Archived: Goffs Park Nursing Home

This inspection was unannounced and was carried out by two inspectors. At the time of our inspection, there was no registered manager working at the home. The previous manager had left the service on 31 July 2014, but CQC had not received the appropriate notification to remove him from the register. This was discussed with the provider at our previous visit 23 September 2014 and again with the acting manager during this visit. We were told by the acting manager, 'I will complete the forms and then ask [the provider] to send them.' There was an acting manager in post who told us that he was, 'Going to apply to become registered manager'. When asked for a timescale for his application to be submitted, we were told the application 'Will be sent [to the Commission] 1st December 2014'.

During the inspection we reviewed records relating to the management of the home which included: supervision and training documentation and staff rotas. We looked at some care plans and daily care records. We also looked at a selection of health and safety monitoring records including those related to the cleaning of the kitchen. We spoke to the acting manager, the cook, the registered general nurse (RGN) and four care staff on duty. We observed the interactions between people in the lounge and staff, this included observation of some of the lunchtime routine. We spoke with people living at the home and three relatives during the visit. On the day of our inspection there were 19 people living at the home.

We found that the service was not safe because there were not enough staff on duty who were suitably trained and supervised. The service was not well led because there were ineffective quality assurance processes in place and no clinical oversight of nursing staff. The provider had not taken steps to comply with the requirements of the regulations. You can see what action we have asked the provider to take at the end of this report.

During the inspection we reviewed records relating to the management of the home which included: the recruitment records for one new staff member, some training documentation, staff rotas and records relating to medication administration, ordering and disposal. We looked at six care plans and daily care records. We also looked at a selection of health and safety monitoring records including those related to the provision of food. We spoke to the acting manager, the provider, the cook, the trained nurse and four care staff on duty. We observed the interactions between people in the lounge and staff, this included observation of some of the lunchtime routine. We spoke with six of the people living at the home and five relatives during the visit. On the day of our inspection there were 20 people living at the home.

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?

This is a summary of what we found -

Is the service safe?

People told us they felt safe. There were enough suitably qualified and experienced staff on duty to meet people's needs. Staff that we spoke with told us that there were enough staff and that they were able to spend time with people. Comments from the people who used the service regarding the staff included, 'Helpful' and 'Very good, they treat me well'. We found that medication was managed safely at the service. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted that whilst no DoLS applications had been required, staff we spoke with demonstrated a good understanding of their responsibilities in this area.

Is the service effective?

We saw that people's health and care needs were assessed and their care plans reflected their current needs. Daily notes were recorded about the people who lived at the home. The records seen gave a picture of the care people had received and showed that people's care was delivered in line with their care plans. Staff we spoke with were aware of the individual needs of each person who lived at the home. Staff could describe people's care, likes and dislikes and how they liked things done. We saw before people received any care they were asked for their consent and the staff acted in accordance with their wishes.

Is the service caring?

During our inspection we saw people were being spoken with and supported in a sensitive, respectful and professional manner. People said they were happy with the care they received and they liked the staff. Relatives spoke highly of the staff, 'They are a really caring bunch. We are so lucky they stayed, what with all the problems there have been. You really can't fault them'.

Is the service responsive?

We found that changes to people's needs were recorded and appropriate actions were taken. For example, changes had been made to people's diets following advice from a dietician. People we spoke with felt staff listened to what they said. At this inspection we found that the compliance actions made at our previous visits in March 2014 and May 2014 had been met.

Is the service well-led?

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were looking after. Staff told us that they had received some good training and felt confident in their roles. Staff and relatives spoke highly of the acting manager. We were told he was, 'Involved in the home', 'He is always about to talk to, if we need him' and, 'It's nice to have someone here who takes an interest'.

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?

This is a summary of what we found-

Is the service safe?

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

Is the service effective?

People told us that the care had improved since the acting manager had taken up post. Comments from people included, 'The staff are great', 'They help me' and 'There's a lovely atmosphere here now'. Staff told us that they had received training, 'The training has improved'.

Is the service caring?

During our visit we saw that people who lived at the home were given assistance with their lunch in a calm and relaxed manner. We saw that staff were able to spend time and interact with people. A relative told us that, '[Name] is so much happier. I think that [people] are well looked after now.'

Is the service responsive?

As a result of our inspection on 8 May 2014 a Warning Notice was issued to the provider. This was because the provider was failing to take proper steps to ensure that effective recruitment processes were being followed. At this inspection we found that action had been taken by the provider and that the Warning Notice was met. People told us that the service had improved since our last inspection, 'It's so much better now'. Staff told us that, 'We were told not to talk to you [CQC] before. We got shouted at if we did. They said we would lose our jobs. The new manager is great, he really cares. He talks to the residents and asks our opinions. It is so much better.'

Is the service well-led?

Since our last visit the registered manager and the operations manager had left the service. There was an acting manager in post. Everyone we spoke with felt the service had improved. People said the atmosphere was more relaxed. A relative told us, 'It was like walking on egg shells. You never knew what was going to happen. Now they keep us informed. The new manager and the owner had a meeting with us all to explain what was happening. I feel involved. They listen to me. [Name] gets his pain killers now, he doesn't have to suffer anymore.' Staff told us that the acting manager, 'Takes us to one side to chat. He likes to make sure things are ok. We are encouraged to say what we think now.'

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?

This is a summary of what we found-

Is the service safe?

Staff personnel records did not contain all the information required by the Health and Social Care Act. This was the same as at our previous inspection on 12 March 2014. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living there. A Warning Notice has been served in relation to this and the provider must tell us how they plan to improve. We found that medicines were not always given as prescribed. The provider could not evidence that accurate records were maintained of medicine administered. Therefore people were not protected from the risks associated with the administration and recording of medicines. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

As a result of our inspection on 12 March 2014 a Warning Notice was issued to the manager regarding staff training. At this inspection we found that steps had been taken by the provider and that some elements of the Warning Notice were met. We found that whilst the Warning Notice was not met in full, sufficient action had been taken to reduce the impact to people. Further improvements were required in relation to staff training and support. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

We saw a training schedule for the year. We found no evidence that staff had been provided with training about strokes despite the manager having informed us that the majority of people who lived at the service had a history of strokes. This was not included in the training schedule for future training. This was the same as at our inspection of 12 March 2014. We asked the manager about systems that were in place that enabled monitoring of the training that staff had undertaken and identified the training required to meet people's needs. We were told that there was no system in place. This was the same as at our inspection of 12 March 2014. We found that whilst the Warning Notice was not met in full, sufficient action was taken to reduce the impact to people. Further improvements were required in relation to staff training and support. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service responsive?

As a result of our inspection on 12 March 2014 three Warning Notices were issued. At this inspection we found that the provider had met one Warning Notice in full and one was partially met. No action had been taken regarding one of the Warning Notices. This indicated that the provider did not take consistent and swift action to address deficiencies. We saw that the service had written a supervision and training policy and procedure since our last visit. The manager told us that since our last visit all staff received formal, one to one supervision support. 'Everyone has now had supervision'. We asked the manager about systems that were in place for monitoring the frequency of staff supervision. He told us that none were in place and that each individual staff member's records would have to be looked at in order to ascertain if the staff group as a whole received regular, formal supervision. One member of staff we spoke with confirmed that they had received one to one supervision, 'I had supervision last week'.

Is the service well-led?

As a result of our inspection on 12 March 2014 a Warning Notice was issued to the manager regarding staff recruitment. This was because the provider was failing to take proper steps to ensure that effective recruitment processes were being followed. At this inspection we found that action had not been taken by the manager and that the Warning Notice was not met. The manager confirmed that he had not taken any action. The manager told us 'I've not got round to it yet. I have been on holiday'. The manager told us that 'The operations manager deals with the staff recruitment checks. I haven't done this because it wasn't in my control.' This meant that the registered manager and registered provider did not take appropriate action to address deficiencies and did not understand their responsibilities to comply with the regulations of the Health and Social Care Act.

The manager told us that of the 29 people who were living at Goffs Park Nursing Home, four were confined to bed, one person was receiving end of life care, five people had dementia and all had nursing needs. The manager also said that, '80% had moving and handling needs that require hoisting. The majority of clients we have are stroke patients'.

People were cared for by staff who were not supported to deliver care and treatment safely, and to an appropriate standard. This included staff not receiving regular, formal supervision, appraisal or training. Staff confirmed that supervision and training was not consistently provided. For example, one person said, 'I think I have had one supervision. I can't remember what we talked about'. Another person said, 'I could give a lot more if I was trained'.

We also found that suitably qualified staff were not always deployed to ensure people received care at the times they wanted and for the effective management of the service. All of the care staff that we spoke with told us that they did not have time to read care plans and that at times the care was rushed. One person said, 'The work level feels too much. Don't always have time to sit and talk to people'. A person who received a service told us, 'They put my pad on without washing me. They said they did not have time. The poor night staff had to get all the faeces off my backside'.

We saw that medication administration records were not accurate, specifically with regards to time the medicines were given. We saw medication given at 11.05 was signed by the nurse as having been taken at 08.00. Nursing staff routinely signed the MAR charts for the application of external preparations such as creams and ointments but had not undertaken this task. This means that medicine records were not always completed by the person who had undertaken the task and this increased the risk of error. We saw open tubs of prescribed creams and food thickening products in people's rooms with the pharmacy labels removed. Removing the pharmacy labels meant it was not possible to establish which person each of these products was prescribed for, or to confirm they were being used as prescribed.

We found that the care records were not always accurate or detailed which meant that people were at risk of receiving inconsistent or inappropriate care. Nutritional intake records did not contain adequate information to be able to assess the nutritional content of the food to determine if this was sufficient and appropriate to maintain people's health. Staff were not always aware of people's dietary requirements. Staff we spoke with did not know which people were diabetic. We were told that people did not receive adequate choice regarding the food. We received complaints that the food was cold.

People told us that they had raised their concerns with the staff and 'They don't listen' and 'They are not interested'.

At this inspection we found that steps had been taken by the provider and one of these areas was compliant. However we also found new areas of non-compliance.

We looked at a selection of records. These included care records and records of accidents and incidents. The provider demonstrated they had in place a system for recording and investigating any complaint that had been made.

We saw that a training schedule was in place for the remainder of the year. However we observed that training was not always applied.

We also found that there were no effective recruitment and selection processes in place.

During our visit we observed interactions between staff and people who used the service. We found these interactions to be positive, sensitive and friendly. Everyone that we spoke with told us they were satisfied with the care and support they or their relative received.

We spoke with staff who told us that they were happy working in the home. They told us the home had a relaxed and happy atmosphere. Observations during our visit supported this. Staff told us that they felt supported in their work. They told us that the manager was approachable and helpful. One member of staff told us, "It's like family here, we all get along really well'.

There was a lack of arranged activities for people individually or in groups. We saw an out of date schedule of activities on display for July 2012. Also one staff member said there was not 'Not much activities'.

Despite people expressing satisfaction with staff we found that people were cared for by staff that were not supported to deliver care and treatment safely, and to an appropriate standard. This included staff not receiving training in areas specific to people's needs.

We also found that there were no effective systems to regularly assess and monitor the quality of service that people received.

We reviewed the care records of people living in the home and found specific assessments and monitoring were requested these were not carried out. This meant people needs were not assessed when care was given.

One relative told us they chose the home because 'it was a friendly place and the carers are very kind.'

Staff told us the lack of essential amenities such as a washing machine in the home made it difficult for them to meet people needs. Relatives complained to us about the lost of people clothing. One relative told us the staff always seemed to be rushing around.

We found staff were not supported to deliver care and treatment to an appropriate standard. We found staff did not receive regular formal supervision and training in areas including safeguarding, the mental health capacity act 2005 and deprivation of liberty.

The provider told us there was an annual service user satisfaction survey which was used to monitor the quality of the service provided.