Archived: Gorseway Care Community

Updated 28 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by concerns we had received about the care and safety of people and the management of the service. This inspection took place on 8, 9 and 12 January 2018 and was unannounced.

The inspection team consisted of two inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed information we held about the service. We looked at notifications and previous inspection reports. A notification is information about important events which the service is required to send us by law. This information helped us to identify and address potential areas of concern. The provider was not asked to complete a Provider Information Return prior to this inspection This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection we spoke with 15 people and 5 visitors. We observed care and support being delivered in communal areas of the home. We spoke with the manager, deputy manager, the regional manager and clinical development nurse. We also spoke with the regional operational trainer, the maintenance manager and 9 staff including, ancillary staff, care staff and nursing staff. We spent time observing interactions between staff and people in communal areas. We looked at the care records for 10 people and the medicine records for 26 people.

We reviewed staff recruitment, supervision and appraisal records for 3 staff. Staff training records as well as management records such as complaints, safeguarding, incident and accident records, staffing rotas for the period 11 December 2017 – 8 January 2018, policies and procedures and governance records.

Updated 28 April 2018

This unannounced inspection took place on 8, 9 and 12 January 2018. The inspection was bought forward due to information of concern we had received about the safety and management of the home, and the care provided to people.

After this inspection CQC was made aware of a person’s death at this location which has been brought to the attention of the police and local authority.

Gorseway Care Community 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.

Gorseway Care Community can accommodate up to 88 people, some of whom live with dementia. This can be provided across two houses, one of which can accommodate up to 28 people and the second can accommodate up to 60 people. The provider was not using the house which could accommodate up to 28 people. The regional manager told us they would only provide support to up to 50 people in the building currently in use. Accommodation in this building was provided over two floors one of which was for people living with dementia and called ‘Memory Lane’. At the time of this inspection there were 42 people living in the home.

At the time of our inspection visit there was not 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. A new manager had been appointed and has submitted an application to CQC to become the registered manager. Throughout the report we refer to this person as the manager.

The last inspection of the service was on the 7 and 8 March 2016 and we rated this service as overall “Good”. At this inspection we found the overall rating showed improvements were required and the extent to which people were being kept safe by the service had deteriorated and was now rated as inadequate.

The information available to guide all staff, including new and temporary staff on how to support people safely and minimise risks to people were not always accurate, sufficiently detailed and consistent. Actions identified in risk management plans were not always followed by staff which placed people at risk of not receiving safe care and treatment.

The provider had used a dependency assessment tool to calculate the staffing levels in the home. Whilst this showed sufficient staff were available to meet people’s needs, we found this was not always the case in practice. During the inspection the provider told us about the recent staffing changes they had made and were confident these would achieve improvements for people. However, following the inspection we received information from the provider in response to concerns raised which showed these changes had not been made.

Care plans were not in place to guide staff as to how people should be supported with their medicines. Risk assessments were not in place for medicines which pose an increased risk to people such as those to thin their blood and we found errors had occurred. When errors had been identified the actions taken to address the error was not always recorded to show how this had been addressed for people’s safety.

Systems were in place to support learning and improvements when things went wrong. There was evidence to show when these were used improvements had taken place. However, this was not always consistent and incidents were not always identified and followed up to ensure the cause was established to enable learning to take place.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from abuse and referrals had been made to the local authority when incidents or allegations occurred.

Equipment used to support people’s needs such as hoists and bed rails was checked and maintained to ensure it was safe for people. The premises were safely managed by maintenance staff including protective equipment such as fire safety equipment and there were arrangements for the safe evacuation of people in an emergency.

Improvements had been made in the stock management of people’s medicines to ensure they were always available as required. Actions had been taken to address medicine errors made by agency nursing staff. Supervisions and daily audits had been implemented to improve the management of people’s medicines in the home.

The home was clean and free from malodours. People and their relatives told us they were satisfied with the environment and the standard of cleanliness.

People’s needs were assessed on admission to the home. We found people’s mental capacity to consent to their care and treatment was not always assessed and decisions were not always recorded in line with the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards (DoLS) applications had been made to the appropriate authority. However, people’s care plans did not include information to guide staff as to how they should support people appropriately in line with their authorised DoLS. This meant there was a risk people were not supported to have maximum choice and control of their lives. We have made a recommendation about this.

People spoke positively about the staff in the home and told us they were “Well trained”. Staff training and evidence based practices enabled staff to develop the knowledge and skills to support people effectively. Processes such as supervision, competency assessments and appraisal were in place to support staff in their role and check they remained competent.

People’s dietary needs were met including when people were at risk of choking or malnutrition and dehydration. Some improvements were required in the monitoring records of what people had eaten and the level of prompting people received from staff when they required this, to support them to eat and drink sufficiently.

People had access to healthcare professionals as required. People’s health was monitored by nurses on site and people’s needs were communicated to staff through handover and a diary to book health appointments and follow up as required.

People and their relatives told us most staff provided kind and compassionate care. One person thought some staff could be more attentive and another person said agency staff did not know them as well as permanent staff. We observed staff to be mostly kind and caring in their interactions with people. However, staff did not always have sufficient time to spend with people and information about people's safety needs was not always available to guide staff and promote a caring approach.

Meetings were held to enable people and their relatives to give their views about the care and treatment provided in the home. In addition a weekly ‘open surgery’ was available for people’s relatives to meet with the manager to discuss their views and concerns.

People told us they were treated respectfully by staff and were able to have privacy as required. The provider promoted the principles of equality, inclusion and diversity through policy, procedures and staff training. Peoples’ cultural, spiritual and inclusion needs were assessed and staff we spoke with demonstrated their commitment to challenging discrimination in practice.

People’s care plans lacked person centred information and how the person and their representatives had been involved in the decisions made about their care. We received mixed feedback from people about their involvement in care planning and review. The provider had identified the improvements required in people’s care plans and this was being addressed at the time of our inspection.

Activities were provided for people by activity staff. These included a programme of events and entertainment as well as activities with people on a small group or individual basis.

People and their relatives told us they would know how to raise a concern or complaint. Most people we spoke with who had raised a concern told us this had been dealt with to their satisfaction. Staff spoke positively about the manager and deputy manager and said they felt confident any concerns they raised would be addressed. The managers told us they were committed to making improvements and ensure staff acted to provide care in line with the provider’s values.

A quality assurance system was in place and information from audits was used to inform a central action plan to drive continuous improvements. We found some improvement was needed to ensure all incidents occurring in the home were identified by staff, recorded and reviewed to ensure the system was effective in addressing risks and driving learning and improvement.

There had been recent management changes in the home and as a result most people and their relatives did not feel able to comment on the management of the service. Although some people told us the manager was ‘approachable and visible’.

People, their relatives and staff were asked for their views on the service through annual surveys. The results of these were not available at our inspection. A programme of resident and relatives meetings, staff meetings and a management surgery for people’s relatives was in place to enable people, their relatives and staff to give their views and receive a response from management.

We found five 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 the report.