Restgarth

Restgarth is a residential care home providing personal and nursing care to up to 32 people. The service provides support to people of all ages with a range of health needs, physical disabilities and people living with dementia. At the time of our inspection there were 26 people using the service.

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

Medicines were managed by an electronic system. The system helped support staff to administer medicines safely. One of the prompts for this focused inspection was that CQC had been informed of a recent medicine administration error. We found appropriate action was being taken to help ensure this did not reoccur.

CQC had received concerns about the lack of management and leadership support prior to this inspection. The service had been without a registered manager since August 2022. A newly appointed manager was in post at the time of this inspection. They had been at the service for a few days prior to this inspection and intended to apply to become the registered manager.

The two deputy managers had worked hard to lead the staff team in the absence of a registered manager. Ensuring staff support and training and regular audits continued to take place.

CQC had received concerns about staffing levels. The service was fully staffed at the time of this inspection. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. People were supported by staff who had completed an induction, training and were supervised.

We looked at infection prevention and control and found we were somewhat assured that the provider was protecting people, staff and visitors from the risk of infection. Several unnamed hoist slings were found hanging in the communal bathrooms. The sharing of slings poses a potential infection risk. These were removed by the manager at the time. We have made a recommendation about this in the safe section of this report.

Some people living at the service were cared for in bed due to their health care needs. These people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. The audit of these mattress settings was not always effective. We have made a recommendation about the audit process at Restgarth in the well led section of this report.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified.

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included, "The staff are all lovely," "The food is particularly good here and it is all very clean everywhere," "It is all well organized, I can't think of anything that could be better."

People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service. People were seen to be engaging in activities during the inspection.

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 knew how to keep people safe from harm. People and relatives confirmed they felt the service was safe.

Staff received appropriate training and support to enable them to carry out their role safely, including nutritional support and dementia care.

The environment was safe, well decorated and appointed. There were no malodours. Cleaning processes were thorough.

People had access to equipment where needed. Equipment was regularly checked and serviced.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records were accessible and up to date. The staff knew people well and worked together to help ensure people received a good service.

People and their families were provided with information about how to make a complaint. People had been asked for their views and experiences and responses had been positive.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good. (Published 26 August 2022)

Why we inspected

We received concerns in relation to staffing levels and lack of consistent leadership. There had been a medicine error and some safeguarding concerns were being investigated by the local authority. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection. We did not identify breaches of regulations but have made recommendations in this report and the well led section of this report has been rated requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Restgarth on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Restgarth is a residential care home providing personal care to up to 30 people. The service provides support to people requiring care and support. Some people were living with dementia. At the time of our inspection there were 30 people using the service.

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

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the service.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training, and this ensured all staff received the training and updates needed to provide safe consistent care.

Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by senior staff and the manager.

The environment was spacious and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

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.

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.

There were processes in place to prevent and control infection at the service. Additional training and systems had been adopted through the COVID-19 pandemic. There were additional cleaning and safe visiting precautions.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

The systems in place to monitor the quality of care within the service were effective. The manager promoted a positive person-centred culture and fully understood their responsibilities as a manager.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good published 19 January 2019.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of procedures and precautions being taken, and how to keep people safe. The registered manager worked with the care staff and housekeeping team to ensure infection prevention and control measures were followed.

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. There were no current essential care givers [A relative or friend who may provide emotional support, or be there to support, when care tasks being carried out, are beneficial to the person’s wellbeing]. Where people were in receipt of end of life care visitors were not restricted. Visits to other people were arranged by appointment and took place in people’s rooms rather than communal areas.

The service had a committed staff team to ensure people received care and support in a safe and hygienic environment. People were supported in the service in accordance with national guidance. The staff team supported people and their relatives to understand the policies and procedures surrounding protection against COVID-19.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. We spoke with the head of housekeeping and looked at cleaning schedules and audits which showed additional systems had been added to increase infection control procedures during COVID-19 pandemic.

Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

We spoke with two staff members who confirmed they had received all the necessary vaccinations to work in the care sector. They told us the registered manager kept them updated on any changes to guidance and they had received training in COVID-19 and infection control procedures. They told us, “It’s all taken very seriously” and “We work well as a team and are very aware of the importance of making sure systems are followed.”

We spoke with two relatives who were satisfied with the way their family members were cared for. Comments included, “It’s the best place I can think of to care for [person’s name]” “[Person’s name] has everything she needs. I have no concerns at all” and “There is no problem with visiting. There is a very good and safe system.”

At the time of the inspection there were 27 people living at the service, some of whom were living with dementia. The accommodation is over three floors with spacious shared lounges and a dining room. The upper floors are accessed either by a passenger lift or two sets of stairs, one of which is fitted with a stair lift. There are also well-maintained gardens which are accessible to people.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We spent time during the inspection in the shared lounges and dining room observing and talking with people. There was a calm and relaxed atmosphere at the service. People and staff welcomed us into the service and were happy talk to us about their views of living and working there.

People received care and support that met their needs because staff had the skills and knowledge to provide responsive and personalised care. People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, “Very happy indeed”, “Can’t fault the staff”, “No problems” and “There’s no barriers, it’s home.”

Care plans contained personalised information about people’s individual needs and wishes. People were involved in the planning and reviewing of their care. These care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Incidents and accidents were logged, robustly investigated and action taken to keep people safe. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risk assessments were kept under review and were relevant to the care provided.

Safe arrangements were in place for the storing and administration of medicines. People were supported to access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. Staff enabled people to eat a healthy and varied diet. People told us they enjoyed their meals and there were ample choices on offer.

People were able to take part in a range of group and individual activities. An activities co-ordinator was in post who arranged regular events and outings for people. These included; bingo, film afternoons, arts and crafts, quizzes and history talks. In addition, external entertainers regularly visited such as singers, musicians and church services. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff knew how to recognise and report the signs of abuse. Staff were supported to develop the necessary skills to carry out their roles through a system of induction, training, supervision and staff meetings. New staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership. People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run.

Details of the complaints procedure were displayed in the service and people and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Further information is in the detailed findings below.

At the last inspection on 29 and 30 July 2015, we asked the provider to take action to make improvements in several areas. At the time of the inspection the service did not have a registered manager in place and had not notified us of significant events in line with their legal obligations. There were not enough staff to keep people safe at all times and not all staff were aware of how to identify abuse or how to report suspected abuse. We found that not all staff training had been updated or reviewed and not all staff had appropriate ongoing support such as supervision and appraisals. Due to insufficient numbers of staff people did not always have their nutritional needs met or were not provided with enough encouragement to eat. Although the service had a complaints policy, not all people’s concerns were acted on or investigated and there wasn’t sufficient evidence to suggest that complaints were used to make continuous improvements. We also found that people’s care plans were not personalised, written with their involvement or reflective of people’s needs. The provider sent us an action plan which explained how they would address these breaches of regulation. During this inspection we found these issues had been fully addressed.

Restgarth is a residential care home which provides care and support to older people who predominately have a form of dementia. Accommodation is over three floors, with spacious shared lounges and a dining room. There are also well maintained gardens which are accessible to people. The home can accommodate up to a maximum of 30 people. At the time of our visit there were 27 people living at the service.

Restgarth had 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.

We observed positive, compassionate and caring interactions between people and staff. Staff took the time to stop and chat with people and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “I love it here. I love the people”.

People’s care plans were detailed documents which contained information about their background, history, likes and dislikes. Staff confirmed that the care plans contained the correct guidance and information in order to provide the right level of support for people.

People enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people told us they had their medicines as prescribed and on time. People were supported to see a range of healthcare professionals including district nurses, chiropodists, doctors and social workers.

People were kept cognitively and socially engaged through a range of activities, both inside the service and in the local community. The service employed an activities coordinator and there was something on offer each day. People were involved in suggesting activities.

People were kept safe by suitable staffing levels. People told us there were enough staff on duty. This meant that people’s needs were met in a timely manner. Interactions between people and staff were unhurried. Staff recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had sufficient training to carry out their roles effectively. Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported by a comprehensive induction and there was an ongoing programme of supervision, competency checks and appraisals.

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

There was a safeguarding adults policy in place at the service and staff had undergone training on this subject. Staff confidently described how they would recognise and report any signs of abuse. There were policies in place around the duty of candour and whistleblowing which staff were aware of and applied to their practice. This encouraged an ethos of openness and honesty.

People, staff and relatives were encouraged to give feedback through a variety of forums including team meetings, residents’ meetings and questionnaires. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. People and relatives said they felt confident that if they raised concerns these would be dealt with appropriately. There was an effective quality assurance system in place with a range of audits including, medicines, care records and staff and resident satisfaction surveys.

This is a summary of what we found-

Is the service safe?

At the time of the inspection the service was safe.

People who lived at Restgarth told us that they felt safe living there.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of the DoLS legislation and was in the process of submitting applications to the Local Authority following the new Supreme Court Judgement. We saw from training records that staff had undertaken training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This demonstrated that the manager had knowledge about the legislation and of the responsibilities associated with it.

There was a safe and robust recruitment process in place which ensured people who lived at the care home were not at risk.

Is the service effective?

At the time of the inspection the service was effective.

From our observations and discussions with the manager and with people who lived at the home, we concluded the home had positive working relationships with other professionals such as local GPs, district nursing teams, chiropody and dental services which ensured people received timely and consistent care.

Is the service caring?

At the time of the inspection we found the service to be caring.

We observed people who lived at the care home were relaxed when engaging with staff. People told us, 'staff are lovely they are as helpful as they can be, if they can do it, they will do it' and 'very helpful'.

From our observation, it was apparent that staff were kind, caring and responsive to people.

Is the service responsive?

At the time of the inspection we found the service to be responsive.

One person told us, 'They are very kind to me, it doesn't matter what I say or do, they are very kind', 'if I need anything they will come and help me all the more so because I'm partially sighted'.

The manager spoke passionately about the importance of working with other professionals and was keen for external professionals to visit the home and provide their advice and opinions on the quality of care and service delivery.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. There was clear audit trail of the response, the action and the resolution to the complaint. A clear audit trail is important to ensure complaints are managed effectively.

Is the service well-led?

At the time of the inspection we found the service to be well-led.

The service had a manager who was registered with the Care Quality Commission.

During our inspection the manager and the provider were both present; we observed that they were visible and, that they took time to speak with people.

The provider had a system in place to identify, assess and manage risks to health, safety and welfare of people using the service and others.

We spoke with staff who told us they felt comfortable in speaking with the manager at any time. Staff told us that they felt their opinions and views were listened to and respected.

The care records were being updated to better reflect peoples care and support needs and associated risk assessments.

We were shown that there was a robust system in place to order, store and dispense people's prescribed medicines.

We saw systems in place to support staff. Staff and residents/relatives meetings have been held or are planned for the near future.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People who lived at Restgarth told us, 'they are wonderful, they are very kind', 'nothing seems too much trouble,' and 'on the whole they are very nice people'. People who lived at Restgarth also told us 'bossy and they don't bother to listen; this is only a few of them', and 'she's a real pain to me'. Other comments included, 'there's a shortage of staff', and 'I would like to go out more'.

Following our inspection the registered manager told us she had reported one of the concerns we were told about during the inspection to social services.

We looked at care documentation and spoke to people and found that people's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

We found information missing from care plans; information, essential to ensure peoples health and social care needs.

We established that people were protected from the risks of inadequate nutrition and dehydration.

We found that people were protected from the risk of infection.

We inspected one staffing outcome and found that the there were enough qualified, skilled and experience staff to meet people's needs.

You can see our judgements on the front page of this report.