Archived: Goldenley Care Home

Updated 19 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was unannounced on the 26 June 2017 and continued on 26, 28 June and 3 July 2017. The inspection was carried out by one inspector, a specialist advisor in dementia and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with seven people living at Goldenley Care Home and three relatives about their views on the quality of the care and support being provided. We spoke with the registered manager, a Quality and Monitoring Manager, an Operations Manager, five staff and one health/social care professional. We looked at six people's care records and documentation in relation to the management of the home. This included staff supervision, training and recruitment records and quality auditing processes. We looked around the premises and observed interactions between staff and people who use the service.

Before our inspection, we looked at previous inspection reports, safeguarding minutes and notifications we had received. Services tell us about important events relating to the care they provide using a notification.

Updated 19 September 2017

We carried out this inspection over four days on 26, 27, 29 June and 3 July 2017. The first day of the inspection was unannounced.

Goldenley Care Home provides accommodation to people who require personal care. The home is registered to accommodate up to 19 people. People supported were living with dementia, a mental health condition, a learning disability or physical disability. On the first three days of the inspection, there were 16 people living at the home. On the last day, there were 17 people.

Our last comprehensive inspection to the service was in November 2016. We issued two warning notices as the provider had repeatedly failed to meet a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed a focused inspection in February 2017 to check the provider had taken appropriate action to meet the warning notices. We saw that improvements had been made. However, further shortfalls were identified at this inspection.

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. The registered manager is responsible for the day to day management of the home.

Prior to this inspection, there had been a number of serious allegations, from a range of different sources, regarding potential abuse at the home. The allegations included verbal, physical abuse and poor care practice. The allegations are currently being investigated by the local safeguarding team and the police. In response to the allegations, the Quality and Monitoring Manager and Operations Manager were deployed to the home. Their remit was to assess, monitor and develop practice, as well as providing support to the registered manager. Both managers told us they would remain at the home, until all actions had been taken and improvements had been made. A clear action plan was in place and being regularly updated. Updated copies were being sent to the Care Quality Commission and the local authority for assurances and monitoring purposes.

At this inspection, potential risks to people’s safety continued not to be properly identified and addressed. This was identified at previous inspections in 2015 and 2016. An audit undertaken by the service had shown risk assessments did not sufficiently identify triggers or specific measures to mitigate the risks. In response to this, all risk assessments were being reviewed. Accidents and incidents were not analysed to minimise further occurrences. Specific risks such as a pressure relieving mattress bleeping and showing a fault, had not been identified.

People's care was not always planned in such a way to meet their individual needs. This was identified at previous inspections in 2015 and 2016. Each support plan was similar in content and much of the information lacked clarity and detail. The Quality and Monitoring Manager had identified this and was in the process of reviewing all information, starting with those areas of greatest priority.

Not all people looked well supported with their personal care. Information did not inform staff of the most effective ways to manage any resistance a person displayed. Some people were subject to restrictions, which had not been formally agreed within the appropriate processes. This included the restriction of cigarettes to minimise the risk of fire and injury but also to minimise the amount smoked.

Staff did not always promote people’s privacy and dignity. Some staff spoke over people and regular terms of endearment were used. Terminology within some records was judgemental and did not show an understanding of the person’s needs. People’s beds did not always look comfortable, which did not show time and care had been taken when they were being made. Staff promoted other areas of people’s privacy such as knocking on doors before entering.

Not all aspects of the environment were well maintained. There was a large amount of rubbish to the side of the property and offensive graffiti on the front wall. Various items such as an old commode and a flower pot containing rubbish were located outside. Some people’s rooms had staining on the walls by the bed and the hand wash basin. The Operations Manager explained a full audit of the environment had been undertaken and measures were in place to address all shortfalls. A skip had been arranged to remove all rubbish.

People received good support from health care professionals. They had regular contact from the GP and specialised services were requested as required. People’s risk of malnutrition and hydration had been assessed and people were supported to have regular hot and cold drinks. People liked the food and had enough to eat. A new catering system was in the process of being implemented. This meant all meals would be purchased frozen and then reheated in a specialised oven. The system was intended to ensure each meal was nutritionally balanced and met the person’s individual dietary needs.

People and their relatives knew how to make a complaint. Meetings were in the process of being arranged to enable people to discuss any concerns they might have. In addition to discussing concerns, the meetings were also intended to find out more about people, in order to develop their support further.

During our inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two of these breaches were repeated from the last inspection as sufficient action had not been taken to address the shortfalls. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.