Archived: Gardenia House

Gardenia House is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 25 older people.

People’s experience of using this service and what we found

There was a lack of guidance for staff to follow when people were at risk of choking. Whilst no-one had been harmed there was a risk staff may not know what action to take. This was addressed during the inspection.

People told us they felt safe living at Gardenia House. Their relatives told us they were reassured their loved one’s always had support at hand when needed. People continued to be protected from the risks of abuse and discrimination. Risks to people’s health and well-being were assessed and reviewed. People told us there were enough staff to provide their care when they needed it. Staff had been safely recruited and completed regular training to keep up to date with best practice.

People lived in a service that was kept clean and tidy. People were able to personalise their rooms with their own belongings to make it ‘home from home’. People chose where they wanted to spend their time and had access to a secure garden.

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.

People’s health continued to be monitored and staff worked closely with people’s health care professionals to provide the support people needed. People told us they enjoyed their food and there was always plenty of choice. They were encouraged to maintain relationships with people who were important to them and there were no visiting restrictions.

People and their relatives told us staff were compassionate, kind and caring. They had built strong, trusting relationships. Throughout the inspection people and staff laughed and chatted with each other. Staff knew people and their relatives well and made sure people were as involved as possible in making decisions about their care.

People did not have any complaints about the quality of service and felt Gardenia House was well-led. Relatives told us they were kept informed of any changes in their loved one’s health. People, their families and the local community were involved in open days and coffee mornings. There were regular visits by children from a local primary school.

Many staff had worked at the service for a long time and there was a strong team ethos. This provided people with consistency. A relative commented, “Continuity of staff is important for feeling valued and secure”. Effective checks and audits were completed and action was taken when shortfalls were identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (report published 1 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gardenia House provides residential care and accommodation for up to 25 older people. On the day of the inspection there were 23 people using the service.

There was a registered manager in place at the time of the inspection. 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.

From our observations of staffing levels on the day of the inspection, feedback from people and staff and from reviewing the rotas, we established that staff were often rushed in delivering care to people. Some people said that they had to wait to receive personal care. Action had been taken to increase staffing levels, although this was not always consistently achieved.

Risk assessments formed part of the person’s agreed care plan and covered risks that staff needed to be aware of to keep people safe. However on one record we saw, it was recorded that a person had four falls over a twelve month period. Despite there being a risk assessment undertaken after each incident, there was no strategy in place to reduce further falls. After the inspection the registered manager issued guidance for the senior staff team to follow.

Medicines were stored, administered and recorded appropriately by staff who had undertaken relevant training. However, there were no protocols in place for people using 'as required' known as PRN medicines. Immediate steps were taken by the manager to discuss this with the GP's that supported the home. Also staff were instructed via written guidance, of the procedures for the use of PRN medicines.

There were systems in place to safeguard people from abuse and staff had a good understanding of the different types of abuse and how they would look out for signs.

People had a Personal Emergency Evacuation Plan (PEEP) on their record. Their PEEP identified the level of support they needed to evacuate the building safely in the event of an emergency.

Recruitment practices ensured staff were appropriately checked prior to employment to ensure they were suitable to work with the people using the service.

Staff received inductions, training and supervision to assist them to carry out their work role effectively.

The registered manager and staff understood the principles of the Mental Capacity Act and supported people to make choices for themselves. People were included in any decisions about how they were supported.

People were supported to eat drink and maintain a balanced diet and they were supported appropriately during meal times.

Staff interacted with people who used the service in a kind and respectful way. They took time to engage with people and responded appropriately to any questions asked.

Equality and diversity was an integral part of people’s care plans and staff were aware of how to ensure peoples differences were respected, valued and upheld.

Pre-admission assessments informed how a person was supported and formed the basis of the person’s care plan. Care plans were detailed; person centred and provided guidance for staff to ensure peoples care needs were met.

There was a log that recorded complaints as well as outcomes of the complaint. We also saw that any learning from complaints was used to improve the service provided for people.

People we spoke with told us they thought the home was well-run the management team were accessible.

There were mechanisms in place to ensure people and their relatives had regular feedback, which included regular residents meetings and resident and relatives surveys.

Regular audits were undertaken, including checks of care records and practices within the home to ensure people were receiving high quality care.

We asked the provider for an action plan which we received on 18 March 2014. This outlined how improvements would be made within a set time frame.

During this follow-up inspection, we found that action had been taken and the provider had achieved compliance with Regulation 9 of the Health and Social Care Act 2008.

We looked at records, including people's care files, accident and incident reports and activity programme. We spoke with six people, two members of staff, the deputy manager and the registered manager. There were 18 people living in the home at the time of our inspection.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People told us that they felt safe living in the home. People were assessed for any risks to their safety or well-being and those associated with the support they received. This was recorded in people's care plans, which included guidance for staff about how to reduce the risk for people.

Staff monitored people's food and drink intake and their weight, so that appropriate action could be taken, if a problem with nutrition was identified.

Each person had an individual evacuation emergency plan in place, that reflected their individual needs.

Is the service effective?

Staff were clear about their responsibilities and showed a good knowledge and understanding of how to meet people's needs. Support for people was planned and delivered in line with their individual care plan. The care plans gave staff clear guidance about how to support each person with their personal, social and health care needs.

Care plans showed that people received care and treatment from both staff and from health and social care professionals outside of the home.

People's mental capacity was assessed and recorded, where appropriate, in line with the Mental Capacity Act 2005 (MCA). There was no one living in the home for whom it had been necessary to make an application under the Deprivation of Liberty Safeguards (DoLS) to restrict their liberty.

Is the service caring?

People told us they were always treated with kindness and that staff respected their privacy. People were supported to be as independent as possible. Staff encouraged people to do what they could for themselves, whilst prompting and providing assistance where necessary. Care plans provided guidance for staff about how to support people with any religious, spiritual or cultural needs or wishes.

People were involved in decisions about their care and support. People told us that staff asked them for their views about their care plan and that they were involved with the planning of their care and treatment.

Is the service responsive?

Care plans contained information about people's life history, their special interests, what they liked to do and what was important to them. There was guidance for staff about how people preferred their care to be delivered and how they preferred to socialise.

The welfare of people was promoted by the opportunity for social and recreational activities. People could choose to pursue their individual interests or take part in individual or group activities. Staff spent time with people individually and were inclusive of people who were not able to join in group activities.

People's needs were monitored from day to day, by staff who could respond quickly to any change. Care plans were evaluated and updated if people's needs changed.

Is the service well-led?

The registered manager had put systems in place to make sure that people's needs were assessed and support was planned and delivered in line with their individual care plan. All care plans had been changed to a new format within the past year. The guidance for staff was clear and easy to follow.

The management team consulted with health and social care professionals, where appropriate as part of the assessment process before people moved into the care home.

Three people's care plans were checked each month by the management team, to make sure that records had been completed and updated appropriately.

We found people did not experience care, treatment and support that met their needs and protected their rights.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People we spoke to told us they liked living at the home. Comments included 'I love it here' and 'I like living here'.

People we spoke to told us they were looked after at the home. Comments included 'The staff are lovely, they look after me'.

We looked at the home's complaints system and found that the provider now had an effective complaints system available, where complaints were logged and acknowledged and investigated within timescale. Complaints people made were responded to appropriately.

We saw people's personal records including medical records were accurate and fit for purpose. We found that risk assessments were regularly reviewed and updated to meet people's individual needs. We found that people's daily records were consistently maintained to demonstrate that people who used the service were safe and receiving appropriate care.

We saw that people were treated with dignity and respect. People looked well groomed, happy, relaxed and comfortable with staff.

Whilst some improvement had been made and the provider and had taken action in ensuring people consented to their care, treatment and support and that care plans were regularly monitored and updated, we found that risk assessments were not regularly reviewed and updated to meet people's individual needs. We also found that people's daily records were not consistently maintained to demonstrate that people who used the service were always safe and receiving appropriate care. We found that the provider had taken action in asking people who used the service and their relatives for their views account the care and treatment and they were acted upon.

We also carried out a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. We looked at the home's recruitment practices and found that appropriate checks had been completed before new staff began working for the home. We looked at the home's complaints system and found that the provider did not have an an effective complaints system available.

People spoke about the activities they liked doing and indicated there was a variety of activities on offer.

People we spoke with indicated that they were happy living in the home. Comments included 'The staff are very good'. Some people spoke about the recent Christmas shopping trip they had been on with the service. One person commented 'I really enjoyed it'.

Relatives we spoke to confirmed that they were verbally informed of any changes in people's care but they were not involved in the review of care plans on a regular basis. People we spoke to told us that they were happy with the care and support that they received, but they were not involved in the review of their care and/or care plans.

People and their relatives told us that they could speak to the manager at any time if they were unhappy about anything at the home. 'I can talk to the manager at anytime'.

Staff told us that safeguarding vulnerable adults was a mandatory part of the induction process and staff attended refresher courses regularly.

Staff we spoke to said they enjoyed working at the home and received the training and support they needed to do their jobs. 'I love it here' and 'It's a friendly place and delivers good care'.

We spoke with people using the services but their feedback did not relate to this standard.