Background to this inspection
Updated
4 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector.
Service and service type
Garlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We visited Garlands on 5 and 6 August 2019. The first day of the inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
Prior to the inspection we reviewed information we had received about the service since their last inspection. This including reviewing any notifications we had received from the service and information we had received from external agencies including the local authority contracts team, safeguarding team and the clinical commissioners.
During the inspection-
We spoke with three people who lived at the home and two visiting relatives. We spoke with six staff, including the registered provider, registered manager, two care staff, a cook and housekeeper. We reviewed a range of records. This included three peoples care records and two peoples medicine records. We looked at four staff recruitment and supervision records and a range of records relating to the management of the home. We spoke briefly with a visiting healthcare professional.
After the inspection
We requested further information from the registered provider and manager to validate the evidence found. This was received, and the information was used as part of our inspection.
Updated
4 September 2019
About the service
Garlands is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up a maximum of 20 people. Garlands is a converted property with communal areas on the ground floor and bedrooms on both the ground and first floor.
People’s experience of using this service and what we found
People were protected from abuse and avoidable harm. Risks identified at our previous inspection relating to fire safety, safety of equipment and premises and cleanliness had been addressed. Staff were recruited safely and there were enough staff on duty to meet people’s needs. The administration of people’s medicines was safe.
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. Where people lacked capacity to make decisions, we saw evidence of capacity assessments and best interests decision making.
New staff were supported through training and induction. There was a programme of ongoing training and regular management supervision for existing staff. People were supported to eat and drink. We saw staff involved other healthcare professionals as required. There was a system in place to ensure relevant information was communicated within the staff team.
People were treated with dignity and respect. Privacy was respected and staff encouraged people to maintain their independence. People were offered choices and were encouraged to be involved in decisions regarding their care and support.
An accurate, complete and contemporaneous record of each person’s care and support was not always maintained. Nutritional supplements were not always record on people’s fluid intake charts. Staff did not always complete people’s fluid records in a timely manner. We saw improvements had been made to the content and accuracy of peoples care plans. People were supported to participate in a range of activities. No formal complaints had been received since our previous inspection.
People, relatives and staff told us the home was well led. A number of improvements had been made since the last inspection including more regular audits. However, we found these audits had not identified or addressed the shortfalls we found with, for example, peoples records. Regular meetings were held with people, relatives and staff. The registered provider and registered manager had worked closely with the local authority and had attended good practice events to learn and improve the quality of care they provided for people.
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 8 February 2019.
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 significant improvements had been made however, further improvement was needed. The provider was still in breach of a regulation.
This service has been in Special Measures since 17 December 2018. 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
This was a planned inspection based on the previous rating.
Follow up
We will request an action plan for the provider to understand what they will do to continue to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.