Archived: Gracewell of Basingstoke

Accommodation at the home is provided over three floors, which can be accessed using the stairs or passenger lifts. There are five different areas within the home, referred to as communities. Two communities are located on each of the first two floors, with a single community situated on the top floor. There is a large enclosed garden and patio area which provides a secure private leisure area for people living at the home. The home also has a boutique café with internet and computer facilities for people to meet and keep in touch with family and friends. The home contains a purpose built salon to provide hairdressing, manicures and other therapeutic services.

The home did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The home has not had a registered manager since 31 July 2015, during which time the home has had four interim managers. At the time of our inspection there was a home manager who had been appointed in January 2016, who was in the process of making an application to become the registered manager with the CQC.

The lack of consistent leadership and management had left people, their relatives and staff feeling concerned about the quality of care provided in the home. Staff told us the perpetual change of management had been demoralising and left them feeling as if they were not valued.

The quality of the service had not been consistently monitored by the series of interim managers. The monitoring systems had not identified that care plans did not contain sufficient up to date information to provide people with safe consistent care, that was focussed on meeting their individual needs. The provider had failed to ensure records were completed in a timely manner or to keep records up to date to ensure people received safe care.

There were not enough staff with the appropriate experience and knowledge to meet people’s needs safely. Without exception people, their relatives, friends and staff told us there were far too many agency staff who did not know the people they were supporting. The home’s high dependency on agency staff often meant they did not know people or their needs and people did not recognise staff supporting them.

The home manager had not completed annual appraisals or two monthly supervisions with staff, in accordance with the provider’s policy. Staff had not been enabled to deliver care and treatment to people safely through the provision of effective supervision and appraisals.

Identified risks to people’s health were not always managed by staff to reduce the risk of harm. Although people received the care they required to manage risks to them, some people’s records did not contain all of the required written guidance for staff unfamiliar with people’s risk management requirements to ensure their safety. This increased the risk of people experiencing unsafe or inappropriate care when agency staff were supporting them.

During the inspection several safeguarding concerns were brought to our attention by the provider’s Director of Operations. The provider took the correct action to ensure people were safe whilst the allegations were investigated.

Staff had completed the provider’s required safeguarding training and were able to recognise the different types and signs of abuse. Staff understood their role and responsibility and knew how to report abuse and protect people from harm.

Staff had undergone robust pre- employment checks as part of their recruitment, to ensure their suitability to support vulnerable people.

Records demonstrated staff administering people's medicines had completed relevant training and had their competency assessed. We observed staff administer people’s medicines safely, in the way people preferred, in accordance with their medicines management plans.

New staff had completed the provider’s induction programme which was linked to the Care Certificate, and the provider’s mandatory training was up to date. This ensured staff maintained the skills and knowledge to meet people’s needs effectively.

Staff supported people to make as many decisions as possible. We observed staff constantly seeking people’s consent about their daily care and allowing them time to consider their decisions, in accordance with their support plans.

Records showed that staff had undertaken training on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a clear understanding of the legal requirements to protect people’s human rights when they lacked capacity to consent to their care. Staff were able to demonstrate that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.

People were protected from the risks of malnutrition and dehydration. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks.

People’s records demonstrated they were referred promptly to healthcare professionals when required, which we observed in practice.

Positive caring relationships were not consistently developed by all staff with people living at the home. People had mixed views with regard to how caring agency staff were.

Staff were careful to ensure that peoples’ privacy and dignity were respected and listened to what people wanted. People were supported by staff to make day to day decisions that reflected their preferences and recognised their individuality.

People’s care records were not consistently person centred, which means they were not always focussed on the individual, their needs and wishes. Regular staff were able to tell us about people’s life histories and things that were important to them. However, this person centred information was not always known by the agency staff.

Most people and relatives told us there was not enough stimulation for those who were less mobile and requested more one to one support and staff being able to just “stop and chat”. People were not consistently supported to follow their interests or to take part in activities of their choice, to ensure they received regular stimulation and social engagement to enhance their wellbeing.

People and their relatives told us they knew how to make a complaint and felt comfortable to do so if required.

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.

During our inspection on 29 August 2014 we found the provider had put measures in place to improve their management of medicines. This meant that the provider had ensured that medicines had been stored and administered to people safely.

Since our last inspection the provider has notified the Care Quality Commission (CQC) of four medication errors. Serious safeguarding concerns had been substantiated in relation to one of these errors which occurred in April 2014.

On the day of our inspection 52 older people were living at Pemberley House Care Home. We spoke with eight people who use the service and the relatives of six people. We also spoke with the registered manager, the clinical lead, the floor supervisor, two nurses, two senior care workers, two care workers, the service administrator and the maintenance officer.

We considered our inspection findings to answer 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?

This is a summary of what we found.

Is the service safe?

We found that the service was not safe because people had not been protected against the risks associated with administration of medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely. We found recording of medicines management had been of variable quality. Temperatures had been measured and recorded where medicines were stored. However, when the temperature fell outside the recommended range no actions had been taken or recorded. Most of the administration records were complete. However the specific quantity administered for variable dose liquid medicines had not been recorded.

People's needs had been assessed and reflected in their care plans. Where necessary, assessments had been completed which identified and reduced risks to people, whilst supporting them to remain independent. Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this.

People said they felt safe with staff, who treated them with dignity and respect. One person said, 'The staff are really kind and gentle. They treat you like one of their own family.' Another said, 'I feel safe here. I didn't want to come but I'm glad I did'.

The service had effective recruitment and selection processes which ensured that checks had been completed to confirm that staff were safe to work with vulnerable people.

We found that effective operation of systems to identify, assess and manage risks, had ensured that the service had provided care to people safely. For example, people had been protected from the risks of malnutrition and dehydration. The provider had identified where people were at risk of poor nutrition and hydration or had swallowing difficulties. We observed that people had a choice of suitable and nutritious food and hydration in sufficient quantities to meet their needs.

The CQC monitors the operation of the DoLS which apply to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lack the mental capacity to make decisions about where to live have not been deprived of their liberty, other than in accordance with the law. We saw that the provider had a policy relating to DoLS and people who lived at Pemberley House were only deprived of their liberty when this had been appropriately authorised.

Staff told us that they had received training about the Mental Capacity Act 2005 (MCA). We spoke with the service dementia champion who told us, 'We try to support people to maintain their independence and enjoy their lives to the full. ' A relative told us, 'We visit regularly but the manager will always call us if things happen rather than waiting for us to visit.'

Is the service effective?

The service was effective because we found that people had been placed at the centre of all decisions regarding their care and support. Where the service identified a person lacked capacity to make a decision, a best interest meeting had been held with people who knew and understood them, which ensured their human rights had been protected. We noted that advance decisions had been appropriately recorded and had been respected by staff. For example, decisions regarding resuscitation had been made with the person and their family, where appropriate.

The service was effective because staff quickly realised when a person becomes seriously ill and requires treatment, and immediately take action to to meet their needs. One person told us, 'I had a bug recently and they made such a fuss of me. I was back on my feet in no time.'

We found that staff were knowledgeable about people's health and personal care needs and had received training to update their skills and knowledge. Staff had also received training to meet the specific needs of people. The provider had ensured that people received appropriate care from competent staff who had been supported in their professional development by an effective system of supervision and appraisal.

Is the service caring?

The service was caring because people were supported by professional, compassionate staff, who spoke to people in a friendly, caring manner. We saw that the activity coordinator and care workers gave encouragement to people who were able to do things at their own pace. One person told us 'They are so gentle and never try to hurry me up.' Another person said, 'Nothing is too much trouble and the carers will do anything I ask.' We observed one person being supported to climb the stairs because they did not wish to use the lift. They told us, 'I know it took me a long time but I'm so glad I did it.'

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One care worker told us, "I look forward to talking to people and finding out about their fantastic lives.'

Is the service responsive?

The service was responsive because people's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each person's needs and how they should be met. For example staff were able to tell us about the care required to support a person recovering after a stroke.

We found that the service was responsive to the changing needs of people and these had been continually reviewed. Where staff required further training this had been planned in advance or where not anticipated had been arranged immediately.

Is the service well-led?

The service was well-led and the management team provided clear and direct leadership, which was recognised and appreciated by the staff. Care workers spoke positively and with pride about the service they provided for people. Staff told us that the managers spoke with them about any changes planned and they felt part of a team where their contribution was valued. One care worker told us, ''If there are any problems the manager will always come in.' A nurse told us, 'The clinical lead is usually on call and encourages us to call if there is a problem.' This meant that care workers felt confident to raise concerns and seek advice.

The registered manager operated systems to deal with comments and complaints which were clearly understood by people, well-publicised and reflected established principles of good complaint handling.

Positive comments were made by people and their relatives about the quality of the care provided. One relative said, 'I wouldn't want her to be anywhere else. The staff are wonderful and give her everything she needs. When she's distressed they know just how to talk to her.' Another relative told us, 'Now I can sleep at night, confident that she is in a safe place being looked after with kindness.'

We looked at the management of medicines and found that the provider had an effective policy regarding the administration of medication, which was carried out in practice. The service had a thorough recruitment and selection process which meant that people were cared for by suitably qualified, skilled and experienced staff. We found that the range of self auditing enabled the manager to assess and manage risks relating to the health, welfare and safety of people being supported.

In this report the name of Geraint Williams 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.