Archived: Goldenley Care Home

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.

This inspection, on 28 February 2017, was carried out to assess whether the provider had taken action to meet the warning notices we issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices have been sustained. The comprehensive inspection will also assess what action has been taken in relation to the two requirements we issued and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued and we have not changed the ratings since the inspection in November 2016. The overall rating for this service is 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Goldenley Care Home on our website at www.cqc.org.uk.

Goldenley Care Home provides accommodation to people who require personal care. The home is registered to accommodate up to 19 people, some of whom may be living with varying degrees and types of dementia. On the day of the inspection there were 16 people living at 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. The registered manager is responsible for the day to day management of the home and was available throughout the inspection.

At this inspection we found that the provider had taken action to address the shortfalls highlighted in the warning notices.

Improvements had been made to the safety of the environment. Covers had been fitted to radiators in people’s rooms and hazards such as a broken bath panel had been replaced. All doors with restricted access were closed appropriately and hazardous substances were securely stored. Fire doors were not held open with items of furniture so could close effectively in the event of the fire alarm being activated.

Improvements had been made to the cleanliness of the home. Cleaning schedules had been amended and additional housekeeping staff employed. A rusted shower chair had been discarded and a stained and odorous commode replaced. New flooring had been installed in the bathroom, communal areas and people’s bedrooms. Furniture such as armchairs and tables had been replaced, which enhanced the quality of the environment for people.

Discussions had been held with staff about the importance of assisting people to move safely. Updated training had been given and spot checks were taking place to monitor practice. During the inspection, staff assisted one person with their mobility without ensuring the wheelchair was stable.

Medicines with a short shelf life such as eye drops were being dated when opened. This enabled staff to ensure the medicines were effective and safe to use. To minimise the risk of error, staff were now signing and countersigning any handwritten medicine administration instructions. Staff had received updated training in the safe management of medicines and their competency had been assessed. However, whilst improvements had been made to these areas, information about “as required” and variable dose medicines, lacked clarity.

The registered manager told us they had worked well with other managers within the organisation, senior managers and the staff team, to implement change. Focus had been given to auditing the service more effectively. Many of these audits had been undertaken by other managers to enable “fresh eyes”. Records showed these audits were identifying shortfalls. However, action taken in response to the shortfalls was not clearly documented. This did not demonstrate shortfalls were being properly addressed. A senior manager told us the auditing system was “work in progress” and in time, all actions would need to be “signed off”.

We have not changed the rating for these key questions regarding safe and well-led because to do so requires a full assessment of all the key lines of enquiry. We will complete this assessment during our next planned comprehensive inspection.

Goldenley Care Home provides accommodation to people who require personal care. The home is registered to accommodate up to 19 people. During the inspection, there were 18 people living at the home and the service was considered full. This was because one double room was being used for sole occupancy.

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 and was available throughout the inspection.

Following the last inspection, the registered manager had agreed with the provider to develop a new care planning format. This was in the process of being implemented and demonstrated greater order and organisation. However, other care plans were limited in their detail and not fully up to date. Information did not clearly state what support people required and how potential risks were being addressed. People were not sufficiently supported to change their position at regular intervals to minimise their risk of pressure ulceration. Continence care and people’s end of life wishes were not clearly stated in their care plans.

Staff did not support people to move safely. We saw out of date, unsafe techniques being used on three separate occasions. Staff had received training on moving people safely but did not apply what they had learnt in practice. There were other risks to people’s safety within the environment including uncovered radiators, unsecured storage of cleaning materials and hazards such as a set of ladders behind a bathroom door.

Not all areas of the home were clean. For example, there was debris on surfaces in the small lounge, underneath the bath hoist and between the seat cushions of armchairs. This meant people were not always safe from poor hygiene practices. The registered manager told us they had recognised the cleanliness of some areas “had slipped” as there had been difficulties with recruiting housekeeping staff. They said this had been resolved and they were now expecting improvements to be made.

People were given their medicines in a person centred way but not all aspects of medicine management were undertaken safely. Staff had not documented the dates when some medicines with short expiry dates, should be disposed of. This did not ensure all medicines were safe to use. Hand handwritten instructions had not been countersigned to minimise the risk of error. Protocols to support staff when administering “as required” medicines did not always correspond to the prescriber’s instructions. Staff’s competency had been assessed when they first received training to administer people’s medicines but this was not regularly repeated.

There was a quality auditing system in place but this was not fully effective. The system had not identified shortfalls which had been noted at this inspection. The audits were not comprehensive and any non-conformity identified did not show a clear action plan. This did not ensure identified shortfalls would be properly addressed

There had been many improvements to the environment. The conservatory had been replaced, the home had been decorated internally throughout and a bathroom had been changed into a shower room. In addition, a new kitchen had been installed following an Environmental Health inspection. However, other areas required attention. There was a hole in a person’s carpet, the armchair seat cushions had lost their spring and a radiator cover in a bathroom was broken.

The provider’s website was not an accurate portrayal of the home. Information stated the home was able to accommodate 21 people but a condition of registration meant only 19 people could be accommodated. There was also an error with the provider’s details and some of the information related to another of the organisation’s services.

Records did not demonstrate a robust staff recruitment process. Gaps in employment history had not been explored and the capacity, in which references were given, was not clear. Interview forms showed newly appointed staff had the appropriate skills and experience to undertake their role but this was not always evidenced within documentation. The registered manager told us they had spoken with each applicant in detail and had explored information such as gaps in employment. They said they had this information but had not written it down.

Staff had received a range of training and felt well supported. Following a recommendation made at the last inspection, all staff had received regular meetings with their manager. Appraisals to discuss staff’s performance and future development had been implemented. Staff were knowledgeable about people’s needs, said they worked well as a team and promoted the homely feel of the home.

There were enough staff to support people effectively and people gave us positive comments about staff availability. However, after the inspection we received a concern about insufficient staffing numbers at night. We asked the registered manager to investigate this and inform us of their findings.

People were supported to receive various services to meet their healthcare needs. This included consistency of visits from GPs and district nurses. People said they had enough to eat and drink and were able to ask for specific preferences, which were added to the home’s shopping list. The home’s menus were in the process of review and it was intended further “home cooking” would be developed.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three of these breaches were repeated from the last inspection as sufficient action had not been taken to address the shortfalls. You can see what action we told the provider to take at the back of the full version of the report.

We found the provider had carried out the required improvements which included the purchase of foot operated pedal bins, a more through clean of some kitchen cupboards and the two base ovens. The linoleum around a base kitchen unit had been replaced and a metal joining strip had been drilled either side of the sink unit to prevent food debris going underneath. In addition, the provider had installed a new extractor fan in the kitchen.

We asked people about their diet and nutrition and if they had enough to eat and drink. People told us that the food was delicious and they had plenty to eat and drink. People looked well-nourished and hydrated.

We looked at the standard of cleaning in the home. One person said "I think it's very clean, no problems". We found most of the home was clean, tidy and free from odours; however some parts of the kitchen were not cleaned to an acceptable standard.

We saw that the home had recently carried out a complete redecoration and people told us they liked the new colour scheme. People also told us that they were to have new carpets in their bedrooms and that the hallways were to have non slip flooring. Everyone we spoke with was happy about the internal and exterior maintenance of the home. People felt it was a really homely and comfortable place to live.

We checked to see if people had access to suitable equipment. Some people said they had their own wheelchair and other people said they used one of the home's wheelchairs if they needed to. We looked at records and found that all of the equipment in the home had been maintained to ensure it was safe for people to use.

We carried out a review in October 2012 to look at the improvements the provider had made. The provider had made the required improvements so that risk assessments were more detailed and identified potential risks. We looked at the quality assurance system which now sought to gain the views of stakeholders to inform the home's planning and development.

One person told us their care had been 'excellent' and their relative told us they felt staff knew exactly what care was needed and when. We observed staff to see how they interacted with the people in their care. We saw that staff were respectful and attentive to people's needs.

In October 2012 we received information of concern in relation to an incident with a staff member giving out medication and another incident whereby unsafe manual handling techniques were used. We also received concerns relating to staff training and induction processes. We investigated these concerns and found them to be unsubstantiated.