Gorseway Nursing Home

Gorseway Nursing Home is a nursing home providing personal and nursing care to up to 88 people. It is split into two areas of living. The Manor provides residential care and the Nursing Home provides nursing care for people. The nursing home additionally has a separate unit that specialises in dementia care. At the time of our inspection there were 21 people living in The Manor and 50 people living in the nursing home.

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

The provider’s quality assurance systems were not fully effective in identifying all concerns in the service, and records were not always accurate or detailed. We have made a recommendation about this. When the provider was made aware of any issues they acted promptly and effectively to address them.

Risks to people's health, safety and well-being had been assessed and staff understood how to keep people safe. People had assessments before admission to ensure their needs could be met and ongoing risk assessments to reduce any risks. People's health and nutritional needs were planned for and met. Any health concerns were raised with health professionals.

People were protected from the risk of abuse because the provider had effective safeguarding systems in place. People received their medicines as prescribed. There were enough staff to safely support people.

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 we spoke with were complimentary about the care they received and told us staff were kind, caring and treated them with respect.

People’s needs were met in a personalised way. People had been supported to maintain relationships and to take part in activities that they enjoyed. The provider took complaints seriously and used them to learn and improve the service.

The service had a positive, open culture. People told us they were happy living at Gorseway and staff enjoyed their work. The registered manager was keen to continually improve the service.

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 (report published 16 January 2021) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted in part, by concerns we received in relation to the caring nature of staff. As a result, we undertook an 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 COVID-19 and other infection outbreaks effectively.

Recommendations

We have made a recommendation for the provider to improve their practice in relation to maintaining accurate and detailed records and governance.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gorseway Nursing Home is both a residential care home providing personal care and a residential care home providing nursing care. The service is registered to provide support for up to 88 people. It is split into two areas of accommodation known as The Manor and The Lodge. At the time of the inspection there were 39 people living in The Lodge and 11 people living in The Manor. ‘Memory lane’ is part of the Lodge and specialises in providing care to people living with dementia.

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

Improvements had been made in the management of risks to people. However, the actions taken to mitigate risks were not always recorded as delivered which meant we could not be assured they were always completed, and this could place people at risk of harm. The provider was acting to address this.

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, the records to support this in practice were not always accurate or complete.

Although there had been significant improvements in the monitoring and evaluation of the safety and quality of the service, the system had not identified the concerns we found in respect of the above. There were plans in place to address this.

Improvements had been made in the reporting and management of incidents, including safeguarding people from abuse. People and relatives told us safety in the service had improved and staff were using tools to help them identify learning from incidents and make further improvements for people. Staff were safely recruited and there were enough staff effectively deployed to meet people’s needs. Peoples medicines were managed safely, and procedures were in place and implemented to prevent the spread of infection. We have offered some guidance to develop the provider’s approach.

Staff had completed training to support them to carry out their role effectively. Staff received supervision and told us they were supported by managers in the home. People’s needs were assessed by a variety of healthcare professionals. However, improvements were required to evidence their guidance was always followed by staff to promote people’s wellbeing. People’s nutritional needs were assessed, and risks were identified and monitored. People had achieved good outcomes from the management of their nutritional needs. People and relatives spoke positively about the food on offer in the home.

We received feedback from people, relatives and staff telling us about improvements in the leadership and culture of the home. Their comments described a safer, happier, more caring and effective service. The registered manager submitted information to CQC as required and continued to work in partnership with others to support the development of the service.

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 Inadequate (published 29 May 2020) and there were multiple breaches of regulation. 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 improvements had been made. However, the provider was still in breach of two regulations.

This service has been in Special Measures since 29 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. Safe and Effective were rated Inadequate at the previous 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to 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 Gorseway Nursing Home on our website at www.cqc.org.uk.

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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Gorseway Nursing Home is both a residential care home providing personal care and a residential care home providing nursing care. The service is registered to provide support for up to 88 people. It is split into two area of accommodation known as The Manor and The Lodge.. At the time of the inspection 52 people were living in The Lodge and eight people living in The Manor.

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

People were not always protected against the risk of harm. Unexplained injuries were not always reported or investigated. Allegations of abuse had not always reported or investigated. Following the inspection the manager and provider implemented changes to the incident reporting process to make this more effective and ensure safety.

Medicines were not managed safely. Assessment of risks for people were not always completed effectively, mitigation plans were not implemented, and staff did not always follow care plans.

The provider had not ensured that staff received sufficient induction to the service or that they had received the training they needed to be able to support people effectively, based on people’s needs. People provided negative feedback about the food although we saw this was eaten during the inspection. Where poeple had lost weight it was not always clear that the cause of this had been explored or that action had been take, where appropriate to ensure people were not at risk of malnutrition. Although other health professionals were involved, we were not always confident that staff followed their advice when delivering care. People told us they were involved in making decisions about their care, and staff knowledge of the mental capacity act was adequate however, records about people’s ability to make decisions was at times conflicting. We couldn’t always see that national guidance was used to inform the service. For example, medicines competency assessments for staff had not taken place annually and although other health assessment tools were in place these were not always kept up to date.

Staff practice demonstrated people were not consistently treated with dignity and respect. People had not been involved in the development of care plans or reviews. However, the manager had planned to introduce a new system to ensure this happened and had care review meetings scheduled for March 2020.

People did not consistently receive personalised care. Care planning was not person centred and staff did not always deliver the care people needed. Planning for end of life care needs required improvements to ensure these needs could be met when they arose.

There had been a lack of effective oversight of the service by the provider, caused by inconsistent management and inadequate governance processes. Improvements identified in the action plan developed after the last inspection had not been addressed. Effective systems were not in place to allow continuous learning and improving care. There was not a robust process in place to monitor, act upon and analyse incidents, accidents and near misses. This placed people at continued risk of harm.

The provider had failed to comply with the requirements of their registration as they had not notified CQC of several significant incidents.

A new manager had been in post for approximately four months. They were working in partnership with other external agencies to make improvements to the service and together had produced an action plan to support this. We were told that some positive changes to the culture of the service had been made since the new manager had started. Following the inspection the provider ensured the manager had additional support to make improvements. The manager was responsive to our feedback and supported the implementation of changes to the incident reporting process to make this more effective and ensure safety. Additional staff training was booked and the work required to make improvements to the risk assessments and care plans continued.

Recruitment processes to ensure people were supported by suitable staff were operated. Staffing levels had increased and met the needs of people but at times deployment could have been more effective. The new manager was addressing this. Risks posed by the environment were managed effectively. Complaints were effectively managed. The new manager was aware of the need to make significant improvements in the service and had engaged the support of other partner organisations to enable this to happen.

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 15 May 2019) and there were multiple breaches of regulation. 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 improvements had not been made and the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, care and incidents. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse or harm, staff training and support, person centred care, treating people with dignity and respect, governance systems and reporting to CQC. We are mindful of the impact of 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.

Follow up

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

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.

Gorseway Nursing Home provides personal and nursing care for up to 88 people. At the time of our inspection 47 people were using the service. Some people using the service were living with dementia or had physical support needs.

People’s experience of using the service:

People were not provided with sufficient and meaningful activities. Engagement between staff and people was poor because the provider failed to deploy sufficient numbers of skilled and experienced staff at all times. Records relating to risk management and the Mental Capacity Act 2005 (MCA) were not always completed, which meant decisions made in people’s best interest were not consistently sought in line with legislative requirements. Feedback from healthcare professionals, relatives and people was mixed and the culture within the home was not person-centred. Staff were task focused, did not always respect people’s dignity and people’s preferences and wishes were not always known or detailed in care plans. The providers governance systems had not been fully implemented and they required time to develop. There was a lack of confidence in the leadership and staff felt unsupported in their role.

The provider had acknowledged there were areas that required improvement such as dementia care, activities, staffing, leadership and the culture. There were some plans in place and additional work that had started after our visit to begin developing the home. The provider was in the process of implementing a new IT system which we were told would drive significant improvement in relation to recording information.

Why we inspected: This inspection was planned as the location was newly registered under a new provider. The new provider took over the registration of the service on 23 October 2018.

Rating at the last inspection: This was the locations first inspection since registering with the Care Quality Commission (CQC).

Follow up: We identified five breaches of the Health and Social Care Act 2008. An action plan will be requested to ensure improvements are made. 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.