About the service GHC Nursing Home is a residential care home registered to provide personal and nursing care for up to 40 older people, some of whom may live with dementia. There were 20 older people living at the home at the time of the inspection. The care home accommodates people across two separate floors with a lift installed between the floors.
People’s experience of using this service and what we found
Medicines were not always managed safely, and people did not always receive their medicines as prescribed. Some medicines were unaccounted for. Risks to people receiving care were not always assessed and actions were not always taken to reduce risks to people. Incidents had not always triggered a review of safety so lessons were not always learnt. Care plans were not always in place to help staff provide consistent care, or when care plans were in place they lacked sufficient detail as to how to guide staff to provide safe care.
Systems to ensure the continuity of governance arrangements in the absence of the registered manager were not effective. Audits designed to assess, monitor and mitigate risk and identify improvements in the quality and safety of care were not always effective. Records were not always accurate or up to date. Audit processes had not identified when notifications were not submitted to CQC as required.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Not all staff were supported to have the necessary skills, experience and competence to use the provider’s medicines systems. Care staff had completed some training however the provider did not have a current overview of staff training, skills and competence.
People saw other health and social care professionals when required with their care. Assessment processes were in place, but not consistently completed or reviewed. A refurbishment plan was in place to ensure improvements to the premises were made. People enjoyed the garden however, some design features in the home were not always helpful for people living with dementia. People enjoyed a varied diet that met their personal needs.
Information on people’s end of life care planning was not always clear. Care plans contained some details on people’s life histories to help staff understand and know them well. Evaluations of care plans did not always show how people and their families had been involved to ensure the care plans were still up to date and relevant. Communication needs were mostly met. People were able to take part in activities and enjoyed sitting with their friendship groups. Complaints processes were in place to investigate any complaints raised.
Enough staff worked at the service so that people received timely care. Recruitment checks were made to help inform the provider’s recruitment decisions on staffs’ suitability to work in care. Staff understood how people could be at risk from abuse and knew how to report any concerns. Infection prevention and control measures were in place and followed and this helped to reduce the risks from infection.
People’s privacy was respected, and their dignity and independence promoted. People had been supported to personalise their own bedrooms. Staff supported people to retain their everyday living skills. Advocates had been involved to help represent people’s views and opinions when needed.
The provider had policies in place for staff to follow to help ensure openness and transparency were shown when investigating incidents. People, relatives and staff told us they found the registered manager and other members of the management team approachable and felt confident they would take action should any concerns be raised with them. Staff told us they felt happy working at the service and were happy with their team colleagues.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This is the first inspection of this service under its registration as GHC Nursing Home. The service has previously been registered under a different legal entity.
Why we inspected
The service was previously registered as Giltbrook Care Home. Whilst the service is now registered as GHC Nursing Home, the key people involved in running the service, including the registered manager and Director are the same people who were involved in running Giltbrook Care Home. When the service was registered as Giltbrook Care Home, we received concerns in relation to the management of medicines, maintenance, food and care. The local authority and CCG had visited in relation to some of these concerns and had provided feedback to the provider. One concern was still under investigation by the local authority safeguarding team. More recently, under the registration as GHC Nursing Home, we had received concerns regarding staff feeling bullied. As a result of all this information, we undertook a responsive comprehensive 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.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Following our inspection, the provider told us they would take action to mitigate the risks found.
The overall rating for the service is 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 GHC 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 and 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.
We have identified two breaches in relation to safe care and treatment and 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 request the provider becomes compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.