Archived: Gracewell of Weymouth

Gracewell of Weymouth is a care home which is registered to provide personal and nursing care to up to 70 people. The home is arranged over three floors and specialises in the care of older people including people who are living with dementia.

At the time of the inspection there were 49 people living at the home.

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

People lived in a home which had not been consistently well led in the past few months. This had led to some audits not being carried out and some identified shortfalls not being addressed. This meant the systems in place to monitor the quality of people’s care and safety had not been fully implemented to drive improvements. At the time of the inspection the provider was taking action to improve the management of the home.

Standards of cleanliness throughout the home were excellent.

People felt safe and were comfortable and relaxed with staff who supported them. Throughout the inspection we saw kind and caring interactions between people and staff.

Risk assessments were in place to support people’s physical health. However, risk assessments regarding people’s emotional well-being had not always been updated to make sure they took account of people’s wishes. This meant risk assessments were not always carried out in a way that enabled people to safely take part in activities of their choosing or promote their independence.

People received their medicines safely from staff who had received specific training to carry out the task. All medicines errors or discrepancies were fully investigated.

People were cared for by staff who had received training to care for people safely. Staff were safely recruited which helped to minimise the risks of abuse to 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 were happy with the food provided at the home. The provider was planning changes to ensure that everyone had a choice of meals.

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

Rating at last inspection – The last rating for the service was good (Report published December 2019)

A further targeted inspection was carried out in November 2020 to follow up on concerns raised with the Care Quality Commission. The rating was not changed as a result of this inspection and remained good.

Why we inspected

The inspection was prompted in part due to concerns received about medicines administration, several safeguarding incidents, staffing and the management of the home. A decision was made for us to inspect and examine those risks.

We identified concerns in relation to the management of medicines, safeguarding incidents, staffing and management. 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.

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 and well led sections of this full report. However, we found no evidence during this inspection that people were at immediate risk of harm from these concerns. The provider was taking action to address shortfalls identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gracewell of Weymouth 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.

Gracewell of Weymouth is a care home. The home was providing personal and nursing care to 60 people aged 65 and over at the time of the inspection. The service can support up to 70 people. The home is situated in a residential area of Weymouth.

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

People were supported by staff who cared about them and knew them well. They told us they felt the staff were kind and listened to their wishes. People were relaxed in the presence of staff.

The service was clean and free from odours. Staff were wearing face masks and following Covid 19 government guidance to minimise risks to people.

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

Rating at last inspection

The last rating for this service was Good. (report published December 2019).

Why we inspected

This targeted inspection was prompted to seek assurances about the safety and care of people after the provider had responded to safeguarding concerns in the home. An investigation was ongoing and as a result, this inspection did not examine the circumstances of the incident.

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.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at continued risk of harm from these concerns. CQC will review of the findings of this investigation separately.

Please see the Safe and Caring sections of this report.

Follow up: We will return to visit as per our re-inspection programme. 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.

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

Gracewell of Weymouth is a residential care home providing personal and nursing care up to to 69 people aged 65 and over at the time of the inspection. The service can support up to 70 people.

The home specialises in the care of older people who are living with dementia and older people with nursing needs.

The home is purpose built with accommodation arranged over three floors. There are lifts to enable people to access all areas including a secure outside space.

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

People lived in a home that was well led by a senior team committed to promoting person centred care within a framework of robust monitoring and developments. There were systems in place to monitor standards and plan improvements. The manager was new to the home and the staff team had not all felt part of changes so did not all feel able to influence improvements. The manager was aware fo this and had a plan in place.

People felt safe at the home and with the staff who supported them. The staff understood their responsibilities and how to protect people from abuse. There were adequate numbers of staff to meet people’s needs and keep them safe. There had been high turnover of nurses which had an impact on treatment. Recruitment ahd been successful to fill vacant posts.

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. Staff respected people’s choices and preferences.

People were cared for by staff who knew them well and were kind and compassionate. Most staff were happy in their jobs and all staff wanted to provide the best care they could. People had built strong relationships with staff and appreciated the familiarity they had.

People enjoyed the food and were supported to eat and drink safely.

People received care and support in a way that met their personal needs and enabled them to follow their own routines, interests and beliefs.

There were organised activities, informal chats and entertainment which provided people with meaningful things to do. People were supported to maintain contact with friends and family members.

Rating at last inspection

The last rating for this service was good (published 1 December 2017).

Why we inspected

This was a planned inspection based on our published guidance for inspecting new providers.

Follow up: 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.

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

As a result of the findings of the inspection in November 2016, we set requirement actions in relation to the four breaches of regulations. The provider wrote to us in January 2017 to tell us how they would achieve compliance with these requirements which we reviewed during this inspection. During this comprehensive inspection we found improvements had been made.

Gracewell of Weymouth is a purpose built nursing home, over three floors and registered to provide nursing care for up to 70 people in the centre of a residential area of Weymouth. The ground floor is for people with residential care needs, the first floor is for people who require memory care and the second floor is for people whose care needs where associated to nursing. At the time of our inspection there were 56 people living in the home.

There was a registered manager in post. 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.

People, relatives, health professionals and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by nurses that were trained and qualified to give medicines. Monthly medicine audits were carried out by clinical leads.

Staff had a good knowledge of people’s support needs and received regular training such as health and safety and infection control as well as training in response to people’s needs for example dementia.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

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.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The head chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. A GP visited the home every Friday.

People told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People and relatives were provided with opportunities to feedback through meetings and surveys.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People and staff felt that the service was well led. The registered and service manager both encouraged an open working environment.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Quality monitoring audits were completed by the registered manager, deputy manager. Clinical leads and the care and quality nurse. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.

The service did not have a registered manager at the time of our inspection. The last registered manager had left the service in February 2015. The current manager had taken up their post in October 2016 and planned to apply to become the registered manager. They had an agreed period of absence of one month which was being covered during our inspection by another manager from within Gracewell Healthcare Ltd, the provider organisation.

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.

Gracewell of Weymouth had been through a sustained period of management change when we inspected. We found a number of areas that required improvement during our inspection. The management and staff team of Gracewell of Weymouth was aware of some of these issues and had started work on plans to make improvements.

Staff were committed to providing a high quality of care for people living in the home and supported each other to achieve this. However, systems to ensure the quality of care were not always embedded and a lack of consistent oversight meant that monitoring was not adequate to review care practice effectively.

People were not always protected from harm because staff did not fully understand the risks they faced. Care plans were not always followed and records were not always accurate. This increased the risk that people could receive inappropriate care.

Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards (DoLs) had been applied for. Staff did not know who had a DoLS in place and this put people at risk of receiving inappropriate care.

The home looked and smelled clean. We observed that some practice did not reflect current guidance for good practice in infection control. This put people at risk of catching health care related infections.

Statutory notifications had not been made to CQC. A statutory notification is a legal requirement for the provider to inform CQC of certain situations as part of their oversight of care provision. This meant that CQC had not received information to support their monitoring of the service.

Health professionals were not always confident that people received support for their health related needs in a timely and appropriate manner. A GP had noted an improvement in this and people felt confident they saw health professionals when necessary.

People had the support they needed to eat and drink in ways that met their needs and preferences. People told us the food was good and we saw that there were robust systems in place to ensure that the food was of a high quality and appropriate for individuals. We observed that meal times were an opportunity for choice and socialising.

Staff were safely recruited, felt supported and knew how to identify and respond to abuse. People were at a reduced risk because staff knew how to report potential abuse appropriately.

We heard some mixed opinions from relatives as to whether there were always enough staff available and we observed times when staff were not deployed in ways that met people’s identified needs. The staffing had been reviewed and increased since the manager came into post and remained under review. Changes to deployment were made immediately following our inspection.

People were engaged with a wide range of activities that reflected individual preferences, including individual and group activities.

People and their relatives were positive about the care they received from the home and told us the staff were compassionate, kind and attentive. Staff treated people, relatives, other staff and visitors with respect and kindness throughout our inspection. Relatives told us they felt able to raise concerns.

We have made a recommendation asking the provider to review signage and environmental cues available in the home for people with dementia.

There were breaches of regulation relating to the management of risk, how consent to care and treatment was sought and the oversight of the service. You can see the action we asked the provider to take at the back of the full report.