Archived: Gracewell of Church Crookham

Gracewell of Church Crookham is a residential care home which provided nursing and personal care for 33 people at the time of this inspection. The service can support up to 60 older people and younger adults who may have a physical disability, sensory impairment or be living with dementia.

The home was organised in four household units across two floors. Each unit had shared areas including a dining area. Shared areas included a cinema, bistro style café and an enclosed garden.

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

People and their relatives all spoke highly of the home and the service they received. Relatives said Gracewell of Church Crookham was “the best place” for their loved one, and they felt “lucky” their loved one had a place there.

People were safe and protected from avoidable harm and abuse. The provider supported people to keep themselves and their belongings safe and secure. The provider had processes to manage people’s medicines safely, and had put in a variety of infection control measures in response to the COVID-19 pandemic. Infection control measures were described as exemplary and exceptional by a healthcare professional and a relative.

People had a service which was effective and led to good outcomes for people. Feedback from people and their relatives about the effectiveness of the service was consistently good. There was particularly good feedback about the dining experience. 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 had a service that was consistently well managed and well-led. The leadership and culture promoted high-quality, person-centred care. Staff morale was noticeably positive after an exceptional period of stress in the adult social care sector, and there was an up-beat atmosphere in the home.

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 requires improvement (published 17 March 2020).

Why we inspected

We undertook this focused inspection to check the provider had made sustained improvements since our last inspection. This report only covers our findings in relation to the key questions safe, effective and well-led which we previously rated requires improvement.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used to calculate the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Gracewell of Church Crookham on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• The provider had arranged for people to have visitors safely. There had been temporary shelters in the garden during the summer, window visits for people who could not leave the building, and video conferences for families who could not visit physically. The provider had re-purposed two vacant rooms on the ground floor for visits where window visits or garden visits were not possible. These rooms had direct access through french windows, provision for visitors to wear appropriate PPE, and screens to protect people from infection via droplets. Arrangements for safe visiting were tailored to the individual needs of people and their families.

• There were arrangements in place to prevent visitors spreading COVID-19. The provider had a questionnaire for visitors on entry to eliminate the most common risks of carrying the infection. Staff helped visitors to don appropriate PPE, sanitise their shoes and wash their hands. If visitors were already wearing PPE, they were invited to change it for new items to reduce the risk of carrying the virus from outside the home.

• The provider had acted to make sure new standards of hygiene and cleanliness could be maintained. They had sourced new cleaning products, and developed and updated staff guidance and audit checklists to meet the new requirements. The home had “fumigation” equipment to clean rooms by spraying a mist of disinfectant on surfaces. They also had a contract with an external supplier to fumigate the wider home periodically. There was appropriate equipment, protective clothing, and signage to make sure this was done safely.

• The provider had made effective use of unoccupied rooms as PPE donning and doffing stations, and changing facilities for staff arriving and leaving. They were using emergency exits near to the changing rooms as temporary entrance and exit points for staff. This made it easier for staff and others to keep an appropriate distance from each other when coming into or leaving the building.

• In addition to routine and regular testing of staff and people living at the home, the provider had sourced rapid results “lateral flow” tests. These were used when an urgent test was needed, for instance to speed up the admission of a new resident or to allow a family member to visit at short notice where this would support the wellbeing of the family member or person using the service.

• Changes to how unoccupied rooms were used took into account any possible future need to divide the home into zones to manage or contain an outbreak of COVID-19. For instance, each zone would have its own staff PPE room in the event the provider needed to isolate people with COVID-19 from those who tested negative.

• The provider’s policies and procedures for infection prevention and control were detailed, thorough and up to date. They took into account recent guidance and provided a sound basis for the provider to prepare for winter pressures, including increased rates of infection in the community.

Further information is in the detailed findings below.

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

We received mixed feedback regarding staffing levels. There were a number of new staff and still some agency staff being used. This meant a number of staff did not know people and their needs as well as they could. Recruitment processes needed to be more robust to ensure staff were fit to work in the care industry.

Staff understood signs of possible abuse to people and how to raise concerns if needed. The manager and senior staff understood their responsibilities in relation to safeguarding. Risks to people were assessed and understood by staff. Medicines were managed safely. Infection control measures were in place to minimise the risk of infection. The provider acted on or learnt from incidents.

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;. However, improvements were needed to ensure that where people lacked capacity to consent for themselves, that appropriate people consented on their behalf.

People were supported to eat and drink enough. Staff did not all understand people’s needs when it came to mealtimes. Mealtimes were stretched, and the experience took a long time with people waiting for their food.

There were systems in place to monitor and improve the service, however these required further improvements. The registered manager had been in the service for a short time and had made improvements to date.

We received positive feedback about the new management of the service from people, relatives, professionals and staff. However, it was fed back that although there had been improvements, further improvements were still required such as embedding the new staff team and structure. The service worked well with other agencies to get the best outcomes for people.

Care workers had developed caring relationships with people they supported. Staff respected people's

dignity and privacy and promoted their independence.

People's care and support met their needs and reflected their preferences.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 January 2019) and there were multiple breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, though some improvements had been made and there were no longer breaches of regulations, enough improvement had not been made or sustained to achieve a rating of good and the rating remains requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Gracewell of Church Crookham is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Gracewell of Church Crookham is registered to provide accommodation for up to 60 people, including people living with a cognitive impairment. At the time of our inspection there were 45 people living in the home. The home is organised in four household units on two floors; Vogue, Poolside, Tweseldown and Galley Hill. Each of these units is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness, while providing additional facilities, such as a cinema and ‘Bistro’. Each household was designed to and furnished to meet the needs of the people living in them.

The home did not have 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. At the time of inspection, the there was a general manager responsible for the daily running of the home. They were being supported by a deputy manager and the provider’s operations director.

The service had not been consistently well-led or well-managed since our last inspection. The provider had failed to operate processes effectively to ensure the service complied with legal requirements. Relatives and staff had consistently raised concerns, which had not been effectively addressed by the provider.

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.

People had not always experienced care that made them feel safe and protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations had not always been carried out, in partnership with local safeguarding bodies.

Risks had not always been assessed, monitored and managed effectively. Interventions had not always been put in place to mitigate or reduce identified risks. This meant that people had been exposed to the further risk of experiencing unsafe care. Care records demonstrated that staff had not always followed the provider’s policy and procedure in relation to the recording and management of falls.

Staff understood their responsibilities to raise concerns, to record safety incidents and near misses and to report them internally and externally. However, the provider had identified that such incidents had not always been reported effectively. The provider had developed an action plan to address these issues.

People’s prescribed medicines had not always been managed safely, which had led to several medicine errors. People had not always received their prescribed pain relief as required.

People had not always been supported to have access to healthcare services and receive on going healthcare support when required. The provider had addressed the need to improve and provide appropriate responses to people’s changing needs within their service recovery plan and their back to basics approach.

The provider had failed to effectively engage with community nursing team forums. Nursing professionals had been concerned that previous management teams had not been open and transparent or demonstrated a proactive approach to delivering effective care based on best practice.

The general manager had completed a review of all authorisations in relation to the Deprivation of Liberty Safeguards and identified that a further 12 applications were required. These applications have been submitted and await authorisation. The general manager had established a tracking system to ensure all future applications are submitted expeditiously.

People had not always experienced personalised care that was flexible and responsive to their individual needs and preferences. People had not consistently been supported to follow their interests and take part in activities that were socially and culturally relevant and appropriate to them.

Care records did not always effectively demonstrate responsive assessment and monitoring of people’s needs, for example; evidence of repositioning had not always been effectively recorded in relation to people’s pressure ulcers, which had healed. People’s preferences and choices for their end of life care were not consistently recorded, communicated and kept under review.

Relatives of people who had limited verbal communication reported a mixed experience in relation to the care their loved ones had received. Three such relatives told us that staff were consistently kind and caring. Seven relatives conversely told us their loved one’s had experienced poor continuity and consistency of care from some staff, who were not caring or compassionate.

People and their relatives concerns and complaints had not been consistently listened and responded to. This meant the provider had missed opportunities to improve the quality of care people received. Prior to our inspection the provider had engaged with people and their relatives and had arranged forums to seek feedback regarding concerns and complaints. The provider had appointed a new management team, including the general manager and new operations director. The provider’s recovery action plan detailed measures being undertaken to ensure all complaints were dealt with in accordance with their policy and used as an opportunity to drive improvement in the service.

At the time of our inspection the provider had deployed sufficient, suitably qualified staff to meet people’s assessed needs. People, relatives and staff consistently made positive comments about recent measures introduced by the general manager to provide continuity and consistency of staffing within the different households. These new measures had had a significant impact on staff morale and people’s confidence and well-being.

Staff had experienced a comprehensive induction and did not work unsupervised until they were confident to do so and the general manager had assessed them to be competent. Staff had completed the provider’s required training, which ensured they had been enabled to develop and maintain the skills necessary to deliver effective care and support. Staff were supported by the provider with their continued professional development and to maintain qualifications relevant to their role. Staff were receiving on- going training and guidance from an area coordinator to embed best practice in relation to supporting people who experienced living with dementia.

The home had been designed to promote the independence and safety of people who live with dementia, which helped them to manage disorientation and confusion.

People were supported to have a balanced diet that promoted healthy eating and the necessary nutrition and hydration. Staff were aware of those individuals who had been identified to be at risk of choking and the support they required to mitigate these risks, which we observed staff delivering in practice.

We observed that staff consistently treated people with kindness in their day-to-day care. Staff knew and respected the people they cared for, including their preferences, personal histories, backgrounds and potential.

The quality of people’s care had improved since the arrival of the general manager who had implemented a staffing system, where staff only worked in a specific household. People consistently told us they now experienced good continuity and consistency of care from staff who knew them and their needs well.

The operations director and general manager had developed a credible recovery strategy to deliver high-quality care and support, which achieved good outcomes for people. The general manager and deputy manager were highly visible within the home and provided clear and direct leadership, which inspired staff. Without exception staff told us they now felt respected, valued and supported by the management team.

The general manager had begun to collaborate effectively with key organisations and agencies to support care provision, service development and joined-up care, for example; community nursing and local authority safeguarding teams.

The inspection was unannounced and was carried out on 15 November 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People lives and wellbeing were enriched because they experienced personalised care and support from staff who were flexible and responsive to their individual needs and preferences.

Staff were especially knowledgeable about people’s right to choose the types of activities they that were important to them. This knowledge has helped them identify innovative ways of supporting people to engage in activities that reflect their personal preferences and meaningful to them.

The registered manager and staff not only strived to improve the lives of the people using the service but took an active role in the wider community.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and recorded, along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who were knowledgeable in caring for people with cognitive impairments and had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Staff had developed positive working relationships with healthcare professionals, such as chiropodists, opticians, dentists, GPs and mental health specialist which enhanced the care people received.

The management team and staff protected people’s rights to make their own decisions. Where people did not have the capacity to consent to care, legislation designed to protect people’s legal rights was followed correctly and confidently by staff.

People were treated with dignity and respect at all times. Staff demonstrated caring and positive relationships with people and were sensitive to their individual choices. Staff were skilled in helping people to express their views and communicated with them in ways they could understand.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People benefitted from a well-managed and organised service. The provider’s clear vision and values underpinned staff practice and put people at the heart of the service. Staff were aware of the vision and values, how they related to their work and spoke positively about the culture and management of the home.

The registered manager was approachable and well supported by the provider. There were comprehensive quality assurance processes in place using formal audits and regular contact with people, relatives, professionals and staff. Family members told us they were given the opportunity to provide feedback about the culture and development of the home and all said they would recommend the service to families and friends. The registered manager was responsive to new ideas and had developed links with external organisations and the community.