Garden House

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

People lived in an extended family atmosphere where they felt safe and well cared for. During the inspection there was a warm atmosphere with lots of chatter, laughter and good-humoured banter.

People received effective care and support from staff who were well trained and competent in their roles. Staff monitored people’s health and wellbeing and worked with other professionals to make sure people received the care they required.

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 made choices about their care and support, what they did each day and how they spent their time.

People had close relationships with other people who lived at the home and kept in touch with friends and family.

People were able to take part in activities and follow their interests. People enjoyed a variety of activities, trips out and social events.

People lived in a home which was well managed and had systems to monitor standards of care and ensure on-going improvements. People told us the registered manager, deputy manager and provider were open, honest and approachable and they could raise any issues with them.

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 13 January 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.

Garden House Rest Home provides accommodation and personal care to up to 14 elderly people.

The care home is established in the main house with an extension to the property named Trudy's Cottage. All rooms apart from one are on the ground floor. One room is situated on a lower level of the home and can be reached by steps or a stair lift. At the time of the inspection there were 14 people living in the main house and in the adjacent building. There was a communal snug area and separate living-come-dining area which was next to the main kitchen which led into a staff area and laundry room.

When we last inspected the service in August 2015 we found that the service did not have effective recruitment and selection procedures in place. We also found that care and treatment was not provided in a safe way and that good governance was not embedded. We asked the provider to take action which they had completed and improvements had been made.

The service had a registered manager in place. 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.

The registered manager had a good awareness of the Mental Capacity Act (MCA) and training records showed that staff had received training in Deprivation of Liberty Safeguards (DOLS). The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest. Staff had some understanding of the principles linked to MCA however specific training had not been delivered and there was no local policy in place.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, end of life and dementia.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. Competency assessments on staff were also carried out to ensure safe practice and reflective learning took place.

People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements.

People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available to people. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected needs identified. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

There was system in place for recording complaints which captured the detail and evidenced steps taken to address them. People and relatives told us that that they felt able to raise concerns or complaints and felt that these would be acted upon. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People and staff felt that the service was well led. The registered manager and others in the management team all encouraged an open working environment. All the management had good relationships with people and all worked shifts with staff.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring audits were completed by the management team. The registered manager reviewed incident reports and analysed them to identify trends and/or learning which was then shared. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Not everyone's care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We learned that oxygen was provided as part of some people's care. We asked several staff about the use of oxygen and hazards and risks. One staff member gave a clear explanation but three staff were less aware of the associated risks and hazards. The acting manager told us that a risk assessment had not been carried out but this would be addressed. This showed that people were not protected from the hazards associated with oxygen therapy because a risk assessment had not been completed and this could have put people at risk of harm. We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

The provider did not have appropriate arrangements in place to manage medicines safely. Medicines were not safely administered or securely stored when in use. Medicines were discharged into a pot by one staff member while a second staff member administered the medicine. This meant that in the event of any errors or omissions, the member of staff who had administered the dose may not be identified, as they were not involved with signing the records. We saw that medicines were stored securely in locked cupboards when not in use, however, medicines were not kept safely when in use. On one occasion the medicine cupboard was left open and medicines left out whilst the staff member went to take a dose to someone. We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

Most people's records and staff records were accurate and fit for purpose. We looked at five care plans. These had been reviewed and updated. Care records were detailed and included relevant information about people's needs.

Is the service effective?

There was a process for involving people in some decisions made about the service. Group meetings were arranged at the home and people could choose to attend and contribute. There were effective arrangements in place to deal with foreseeable emergencies. People at the home had access to working emergency call bells to raise an alarm if required.

Is the service caring?

People told us that staff were friendly, kind, patient and helpful. Everyone we spoke with commented on the happy and homely atmosphere at Garden House. People told us that staff were caring and took an interest in the people living at the home. One relative said, "Staff are endlessly kind, very patient and knock on people's doors. They ask people how they want to be addressed," "Garden House is a small caring environment, staff are kind and absolutely lovely. They are cheerful and nothing is too much trouble. Most staff have an enabling approach."

Is the service responsive?

Staff responded to people's needs and requests for support. People told us that staff contacted nurses, dentists, doctors and chiropodists to help maintain their health. We found examples of this reflected in their records. This showed that staff were aware of the health care needs of people and made the necessary arrangements to address these. One person said, "Staff are busy but willing to help." Three people told us that staff responded to call bells and had their needs met when the system was used.

Is the service well-led?

The Care Quality Commission (CQC) request information about specific incidents occurring within services regulated by the Health and Social Care Act 2008. These are known as Notifications. The provider is required to inform us of certain events such as serious injuries and deaths of people using the service. During the inspection we were informed of two events at the home within the last eighteen months. We checked our records and found that the provider had not notified the Care Quality Commission of these events through our statutory notification process.

The provider did not have effective systems for monitoring the quality and safety of the service. The provider did not monitor the quality of safety at the service. We asked the acting manager whether checks were used to monitor care, record management, staff training and other aspects of the service. These areas were not routinely or regularly checked and there were no internal audit tools used to judge the quality or the operational aspects of the service provided. We have set compliance actions in relation to these concerns and the provider must tell us how they plan to improve.

We found that although the home was currently understaffed, a recruitment process had been undertaken. The provider had made suitable arrangements that ensured there was always a sufficient number of staff on duty.

People chose how they spent their time, however, they were not always involved in making decisions about their care. One person told us that they felt their bath time was 'set in stone'. People's needs were assessed but assessments were not always up to date. As a result, care was not always planned and delivered in line with individual care plans.

People were cared for by a small staff team who knew them well. People told us that there were enough staff to meet their needs. One person told us that: 'Staff always come if I ring my bell, if they are busy they come and tell me so'. One person said, "I'm happy enough here. They look after me very well". The staff team had got smaller over the last year and this meant the managers were working on shift.

The home did not have effective systems in place to monitor the quality of the service or to assess and manage risks to people living in the home. People's care records were not consistently completed and did not include an accurate record of the care that they should receive. Most of the records of people's care plans we saw had been completed, however, there were significant gaps and omissions regarding daily recording and a fall had not been recorded.