Garlands Residential Care Home Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure there was a proactive and positive learning culture. There was no clear process in place for staff to record incidents which would allow learning from any incidents that occurred. Upon review of people’s care records, we found incidents had not been recorded as such, which also meant there no management oversight to ensure these incidents were appropriately analysed. We asked the provider to review people’s care records as an immediate action during the assessment to ensure there were no incidents that required immediate attention. One incident was found which needed to be reported to the local authority which the provider completed.Following our findings, the provider took prompt action to introduce a system for recording and analysing incidents. The provider also planned to arrange training for staff around recording incidents.

People and relatives spoke positivity about how safe they felt at the service and got the support they needed. One person told us, “I am happy here. I feel safe including with the staff and others living here, you can have a laugh with them.” Another person told us, “I am safe because the people are nice and friendly."

Staff had completed safeguarding training. The registered manager understood their responsibilities in relation to safeguarding and told us they would report any concerns to the local authority and CQC. There were systems in place to protect people from the risk of abuse. There were safeguarding and whistleblowing policies in place to report potential abuse.

The provider had identified people’s individual risks; however, they had not consistently worked with people to understand and manage their risks. We found there was a lack of consistent information on how to support people during periods of distress which did not support staff to recognise and escalate any concerns. People presented challenging behaviours towards staff and there was a mixed response in how staff supported people around challenging behaviours. The service encouraged positive risk taking and ensured risk assessments were completed around choices that posed a risk. We observed staff supporting people to move around safely, respond to calls for assistance and carry out regular checks.

The home was undergoing renovation work. An action plan was in place which outlined work to be completed. There was an outside space for people to use and enjoy. Routine checks on equipment and the environment were completed regularly. We noted there was only 1 bath in use for 19 people at the time of our assessment, even though we found no evidence of any impact to people, the provider assured us they would immediately start the repair works for the other 2 bathrooms.

We found that the service did not have a clear staff structure, some staff had multiple roles which made it difficult to determine what roles needed covering. We found that some staff were repeatedly taken away from their allocated role to step into another role. We were told by the provider that they do not always use a dependency tool. Staff told us that it was hard at times due to being short staffed, but that they all work well together and all support each other. Feedback was also received from relatives in relation to staffing. One relative said, “Staffing levels have deteriorated, and turnover is high, sometimes you can barely find anyone, it’s worse on a weekend and I would say 7 out of 10 times I visit they are understaffed. Staff aren’t visible and you are never sure of who is the designated shift leader.”We found that the provider was not always following safe recruitment practices, we found some inconsistencies with staff recruitment files and no evidence to suggest the appropriate background checks were always carried out before employment commenced. We found that supervisions and appraisals were not carried out consistently, the ones that were completed we found to be very basic with no monitoring of staff concerns and little support for staff well-being. However, staff told us they felt supported by the registered manager and any concerns they had were dealt with in a timely manner. One staff member told us “I’ve had one appraisal so far, I’ve not had any supervisions yet, but the manager does ask how I’m getting on”. The registered manager told us there had been some recent challenges which have affected staff morale and staff recruitment.

We found that the premises were clean and welcoming with no malodour. Staff were wearing the appropriate PPE whilst carrying out personal care tasks to minimise the spread of infection. We witnessed the correct disposal of soiled materials, we observed staff wearing appropriate PPE whilst serving meals and following good food hygiene practices. We observed the sluice and waste disposal areas; we found that the provider was following good practices and had measures in place to ensure the correct disposal of contaminated materials. We found that the provider did not have a robust cleaning schedule and infection control audits were not updated or consistently completed, however people using the service told us that they thought it was clean and tidy, and the bedrooms were well maintained.

The provider made sure people received their medication on time and by suitably trained staff. We saw medication administration records were completed consistently and medicines were stored and disposed of appropriately including controlled drugs. We did note that the medication audit did not allow the provider to review times between doses and rotation of patches. There was also no oversight of the use of thickener for people. The provider informed us that on many nights there was no medication trained staff member on shift and relied on the on-call staff member to come in if people required any medication. This advice was not incorporated in the medicines management policy for all staff to follow.