The Care Quality Commission
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  • Community healthcare service

Archived: Gallions View

Overall: Inadequate read more about inspection ratings

Duncan House, 20 Pier Way, London, SE28 0FH (020) 8854 8884

Provided and run by:
Bridges Healthcare Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

05 December 2019

During an inspection looking at part of the service

Gallions View is operated by Bridges Healthcare Limited. The service is a short stay, planned discharge unit operated by registered nurses, health care assistants, a therapy team and a GP. The service offers short term stays of about one month for medically fit patients awaiting placement or next move following an admission to an acute hospital.

We carried out the focused unannounced visit to Gallions View on 5 December 2019 as we had concerns about the safety and effectiveness of the service following a previous inspection in August 2019, where it had been rated as Inadequate. At this inspection we inspected aspects of the safe, effective and well-led key questions. As this was not a comprehensive inspection we did not re-rate the key questions we inspected. The previous ratings remain in place.

Our rating of this service stayed the same as this was the rating applied following the last inspection in August 2019; when it was rated as Inadequate for safe and well-led; and Requires Improvement for effective, caring and responsive.

Throughout the inspection, we took account of what people told us, what we observed and how the provider understood and complied with the Mental Capacity Act 2005.

Our findings from this inspection were:-

  • The service lacked effective governance systems to enable it to operate effectively and ensure compliance with the regulations. Environmental risk assessments had not identified out of date medical equipment in an unlocked cupboard and liquid detergent in a food store.

  • An inspection by the fire brigade in November 2019 had noted fire safety concerns at this location. The registered manager had raised these safety concerns, relating to the structure of the building, with the landlord. The concerns had to be addressed by 21 May 2020. Staff we spoke with gave different answers in respect of procedures related to the activation of the emergency exits during evacuation of the building in the event of fire. This could have led to delays in evacuating patients in an emergency. Some staff did not know what patients’ personal emergency evacuation plans were or where they were kept.

  • Patient sleeping and bathroom areas were not segregated. The service did not safely separate areas for male and female patients in the unit so that the dignity and respect of patients was maintained.

  • Staff did not always ensure that medicines were given in line with the instructions of the prescriber. Staff did not routinely record the position of topical patched applied to patients.

  • There was no evidence provided during the inspection that a pain assessment tool was in use. This meant that would be difficult for staff to assess if additional pain relief was needed for patients who had difficulty communicating. Staff monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.

  • The service had not carried out a formal risk assessment in respect of the need to keep emergency equipment on site.

  • The service had not considered the wider needs of patients with dementia or cognitive impairment, who made up a majority of the patient group, and implemented ways to make sure the environment and approach to care better met their needs.

  • Staff did not have access to a blood spillage fluid kit to ensure safe clean up of blood and other bodily fluids.

  • Patients’ treatment records were difficult to navigate. There was no consistency in recording patient information, which meant that important information could be missed.

  • Some staff lacked confidence in moving and transferring patients safely and in completing tissue viability assessments.

However:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, although lacked confidence in some areas. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service had made some improvements since the last inspection. For example, staff assessed and monitored patients’ skin integrity and worked with tissue viability nurses to in the prevention and the treatment of wounds. Staff gave patients enough food and drink to meet their needs and improve their health, and kept records of this.

  • At the previous inspection the registered manager and staff lacked understand of deprivation of liberty safeguards and had failed to apply for authorisations to deprive patients of their liberty. At this inspection we saw evidence that staff had applied for deprivation of liberty safeguards authorisations for those patients that had been identified as lacking capacity and held best interests meetings to ensure that any restrictions were in the person's best interests. The registered manager and staff demonstrated that they understood deprivation of liberty safeguards.

  • The registered manager had worked with commissioners of the service and NHS partners to improve standards of care since the last inspection in August 2019. A number of systems were being introduced but would need time to become embedded.

  • Staff assessed the needs of all patients. They worked with patients and families and carers to develop individual care plans and updated them when needed. Care plans reflected the assessed needs and highlighted how these needs were to be met. Handover records were clear and included all information staff on the oncoming shift would need to know about patients.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, to help the service improve. We issued the provider with four requirement notices. Details are at the end of the report.

Kevin Cleary

Deputy Chief Inspector of Hospitals

6 August 2019

During a routine inspection

About the service

Duncan House is a care home that provides nursing and personal care and support for up to 30 older people. The home works closely with local clinical commissioning groups in providing services to support planned hospital discharges. People stay at Duncan house for a period of up to 28 days whilst their ongoing needs are assessed. They are then moved on to a suitable placement or back to their own homes. The home specialises in caring for people living with dementia. There were 24 people using the service at the time of our inspection.

People's experience of using this service

A staff member used unsafe moving and handling techniques when supporting one person to transfer into a chair.

Medicines were not safely managed. Systems and processes in place to order medicines to ensure they remained in stock and people could receive them as prescribed were not effective. Medicines audits showed that medicines administration records (MARs) for medicines out of stock had been signed to show these medicines had been administered. Multiple medicines without packaging or people's names were found in the medicines trolley. Prescribed creams and drinks thickener were not stored safely.

Risks were assessed and identified, however risk management plans in not always in to guide staff on how risks should be minimised.

People’s food and fluid charts were not always completed to help ensure people’s safety.

There were no documents regarding the level pressure mattresses should be set at for people using pressure relieving mattresses.

People's rights were not upheld with the effective use of the Mental Capacity Act 2005. 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. Their needs were not accurately assessed, understood and communicated.

Overall staff were kind and caring, however the provider's systems and processes did not support them to consistently display their caring values. People including those living with dementia were not offered stimulating activities on a regular basis.

Information was not available to people in a format to meet their individual communication needs when required. The service was not currently supporting people who were considered end of life, but if they did relevant information was not recorded in their care plans.

The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection.

People said they felt safe and that their needs were met. People were protected against the risk of infection. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Sufficient numbers of suitably skilled staff were deployed to meet people’s needs in a timely manner.

Assessments were carried out prior to people joining the home to ensure their needs could be met. Staff were supported through induction, training and supervisions. People were not always supported to eat a healthy and well-balanced diet. People had access to a variety of healthcare professionals when required to maintain good health.

People’s independence was promoted. The provider worked in partnership with key organisations to ensure people's individual needs were planned.

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 of the service was requires improvement (published on 28 August 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, consent and good governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

19 July 2018

During a routine inspection

This inspection took place on 19 July 2018 and was unannounced. This was the provider's first inspection since their registration in January 2018.

Duncan House is a care home that provides nursing and personal care and support for up to 20 older people and works closely with the clinical commissioning groups in providing services to support planned discharges. People stayed at Duncan house for a period of up to 28 days whilst they were assessed. They then moved on to a more suitable placement or back home.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, 17 people were using the service.

There was a registered manager in place. 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 this inspection, we observed that staff did not always support people safely to mobilise. We observed staff members using unsafe moving and handling techniques when supporting one person to move. The person’s care plan recorded that a full hoist should be used when mobilising the person, but this was not done. There were processes in place to monitor the quality and safety of the service but they were not always effective as they had not identified this issue. Other risks to people were assessed, identified and safely managed.

People told us they felt safe. There were appropriate safeguarding procedures in place to protect people from the risk of abuse. The home had a system in place to record accidents and incidents and acted on them in a timely manner. We saw accidents and incidents were discussed with staff and learning disseminated. Medicines were stored, administered, managed safely and accurate records were maintained. People were protected from risk of infection as staff followed practices that reduced the risk of infection. There were enough staff deployed to meet people’s needs in a timely manner and the provider followed safe recruitment practices.

Staff received an induction when they started work at the home and were supported through regular training and supervisions to enable them to effectively carry out their roles. People's needs were assessed prior to moving into the home to ensure their needs could be met. The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff told us they asked for people’s consent before offering support. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health. The service met people's needs by suitable adaptation and design of the premises, which included appropriate signage to help people orientate themselves and appropriately adapted bathrooms to manage people’s needs effectively.

People told us staff were caring and respected their privacy and dignity. People were supported to be independent wherever possible. People said staff involved them in making decisions about their daily care and support requirements. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People’s care plans were reflective of their individual care needs and preferences and care plans were reviewed on a regular basis. Activities were on offer and available for people to enjoy and take part in. People were aware of the home’s complaints procedures and knew how to raise a complaint. People's cultural needs and religious beliefs were recorded and they were supported to meet their individual needs if required. Where appropriate people had their end of life care wishes recorded in care plans.

Regular staff and residents' meetings were held and feedback was also sought from people about the service through annual surveys. Staff were complimentary about the registered manager and the home. The provider worked in partnership with the local authority to ensure people’s needs were planned and met. The registered manager was knowledgeable about the requirements of a registered manager and their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. The ethos of the home was to treat people with dignity and respect.