Goole Hall

Goole Hall is a residential care home which is registered to provide personal care and accommodation for up to 28 older people, some of whom may be living with dementia. At the time of the inspection, 15 people were using the service. The building has three floors and a lift which operated between all levels.

People’s experience of using this service and what we found

Records did not always support staff to administer people’s medicines when they needed them. The provider had reviewed and updated their quality assurance systems, though they had not identified all shortfalls found during the inspection.

Systems were in place and staff understood how to keep people safe from harm and abuse, though staff were not always sure where to find safeguarding information. We have made a recommendation about safeguarding. Risks to people’s safety and wellbeing had been identified and were monitored and managed by staff. Accidents and incidents were monitored to support learning from them and reduce the risk of them happening again, though systems required further improvement.

Staffing levels were safe and enabled staff to support people in a timely manner. People took part in meaningful activities. Recruitment processes supported the safe recruitment of staff, though records did not show gaps in employment history had been explored. We have made a recommendation about recruitment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were appropriately supported to eat and drink and people had access to a varied diet. We have made a recommendation about fluid monitoring systems. Staff worked with relevant healthcare professionals to meet people’s needs. Staff had the required skills and knowledge to support people.

The senior management team were supporting the service and we received positive feedback regarding the new manager.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 07 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that although some improvements had been made the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 February and 01 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Goole Hall on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Goole Hall is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 28 people. The building has three floors and a lift which operated between all levels.

People’s experience of using this service and what we found

People were not receiving a service that provided them with safe, effective, high-quality care.

Care and support were not tailored to meet people’s specific needs. Care plans and risk assessments were not personalised. Information generated from an electronic system did not contain personal information about people. Medicines practices were not safe or robust.

The provider had failed to ensure government guidelines for working safely in care homes during the COVID-19 pandemic were implemented and adhered to.

Staff morale was low; staff felt unsupported and frustrated with the running of the service. Staff did not always complete their training in line with policy and relatives told us they didn’t feel staff had the understanding to support the needs of people. Supervisions and inductions were inconsistently completed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not well led. Ineffective quality assurance systems failed to identify the improvements required within the service.

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

Rating at last inspection.

The last rating for this service was good (published 14 September 2018).

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well- led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care, decisions on behalf of people, staff training, record keeping and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Goole Hall 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.

Goole Hall accommodates up to 28 older people, including people who are living with dementia. On the day of the inspection there were 19 people living at the home. The premises have three floors and the lift operates between all levels.

We were supported during our inspection by a manager who was registered with the Care Quality Commission (CQC). 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 our last inspection in December 2017, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations for Regulation 12: Safe care and treatment, Regulation 17: Good governance and Regulation18: Staffing. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found the provider had implemented the actions and was no longer in breach of these regulations.

Improvements to the oversight of systems and processes that were in place to monitor, and where appropriate to improve the service were required to ensure they were fit for their purpose and included any actions with appropriate timescales for completion. This included provider review of service checks and audits completed.

Audits and reviews of records associated with people’s care and support were in place but required oversight to ensure they were effective for their purpose because they had failed to ensure information about people’s care and support was always accurate, and up to date in all formats.

Systems and processes were in place to record decisions made under the Mental Capacity Act 2005. However, improvements to checks on records was required to ensure information was always up to date and comprehensively documented.

The provider completed pre-employment checks for staff. However, oversight of audits of staff files failed to ensure staff checks against the Disclosure and Barring Service had always been returned by the provider prior to commencing their duties. These checks were reviewed and actions implemented during our inspection.

People were assessed to ensure they received appropriate support to take their medicines safely as prescribed. Medicines were managed and administered according to national guidelines and best practice by staff who had been assessed as competent in this role.

The provider had implemented actions to ensure the home was free from odours that are offensive or unpleasant. However, the actions implemented had not been reviewed for their effectiveness and at this inspection there was an unpleasant odour in a communal area on both days.

Systems and processes were in place to ensure staff recognised signs of abuse and any concerns were appropriately investigated. Lessons were learnt and actions put in place to reduce the risk of reoccurrence.

The provider continued to utilise a staff dependency tool which helped evaluate people's individual needs against the support they required.

People were supported with their health and wellbeing. Drinks were provided throughout the day and a menu was provided with a choice of food for people. People received additional support from dietary and nutritional specialists where this was required.

People received information in a format they could understand and the provider discussed further planned improvements for implementation in this area. People's personal preferences and wishes were recorded and staff were aware of any diverse needs.

People continued to enjoy activities of their choosing. An activities co-ordinator and staff were available to support people with their individual interests and hobbies.

Staff received training and support to ensure they had the appropriate skills and knowledge to perform their role.

There was a formal complaints system in place to manage complaints if or when they were received.

Goole Hall is required to have a registered manger. There was a new manager in post who told us they were awaiting further checks before submitting an application for their registration with the CQC. We made checks after the inspection and evidenced the new manager had submitted an application to register with the CQC. 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.

Goole Hall 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.

Goole Hall accommodates up to 28 older people, including people who are living with dementia. On the day of the inspection there were 18 people living at the home. The premises have three floors and the lift operates between all levels. Most people have single bedrooms and 17 bedrooms have en-suite facilities. There is a communal bathroom on two floors but no shower room.

At our last inspection in November 2016, we found the provider was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Premises and equipment and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Notifications of other incidents. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found the provider had implemented the actions and was no longer in breach of the two regulations.

The provider had implemented actions to ensure the home was free from odours that are offensive or unpleasant. However, the actions implemented had not been reviewed for their effectiveness and at this inspection there was an unpleasant odour in the entrance hall on both days.

The provider had failed to implement measures to prevent the spread of infection and possible contamination of people’s clothing. The laundry room was not used solely for the purpose it was intended which along with the design and layout of the room meant it was not clean.

The provider had failed to ensure systems and processes that were in place to manage risks from the environment were effective. Areas of maintenance and checks around the home were not completed following the providers procedure and failed to highlight areas that required attention to keep everybody safe from harm.

People were at risk from not receiving their medicines as prescribed. Systems and processes in place to store, manage and administer people’s medicines did not always follow best practice or manufacturer’s guidance.

Risks associated with peoples care and support was recorded with associated support plans in place. However, these were not always robust or completed for all activities of care and support or for the environment which meant the service provided was not always safe for everybody.

We found people who used the service were not assured a quality service because there was not effective system in place to assess, monitor and improve the quality and safety of the services provided in the carrying out of the regulated activity.

Systems and processes in place to assure the service of a skilled and supported workforce were not checked for their completeness. The provider had failed to follow their procedure to ensure care workers received regular, appropriate supervision and appraisal of their performance in their role. Provision to ensure any induction, training, learning and development needs were identified, planned for and supported were ineffective.

People were protected from avoidable harm and abuse and understood how to escalate their concerns for further investigation. The provider ensured all concerns were recorded and evaluated to help prevent re-occurrence to keep people safe.

People confirmed they received person centred care, and that staff understood the importance of maintaining their dignity and privacy. Staff discussed how they maintained people's confidentiality and when to raise any concerns.

People were supported to maintain their health and wellbeing. People had a choice at meal times and any dietary needs were recorded and catered for. The provider worked with other health professionals to ensure people’s health and wellbeing was maintained.

Recruitment checks were completed which helped the provider to make safer recruiting decisions and minimise the risk of unsuitable people working with adults who may be vulnerable.

The registered provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

Care workers had received some training in, and understood the requirements of The Mental Capacity Act 2005 and the registered provider was following this legislation.

A package of activities was provided by a dedicated activities co-ordinator. We saw activities were provided in groups, on a one to one basis and at people’s individual requests. The manager discussed planned improvements and fund raising that meant people would be able to enjoy future trips away from the home.

Consultation with stakeholders and a variety of meetings helped discuss and develop areas for improvement and share information around the service.

At this inspection we found the registered provider was in breach of three regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and was rated Requires Improvement. This is the second time the service has been rated Requires Improvement.

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

The home is registered to provide accommodation and care for up to 28 older people, including people who are living with dementia. On the day of the inspection there were 22 people living at the home. The home is situated in Old Goole, on the outskirts of the town of Goole, in the East Riding of Yorkshire. The premises have three floors and the lift operates between all levels. The home is located along a drive way from the main road and sits within its own grounds. Most people have single bedrooms and 17 bedrooms have en-suite facilities. There is a communal bathroom on two floors but no shower room.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 premises were clean but there was an underlying odour in the entrance hall and some communal areas of the home. In addition to this, some carpets needed to be replaced, the lift was very noisy, the gate at the front of the premises was open when we arrived and there were pot holes in the drive. This meant that the premises were not always suitable for the purpose for which they were being used.

This was a breach of Regulation 15 of the Care Quality Commission (Registration) Regulations 2009: Premises and equipment. You can see what action we asked the provider to take at the end of the full version of this report.

People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults and understood their responsibilities in respect of protecting people from the risk of harm. There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, the registered manager had not informed us when DoLS authorisations had been authorised, which is a legal requirement.

This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents.

Quality audits undertaken by the registered manager and senior managers were designed to identify that systems at the home were protecting people’s safety and well-being. However, we were concerned that health and safety audits had not identified the safety aspects of the main stairs. Although this was rectified following the inspection, this was only as a result of us raising this during the inspection. We have made a recommendation in respect of this shortfall.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs although the deployment of staff needed to be reconsidered over lunchtime. There were recruitment and selection policies in place and these had been followed on most occasions, although not in all. This could have resulted in people who were not considered safe to work with vulnerable people being employed. We have made a recommendation in respect of this shortfall.

Staff told us that they were well supported by the registered manager. They confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them.

Staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home and relatives told us that staff were very caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

A variety of activities were provided to meet people’s individual needs, and people were encouraged to take part. People’s family and friends were made welcome at the home.

People told us that they were very happy with the food provided and we observed that there was ample choice. We saw that people’s nutritional needs had been assessed and individual food and drink requirements were met.

The registered manager was aware of how to use signage, decoration and prompts to assist people in finding their way around the home, and good progress had been made towards making these available.

There were systems in place to seek feedback from people who lived at the home, relatives and staff. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements.

At this inspection we spoke with the regional manager, the senior care worker on duty and the cook. We also chatted with people who lived at the home but did not ask them specific questions to help us make a judgement about compliance. We found that the home was now compliant with these outcomes.

We found that care records included care needs assessments and individualised care plans, and that they included information about a person's life history. Care plans had been reviewed regularly to ensure they were up to date. They included thorough information about a person's dietary needs. Discussion with staff and observation on the day of the inspection evidenced that these needs were being met.

Staff had monitored the quality of the service provided and people had been given the opportunity to express their views about the care they received. Audits had been carried out by staff to evidence that the systems in place at the home had been followed consistently. This helped to ensure that people received safe and good quality care.

We spoke with the manager and staff as part of the inspection. We chatted to people who lived at the home but did not ask them specific questions about these outcome areas.

We found that policies and procedures on the control of infection had been updated and there were audits in place to monitor that staff were following them. Some action had been taken to eradicate unpleasant odours; the lounge chairs and some bedding had been replaced and a regime had been introduced for cleaning curtains. Staff had undertaken or were due to undertake training on the control of infection.

The management of medicines had also improved. A new pharmacy supplier had been sourced and systems had been introduced by the home to record the use of medication prescribed as 'as and when required' (PRN) and boxed medication. We found that medication administration records were being completed correctly, including those for anticoagulation medication. Regular audits had been carried out to monitor that staff were following the policies and systems that had been introduced.

People who used the service told us they were asked for their consent before staff provided any personal care. One person told us “What I like about it is they are always saying ‘are you sure you are alright?’”

Although the majority of people told us they were satisfied with their care we found that people had not been supported to meet their assessed dietary requirements appropriately.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We found this had led to arrangements to loan medicines between service users where one person had run out of their anticoagulant medication.

We found improvements were required to ensure that cleanliness and infection control was maintained at the service.

The provider had made improvements regarding the safety and suitability of the premises since our last visit; though continuing maintenance was required due to the age and nature of the building to ensure on-going compliance. Records were not always available at the service to evidence where maintenance had been completed. The provider forwarded this information to us following our visit.

The provider had systems in place to ensure staff who worked at the service were recruited and pre-employment checks were completed to ensure the safety of people who used the service.

We found that although the provider had quality assurance systems in place they did not always implement action plans to secure identified improvements.

People we spoke with said they like living in the home and that their care and support was very good. One person told us, 'Staff are friendly and give us the support and help we need' and another said 'There is a lovely atmosphere in the home, very friendly and welcoming.'

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity.

We found that the service was clean, tidy and there were no malodours in the building. However, we had a few minor concerns about infection control practices which we have addressed in our report.

We found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

We raised a number of minor concerns about the environment with the manager. We found there were areas of health and safety that could be improved.

Staff were suitably trained and supported to ensure they could offer the appropriate care to people. People told us they saw the manager most days to talk to and they were confident of using the complaints system if they needed to.