This inspection took place on 11, 13 and 14 December 2018 and was unannounced.Gracewell of Church Crookham is a 'care home'. People in care homes receive accommodation and nursing or personal care, as 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.
Gracewell of Church Crookham is registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 45 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.
The home did not have 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. At the time of inspection, the there was a general manager responsible for the daily running of the home. They were being supported by a deputy manager and the provider’s operations director.
The service had not been consistently well-led or well-managed since our last inspection. The provider had failed to operate processes effectively to ensure the service complied with legal requirements. Relatives and staff had consistently raised concerns, which had not been effectively addressed by the provider.
We found three breaches 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 this report.
People had not always experienced care that made them feel safe and protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations had not always been carried out, in partnership with local safeguarding bodies.
Risks had not always been assessed, monitored and managed effectively. Interventions had not always been put in place to mitigate or reduce identified risks. This meant that people had been exposed to the further risk of experiencing unsafe care. Care records demonstrated that staff had not always followed the provider’s policy and procedure in relation to the recording and management of falls.
Staff understood their responsibilities to raise concerns, to record safety incidents and near misses and to report them internally and externally. However, the provider had identified that such incidents had not always been reported effectively. The provider had developed an action plan to address these issues.
People’s prescribed medicines had not always been managed safely, which had led to several medicine errors. People had not always received their prescribed pain relief as required.
People had not always been supported to have access to healthcare services and receive on going healthcare support when required. The provider had addressed the need to improve and provide appropriate responses to people’s changing needs within their service recovery plan and their back to basics approach.
The provider had failed to effectively engage with community nursing team forums. Nursing professionals had been concerned that previous management teams had not been open and transparent or demonstrated a proactive approach to delivering effective care based on best practice.
The general manager had completed a review of all authorisations in relation to the Deprivation of Liberty Safeguards and identified that a further 12 applications were required. These applications have been submitted and await authorisation. The general manager had established a tracking system to ensure all future applications are submitted expeditiously.
People had not always experienced personalised care that was flexible and responsive to their individual needs and preferences. People had not consistently been supported to follow their interests and take part in activities that were socially and culturally relevant and appropriate to them.
Care records did not always effectively demonstrate responsive assessment and monitoring of people’s needs, for example; evidence of repositioning had not always been effectively recorded in relation to people’s pressure ulcers, which had healed. People’s preferences and choices for their end of life care were not consistently recorded, communicated and kept under review.
Relatives of people who had limited verbal communication reported a mixed experience in relation to the care their loved ones had received. Three such relatives told us that staff were consistently kind and caring. Seven relatives conversely told us their loved one’s had experienced poor continuity and consistency of care from some staff, who were not caring or compassionate.
People and their relatives concerns and complaints had not been consistently listened and responded to. This meant the provider had missed opportunities to improve the quality of care people received. Prior to our inspection the provider had engaged with people and their relatives and had arranged forums to seek feedback regarding concerns and complaints. The provider had appointed a new management team, including the general manager and new operations director. The provider’s recovery action plan detailed measures being undertaken to ensure all complaints were dealt with in accordance with their policy and used as an opportunity to drive improvement in the service.
At the time of our inspection the provider had deployed sufficient, suitably qualified staff to meet people’s assessed needs. People, relatives and staff consistently made positive comments about recent measures introduced by the general manager to provide continuity and consistency of staffing within the different households. These new measures had had a significant impact on staff morale and people’s confidence and well-being.
Staff had experienced a comprehensive induction and did not work unsupervised until they were confident to do so and the general manager had assessed them to be competent. Staff had completed the provider’s required training, which ensured they had been enabled to develop and maintain the skills necessary to deliver effective care and support. Staff were supported by the provider with their continued professional development and to maintain qualifications relevant to their role. Staff were receiving on- going training and guidance from an area coordinator to embed best practice in relation to supporting people who experienced living with dementia.
The home had been designed to promote the independence and safety of people who live with dementia, which helped them to manage disorientation and confusion.
People were supported to have a balanced diet that promoted healthy eating and the necessary nutrition and hydration. Staff were aware of those individuals who had been identified to be at risk of choking and the support they required to mitigate these risks, which we observed staff delivering in practice.
We observed that staff consistently treated people with kindness in their day-to-day care. Staff knew and respected the people they cared for, including their preferences, personal histories, backgrounds and potential.
The quality of people’s care had improved since the arrival of the general manager who had implemented a staffing system, where staff only worked in a specific household. People consistently told us they now experienced good continuity and consistency of care from staff who knew them and their needs well.
The operations director and general manager had developed a credible recovery strategy to deliver high-quality care and support, which achieved good outcomes for people. The general manager and deputy manager were highly visible within the home and provided clear and direct leadership, which inspired staff. Without exception staff told us they now felt respected, valued and supported by the management team.
The general manager had begun to collaborate effectively with key organisations and agencies to support care provision, service development and joined-up care, for example; community nursing and local authority safeguarding teams.