post. People, their relatives and staff spoke positively about the overall management of the home. Staff were clear what was expected of them and felt able to seek any additional support required from a registered manager who was approachable. Staff understood how to raise any serious concerns about the way the home was being run.

You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection on 18 November 2014, we asked the provider to take action to make improvements because people were not supported to receive person centred care that met their preferences and because effective systems were not in place to assess, monitor and improve the quality and safety of the service provided. At this inspection, we saw that action had been taken and improvements had been made though some improvements were still required to ensure that findings of audits and analysis were acted upon to drive improvement. The registered manager had completed an analysis of falls in the home and identified trends. However, suitable actions had not been taken following this analysis to reduce the risk of similar incidents, this included a review of staffing levels.

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.

We found there were not always enough staff to ensure that people’s needs and risks were monitored in line with their care plans. The provider had not reviewed staffing levels following the last inspection or listened to feedback from staff to ensure that there were adequate staff to meet the needs of people who used the service. This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People were not consistently protected from avoidable harm and abuse because we saw that an incident had taken place and concerns had not been reported to the local authority in line with local safeguarding adult’s procedures. No plans had been put into place to reduce the risk of a similar incident occurring again.

People’s risk were mostly assessed and monitored though some people did not have plans in place to manage specific risks.

People were asked for consent before care was provided though people’s mental capacity to make their own decisions had not been assessed when required which meant that the service could not be sure they were acting in accordance with the Mental Capacity Act (2005).

People's care plans were not always reviewed regularly to ensure that plans in place met their current needs. People and their representatives were encouraged to be involved in creating their care plans to ensure they reflected people’s preferences.

People were provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks though records in relation to people’s nutrition were not always accurate.

Medicines were safely managed, stored and administered to ensure that people got their medicines as prescribed. Staff were suitably trained to meet people’s needs and were supported and supervised by the registered manager.

People’s health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People were offered opportunities to participate in activities that interested them and could choose how to spend their time. People knew how to complain if they needed to. A complaints procedure was in place though no formal complaints had been received.

People, relatives and staff felt that the registered manager was visible in the home and felt they were approachable.

At a previous inspection completed on 9 April 2014 we identified non compliance with the regulations we inspect against. We issued a warning notice in respect of the care and welfare of people who used the service. We issue warning notices when we want to see rapid improvements in the way care is provided. We carried out this inspection to check that the provider had taken action to ensure the safety of the people who used the service, was protected. A further inspection will be undertaken to monitor the progress in the other areas of non compliance.

During this inspection we asked the questions we always ask; is the service safe, effective, caring, responsive and well-led.

Is the service safe?

The provider had taken action to address the safety concerns we identified at our last inspection.

People's risks had been assessed and actions taken, where necessary, to reduce the impact the risk might present.

The process for information sharing between staff had been improved and formalised by the introduction of a signature sheet.

Is the service effective?

The people who used the service had detailed care plans, which provided staff with the information they required to care for people. People's individual preferences on care were recorded.

The equipment used to monitor people's weight had been replaced with appropriate and accurate medical scales.

Is the service caring?

We observed that people experienced kind and dignified care from the staff. A relative told us, 'The staff look after my X (the person who used the service) really well. The staff really do care. X is better than she has been for years'.

Is the service responsive?

The registered manager had responded to specific concerns we raised at our last inspection about a person's vulnerability to financial abuse and the legality of preventing a person from leaving the home.

Is the service well-led?

The registered manager had implemented improvements to the way care was delivered, recorded and monitored.

During this inspection we spoke with people who used the service, relatives, care staff, a visiting health care professional and the registered manager.

We considered our inspection findings to answer the questions we always ask.

Is the service safe?

Some people who used the service had not had their needs or risks fully assessed to ensure they received the most appropriate care which protected their health and well-being.

Staffing levels were not sufficient to meet people's care needs and identified risks. We saw people who required the support from two staff left without assistance.

We identified some people who were vulnerable to abuse but appropriate referrals had not been made to ensure they were suitably protected.

Is the service effective?

A person who used the service told us, 'We're well fed and well kept'.

There was no evidence to support the care plans were effective or had been reviewed regularly. There was a stable workforce who knew people well however when people's needs changed there was no effective process in place to update staff.

Is the service caring?

A person who used the service told us, 'I find it alright. They always treat me alright'.

We saw good interactions between people and staff. Staff treated people with kindness and protected their dignity when providing personal care. Staff entries in the care plans were sometimes written in an unprofessional manner which did not support people's dignity.

Is the service responsive?

We saw examples where the staff had not responded to changes in people's physical health or taken action to ensure the care provided to them was appropriate.

The home had a complaints procedure. People who used the service and their relatives told us they knew how to complain if necessary.The views of people had not been sought through meetings or satisfaction surveys.

Is the service well led?

There were no systems in place to regularly audit the environment or the quality of the service provided.

Staff told us they were well supported by the registered manager and had regular appraisal and supervision sessions. The registered manager did not receive an appraisal, supervision or management review meetings.

Care was provided that met people's needs and kept them safe. Care staff were skilled and experienced in meeting people's needs. The manager and care staff had a good understanding of when concerns with people's safety and welfare needed to be reported.

There were effective recruitment and selection processes in place. It was not clear how the number and skill mix of care staff had been assessed and kept under review to ensure that staffing levels continued to meet people's needs and keep them safe.

At our previous inspection, we identified that the provider was not meeting the expected standards in some of the outcome areas. We set compliance actions, requiring the provider to make the improvements required to ensure the quality and safety of care. The quality and accuracy of records about people's care still needed to improve. Everyone had a record of their individual care and health needs but there was no written plan, setting out how these care needs should be met.

We found that relatives remained involved in people's care and day to day life at the home. We spoke with four relatives, who were all complimentary about the staff. One relative told us, 'The staff know my mum better than me.'

The home had a small but stable workforce, with no recent changes in care staff. There was an ongoing training programme provided for all staff. We spoke to two members of care staff. They were both positive about working at the home. One care staff told us, 'I couldn't work anywhere better.' Another member of staff told us, 'I would come to work every day, I love my job and working here.' The staff we spoke with had a good understanding of people's current needs.

We looked at the care records for five people to check how well their needs were assessed and planned for. Everyone had an assessment of their care, which included information about their needs. There were also risk assessments in place. We found that changes in people's needs were not always reflected in their care plans and risk assessments.