Gedling Village Care Home

Gedling Village Care Home is a care home providing personal care for 36 people aged 65 and over, some of whom were living with dementia. The service can support up to 60 people in one adapted building over three floors.

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

Changes had been made to the management of medicines although we found there were still areas which required improvement. Storage of prescribed creams and medication competency training still required further development in order to ensure all prescribed medications were managed safely and reduce risk further.

Infection control practices had improved, and we were assured that government guidance was being followed. Some signposting in regard to monitoring the testing process for COVID-19 was given in relation to agency staff.

Action had been taken by the new manager to improve the culture within the home. People told us the manager had been open and transparent about issues within the home. Action plans were in place to learn from previous incidents and improve the quality of care people received. The service was undergoing several changes and the manager was well supported by the provider. The manager acknowledged that sustaining and embedding the changes would take time.

Improvements had been made to assessing risk and changes to the governance system had been made to ensure people were cared for safely. Changes to staffing levels improved the care people received and significantly reduced the times people waited for care. Appropriate action had been taken following several safeguarding concerns, although there were some inconsistencies with the level of investigation that had taken place.

People were offered choice in what activities they wanted to undertake, and we observed people to be happy and engaged with the staff. Staff treated people with kindness. Relatives felt when they raised concerns they were listened too.

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 23 March 2021). 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.

This service has been in Special Measures since 23 March 2021. 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 carried out an unannounced focused inspection of this service on 19 January 2021. Breaches of legal requirements were found. Breaches were around safe care and treatment, good governance, staffing and person-centred care. We also received safeguarding concerns relating to how people were treated following our last inspection.

We undertook this focused inspection to check they now met legal requirements and to examine the safeguarding concerns raised. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements. 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 the key question 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection 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 Gedling Village Care Home on our website at www.cqc.org.uk.

Gedling Village Care Home is a care home providing personal care for 36 people aged 65 and over, some of whom were living with dementia. The service can support up to 60 people in one adapted building over three floors.

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

People living at the service were not safe and were placed at risk of harm. Staffing levels, risk management and poor infection control practices at the service put people at risk. Medicines were not consistently managed safely, and action was not taken when issues were found. Records relating to people’s care contained contradictory information; this did not enable staff to provide safe care.

We received mix feedback from people and their relatives regarding the quality of care and the support people received. People were left alone for long periods of time and when people called for help, they also waited for long periods; our observations supported this and indicated there were not enough staff to meet people’s needs.

The leadership, management and governance measures did not provide assurances the service was well-led, and that people lived and were cared for in a safe environment. Lessons were not being learned, and this resulted in a pattern of incidents which placed people at risk of harm.

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 10 July 2019) and there were multiple breaches in 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 February 2019. Breaches of legal requirements were found around regulation 12 (safe care and treatment), regulation 9 (person centred care), regulation 17 (good governance) and regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC issued requirement notices and a warning notice for these breaches of regulation. We did not follow up on the warning notice in a timely manner and due to the pandemic were unable to conduct a comprehensive inspection of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Responsive and Well-led which contain those requirements. 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 requires improvement to Inadequate. This is based on the findings at this inspection.

Following receipt of further information and ongoing concerns relating to people’s care, we carried out an early morning second visit to the service on 27 January 2021.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gedling Village Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Following our second visit to the service we sent a letter to the provider outlining the concerns we found during the inspection, which they responded to with a detailed plan of what action they would take. The provider took immediate action to reduce risks and ensure the safety of people at the service.

We have identified breaches in relation to keeping people safe, risk, medicines, infection control, staffing, care planning and governance at this inspection.

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 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.

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.

People’s experience of using this service: Risks associated with people’s care and support were not always managed safely. People were placed at risk of harm as medicines were not managed safely. There had been a failure to learn from incidents. There were not always enough, adequately trained staff available to meet people’s needs. Action was underway to protect people from improper treatment and abuse. Overall, the home was clean and well maintained and safe recruitment practices were followed.

Further work was needed to ensure people’s rights under the Mental Capacity Act 2005 were protected. Mealtimes were not always positive experiences and improvements were needed to ensure risks associated with eating and drinking were managed safely. People had access to a range of health care professionals, but care plans required more information about people’s health to ensure consistent support. Overall, the home was adapted to meet people’s needs. Staff had training and told us they felt supported, however, formal supervisions was inconsistent.

Staff were not consistently kind and caring. People were supported to be as independent as possible. People had access to advocacy services if they required this.

People did not consistently receive personalised care that met their needs. People were at risk of receiving inconsistent support as care plans were confusing, contradictory and not up to date. People were provided with some opportunity for meaningful activity. There were systems in place to respond to complaints.

Systems to ensure the safety and quality of the service were not fully effective. Where issues had been identified, improvements had not always been made or sustained. This failure to identify and address issues had a negative impact on the quality of the service provided at Gedling Village Care Home. The management team were responsive to feedback and took swift action to address issues identified in this inspection. People living at the home, their families and staff were positive about the management team and were consulted about the running of the home.

The service met the characteristics of Requires Improvement in all areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Good (report published on 5 May 2017)

Why we inspected: This inspection was conducted due to concerns we received about the safety and quality of the service provided at Gedling Village Care Home.

Enforcement: You can see what action we told the provider to take at the back of the full version of the 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: During our inspection we requested evidence of action planned in relation to staffing, medicines management and risk assessment. 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.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff who understood the risks they could face and knew how to keep them safe. Risks to people’s health and safety were identified and action was taken when needed to reduce these. There were sufficient staff employed to meet people’s needs. People received their medicines as prescribed and these were managed safely.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were supported to make choices and decisions for themselves. People who might lack capacity to make certain decisions were assessed to see if they did, and if needed decisions were made in their best interests.

People were provided with a nutritious diet which met their needs and were provided with any support they needed to ensure they had enough to eat and drink. Staff understood people’s healthcare needs and their role in supporting them with these.

People were cared for and supported by staff who respected them as individuals. Staff had caring relationships with people and respected their privacy and dignity. People were involved in planning and reviewing their own care and some people were supported by relatives in doing so.

People received individualised care and they were able to participate in meaningful interaction and activities. People knew how to raise any complaints or concerns they had and felt confident that these would be dealt with.

Some systems for auditing and monitoring the service were not being used effectively. Staff worked well as a team and were supported with their work by the registered and deputy managers.