Genesis Care Home

Genesis Care Home accommodates up to 42 people in one purpose built building. On the day of our inspection there were 35 people living at the home. Genesis Care Home is a three storey building with single bedrooms that all have en-suite facilities. Each floor has a lounge and dining area and a passenger lift is available.

The home has 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We were assured that this service met good infection prevention. We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

We found the following examples of good practice:

• The provider supported residents and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely, such as dedicated support time from their assigned staff member.

• The provider had utilised a single room near to the front door of the premises (on the ground floor) for visiting, this gave relatives access to see residents without them having to move very far into the care home, reducing the amount of contact with staff and other residents to a minimum.

Genesis Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Genesis Care Home accommodates up to 42 people in one purpose built building. On the days of our inspection there were 40 people living at the home. Genesis Care Home is a three storey building with single bedrooms that all have ensuite facilities. Each floor has a lounge and dining area and a passenger lift is available.

The home has 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection the home was rated Good. At this inspection we found the home remained Good. The home is rated Good as it met all the requirements of the fundamental standards.

Safe and robust recruitment procedures were in place and sufficient staff were employed to meet people's assessed needs. All staff had completed an induction and completed mandatory training for their roles. Staff supervision took place regularly and also an annual appraisal. Staff attended team meetings.

People's needs were assessed prior to moving in to the home and this information was used to develop risk assessments and person centred care plans. These documents were regularly reviewed and updated as required. People were offered choice and their independence promoted where possible.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment stage and care planning development.

The dining experience at the home was positive. People were complimentary about the food and drink and told us they were always offered a choice. Staff offered appropriate support as required and demonstrated good interaction throughout mealtimes.

We observed people being treated with dignity and respect. Positive interactions between people and staff were consistently observed throughout our visit. Staff were caring and demonstrated kindness and empathy.

Activities were available for people to participate in if they chose to and they told us they enjoyed these.

A safeguarding policy and procedure was in place. Staff had received training in safeguarding and were confident to raise any concerns they had.

The registered provider had medication policies and procedures were in the place. medicines were ordered, stored, administered and disposed of in accordance with good practice guidelines.

Governance systems were in place and included regular audits of key areas across the home. The information from the audits was analysed to identify areas for development and improvement and these areas were actioned in a timely manner.

The home operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). Records showed that capacity assessments were in place when required. Consent was sought for care and treatment.

A complaints procedure was in place and people and their relatives told us they knew how to raise a concern or complaint.

Genesis Care Home was well maintained and all equipment was regularly serviced. All required health and safety checks and documentation were in place as well as fire safety equipment checks.

During the inspection we spoke with seven members of staff. Some were on duty in the home and some we spoke with on the telephone. We also spoke with seven of the people who lived in the home and two of their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' 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, 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?

We had been told prior to our inspection that an incident had occurred where a person who lived in the home had behaved in an abusive manner. We were able to confirm that this had occurred and had not been dealt with in line with safeguarding procedures. We looked at the systems that had been put in place following this incident and were not satisfied that people were being protected from potential harm or abuse. We contacted the local authority safeguarding unit to share our concerns and to ensure that appropriate steps were taken to protect the people who lived in the home.

Prior to our inspection we had received information of concern that told us that staffing levels were very low at the home and there were regular times when there were not enough staff on duty to meet the needs of the people who lived in the home.

We asked the deputy manager and they told us that the agreed staffing levels were six staff on the morning shift, four staff on the afternoon shift and three staff on the night shift. We looked at the rotas for the six weeks prior to the inspection and we saw that these staffing levels were often not maintained. We saw that there were regular night shifts that were covered by only two members of staff. We were aware that there were a small number of people living in the home who required two staff to support them with their personal care needs. This meant that if staff needed to support them during the night this left the rest of the building unattended. We asked if a dependency tool was used to monitor and evaluate the changing needs of people to ensure that staffing levels were maintained at adequate levels. We were told that there were no tools used and the staffing levels had been the same for years but were currently not maintained.

Is the service effective?

We asked about staff support and supervision sessions and were told that these did not take place. We looked at the supervision records for 11 staff and saw that only three of them had received one supervision this year and some had never had any supervision sessions. We saw that some appraisals had taken place but that most of these were over a year ago.

We asked about training and staff told us that training did not often take place due to staff shortages. We spoke with one of the senior care staff who was also the home's staff trainer. They told us that training was often cancelled due to time and staff constraints. They were constantly working on the rota which left no time for training.

Is the service caring?

During our inspection we spoke with seven people who lived in the home and two of their relatives. All of them spoke very highly about the staff and the care that they received but significant concerns were raised about staff shortages. People told us that the staff worked very hard to meet their needs. Comments we received included; "I have really good relationships with the staff but they work too hard and never get a minute to chat" and "The staff are very busy and very kind. They do so much for us and they are run ragged and it's not fair on them."

Throughout the day of our inspection we observed staff interacting with people who lived in the home. We saw warm, positive interactions. It was obvious that the staff had very close relationships with the people that they were caring for. We saw that people were treated with dignity and respect and were also having a laugh and a joke with the staff. One person who lived in the home said to us "I love it here. I've acquired a selection of daughters."

Is the service responsive?

Examination of care records showed that care plans had not always been updated to reflect people's current personal and healthcare needs. For example, we saw one person in the home whom we had observed required significant support from staff to meet their personal care and mobility needs and to support them to eat and drink. We looked at their care records and saw that they had not been updated to meet their current needs and had not been evaluated since March 2014. We were concerned as their needs had changed considerably but the records did not reflect any of these changes.

Is the service well led?

During our inspection we were not able to access any audit information as the staff were not aware of where the information was stored. We spoke with the manager the following day and they emailed us the most up to date audits. We saw that the last care plan audits had been carried out in February 2013. We were concerned as the care plans were very poor and the lack of monitoring had contributed to this as regular audits would have highlighted the issues. There were no audits in place to monitor staff supervision or training. Regular monitoring of these would have identified the lack of both taking place for the staff.

We saw that no staff team meetings were taking place and the last meeting for people who lived in the home had been held in December 2013. The activities programme we saw said that a 'resident's forum' took place on a monthly basis but there were no records to evidence that these were taking place.

We looked at the food provided in the home and the way the home met people's nutritional needs and we found that on the whole they did this well. People who lived in the home said that the food was very good and they enjoyed it.

We looked at the arrangements in place to protect people from harm and abuse. We found that the staff knew what they would do if they had some concerns.

During this inspection we looked at the support available for staff as at our previous inspection we had some concerns. We found that the support for staff had improved and they were receiving more supervision and training.

We looked at the home's systems for ensuring that they provided a quality service. We found that these were generally good and that the systems relating to monitoring the care provided were completed on a monthly basis.

We spoke to the manager of the home and five members of staff and found that this action plan had not been followed and the appropriate changes had not been made. The staff are still not receiving appropriate support to enable them to do their jobs effectively.

We found that staff are not receiving supervision, most staff have not had appraisals and team meetings are not taking place on a regular basis.

We found that individual care plans and risk assessments were in place and that people's needs were being met. A relative told us, 'My mum was ill and said she didn't want to go to hospital. The staff looked after her here with help from the district nurses and she was fine.'

A visiting district nurse told us the staff team were co-operative and always willing to follow care instructions and guidance.

We found that staff were trained and supported to provide safe and effective care to residents. We found that staff did not have access to regular, planned supervision sessions or appraisals.

There was a suitable and sufficient range of equipment in place to safely meet people's needs and promote their independence.

We found that a suitable system was in place for people to make complaints both within and outside of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The manager at the home was not registered with the Care Quality Commission.