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Garland House Requires improvement

Reports


Inspection carried out on 16 December 2019

During a routine inspection

About the service

Garland House is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 20 people.

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

We found improvements were required to the way in which people’s medicines were managed because storage area temperatures were not monitored, and stocks of people’s medicines could not always be accurately checked to ensure they were correct. Improvements were also required to the provider’s systems for monitoring service quality and safety because medicines audits were not robust in identifying these issues.

We have made a recommendation about the use of nationally recognised assessment tools when assessing people’s needs.

People told us they were happy living at the home and that they received high quality support. They were protected from the risk of abuse because staff were aware of the action to take if they suspected someone had been abused. Risks to people had been assessed and staff followed the guidance in people’s care plans in order to safely manage identified risks. Staff also worked in ways that minimised the risk of the spread of infection.

The home had enough staff working on each shift to meet people’s needs. The provider followed safe recruitment practices. Staff knew to report incidents or accidents that occurred and the registered manager reviewed incident and accident records for learning, to reduce the risk of repeat occurrence. Staff were supported in their roles through an induction, training and regular supervision. The home had been adapted to meet people’s needs.

People were supported to maintain a balanced diet and told us they enjoyed the food on offer at the home. They were able to access to a range of healthcare services where needed and staff worked to ensure they received consistent support when moving between different services. Staff sought people’s consent when offering them support. 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.

Staff treated people with care and compassion. They respected people’s privacy and treated them with dignity. People were able to express their views and were involved in making decisions about the support they received. They had also been involved in the planning of their care and told us that staff supported them in line with their expressed preferences. The provider arranged activities for people to take part in which they told us they enjoyed. People knew how to complain and expressed confidence that any issues they raised would be addressed.

Staff spoke positively about the way they worked together and told us they were well supported by the registered manager. The registered manager demonstrated a good understanding of the responsibility of their role. They sought feedback from people and their relatives on the service they provided, and this feedback had been positive.

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 16 June 2017).

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 improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 30 May 2017

During a routine inspection

Garland House provides personal care and accommodation for a maximum of 19 older people. At the time of our inspection, there were 16 people accommodated in the service, five of whom were living with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and met all relevant fundamental standards.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks for people. There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role.

Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions. Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People were supported to have choice and their independence was promoted by staff who understood the needs of older people and of those living with dementia. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People were very complimentary about the meals and quality of food provided. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records help staff deliver care that met people’s individual needs. The activities provided were suitable for older people and people living with dementia.

The provider and the management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was a system of monitoring checks and audits to identify any improvements that needed to be made. The registered manager acted on the results of these checks to improve the quality of the service and care.

Further information is in the detailed findings below.

Inspection carried out on 27 and 28 April 2015

During a routine inspection

The inspection was carried out on 27 and 28 April 2015 by two inspectors and an expert by experience. It was an unannounced inspection. The service provides personal care and accommodation for a maximum of 19 older people. There were 19 people living there at the time of our inspection. One person was living with the onset of dementia. All the people living in the service were able to express themselves verbally.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. People told us, “Nothing bad happens here, the staff make sure we feel safe, they watch over us”.

Accidents and incidents were recorded and monitored to identify how the risks of re-occurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained. The building was warm and welcoming. People’s own rooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed.

Staff’s training was renewed annually, was up to date and staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs and to the expected standards.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no one living at the home was currently subject to a DoLS, we found that the manager understood when an application should be made and how to submit one.

Staff sought and obtained people’s consent before they helped them. One person told us, “The staff ask for my consent when doing things for me”.

The service provided meals that were in sufficient quantity, well balanced and met people’s needs and choices. People told us, “The food is very nice, no fault with that; there is plenty of it” and “This is good and well cooked”. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People were satisfied about how their care and treatment was delivered. They commented, “I am contented here”, “The staff treat us with definitely with respect”. and “I am the happiest here I have been in 15 years”.

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend the reviews and contribute.

Clear information about the service, the facilities, and how to complain was provided to people and visitors. Menus, activities programme satisfaction surveys were provided for people in a suitable format.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly with their participation and updated when their needs changed. Two people told us, “I know what is going on and what the workers are supposed to do as far as I am concerned” and, “They talk with me to check if I want anything changed”.

People were involved in the planning of activities. An improvement of the programme of activities was scheduled so that people would be offered more varied options to choose from.

The service took account of people’s feedback, comments and suggestions. People’s views were sought and acted on. The registered manager sent annual satisfaction questionnaires to people’s relatives or representatives, analysed the results and acted upon them. Staff told us they felt valued under the manager’s leadership.

The registered manager notified the Care Quality Commission of any significant events that affected people or the service. The registered manager kept up to date with any changes in legislation that may affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

Inspection carried out on 25 April 2013

During a routine inspection

At the time of our inspection there were 19 people using the service. People told us that they were happy with their care, staff treated them with respect and that their privacy and dignity were maintained. We were told that the staff made sure that people's healthcare needs were responded to and appropriately met, and that staff had a good understanding of people's individual care and support needs. Care records were detailed, contained people's support plans and preferred routines throughout the day and staff were observed to follow these in practice. Risks to people's safety and welfare had been assessed and minimised as far as possible and kept under review. A visiting relative told us that they had never had any concerns, that they were welcomed as a visitor to the service and that "the family are very happy with the home".

All the people we spoke to expressed their satisfaction with the service and the level of support provided, and did not raise any concerns about the quality of care. They also said that they would go the manager or staff if they needed to raise a concern and would feel comfortable in doing so.

Many comments we received were complimentary of the service. One person said "the care is really extraordinary, they think of everything" and another stated that they were "well looked after" and "treated with respect". Another person commented how the staff "get to know people and what they like".

Inspection carried out on 6 June 2012

During a routine inspection

We spoke individually with nine people who lived at the home. We also used some other methods to gain information about what it was like to live there. We spoke with people visiting the home, spoke with staff, read records including care plans, and observed people during the day.

The people using the service told us they were given choices about their daily routines such as when to get up and go to bed, what to eat and what to do each day. They said staff respected their choices. One person told us they had chosen to have breakfast in bed that day and another that they had got up later than usual as they felt tired. They said staff understood that sometimes they liked to change their usual routines.

People told us that staff were kind and caring and when they needed assistance with anything, staff responded quickly during the day and at night.

People said they were happy with their rooms and said that that their rooms were always kept clean. They said the rest of the home was always kept clean and tidy.

People told us that they liked the meals at the home and there was enough choice. They said that if they did not like a meal there was always an alternative and that staff understood their likes and dislikes and made options available for them.

Some of the comments people living at the home made were,

� The food is good and the place is kept clean�

�The food is excellent, remarkably good�

�I chose the home as this one had the right atmosphere, people were chatting to each other and seemed happy�

�They really look after you well �

� The carers are absolutely marvellous but they can be short at weekends�

�The caring is 100%�

� I manage my own medicines and they just check it is all there�