Garson House Care Home

Garson House is a residential care home for 13 people with conditions associated with old age including dementia. There are some bedrooms on the ground floor, but most bedrooms are on the first floor with access via a passenger lift. Communal lounges and the dining area are all located on the ground floor. The home is in the middle of a small town and so access to local shops and cafes is available. At the time of our inspection there were 12 people living in the service.

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

Following our last inspection, we imposed conditions on the provider's registration which required them to complete a selection of monthly audits and report their findings to CQC. This was because we identified people were at risk of receiving unsafe or inappropriate care as care records did not always reflect their current needs and safety monitoring was not always completed. We also identified risks due to poor environmental management.

The provider had worked closely with the local authority and the service manager had received significant support around implementing a good governance framework. There had been improvements around the management of the service environment and financial investments had been made. The new arrangements were currently being embedded into the service to ensure they were fully effective.

People told us they felt safe at the service and staff knew how to identify and report concerns. People received their medicines when they needed them, however although there was no impact to people, we identified improvements were still needed around the management of medicines. The service manager had elected to delegate the medicines audit out as opposed to completing the audit themselves. This had resulted in an audit being completed inaccurately and had not identified the minor issues we found relating to medicines. We have made a recommendation about the management of medicines.

People’s risks were now managed through an electronic care planning system which the service manager was implementing. There was now a formal system to review incidents and accidents to reduce risks to people. The service was clean and there were now systems to audit the cleanliness of the environment. The service worked well with other health professionals to meet people’s needs.

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. Improvements had been made around Deprivation of Liberty Safeguards (DoLS) applications and compliance with the requirements of the Mental Capacity Act 2005. The provider had sought advice and guidance following our recommendation.

There were new governance systems in operation to ensure the health, safety and welfare of people using the service and others. Auditing of care records, environmental risks and Mental Capacity Act 2005 documentation had been implemented and was being embedded into the service. The provider had now notified CQC in full about any significant events at the service in line with regulatory requirements.

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 Inadequate (published 3 November 2022). The provider sent us monthly reports in line with conditions imposed on their registration.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the service sought advice and guidance from an accredited source to ensure the Mental Capacity Act 2005 and relevant supporting legislation was well embedded in the service. At this inspection we found improvements had been made in this area.

This service has been in Special Measures since 3 November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

Enforcement and Recommendations

We have made a recommendation about the management of medicines.

Follow Up

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

Garson House Care Home is a residential care home for 13 people with conditions associated with old age including dementia. There are some bedrooms on the ground floor, but most bedrooms are on the first floor with access via a passenger lift. Communal lounges and dining area are all located on the ground floor. The home is in the middle of a small town and so access to local shops and cafes is available.

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

People were at risk of receiving unsafe or inappropriate care as care records did not always reflect their current needs and safety monitoring was not always completed. We found assessments and care planning was, at times, based on historical documents and did not reflect people’s current needs. Care planning documentation that detailed care delivery measures and outcomes was not always completed.

People, staff and visitors were placed at risk by poor environmental management. Fire risk assessments were not current, people were using mobility equipment that had not been serviced for in excess of two years and the expired electrical safety certificate for the service could not be located. Action was being taken to address this.

There were no formal systems to review incidents and accidents in operation, placing people who may have evolving care needs at risk. We also identified one staff member had not been recruited in line with requirements.

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. However, there was a lack of understanding around the Mental Capacity Act 2005 and how it was applied in the service. Whilst there were systems in place that ensured for those people who were deprived of their liberty, it was done so with the appropriate legal authority, it was not clear the service management fully understood when an application was needed. We have made a recommendation about this.

People received personalised care; however, the records being used were historical and did not reflect peoples’ current care needs. Improvements were needed around end of life care planning to ensure it was consistent throughout the service for all people being supported.

There were insufficient governance systems in operation to ensure the health, safety and welfare of people using the service and others. Auditing of care records, environmental risks and Mental Capacity Act 2005 documentation had not been consistently completed. The provider had also failed to notify CQC in full about any significant events at the service in line with regulatory requirements.

People told us they felt safe at the service and staff knew how to identify and report concerns. Medicines were managed safely, and the service were following current infection control guidance. Visitors were able to enter the service. Staff received training and felt well supported by the service management. The service worked well with other health professionals and we received positive feedback from the professionals we contacted.

People and their relatives spoke positively of the caring staff that supported them. One person told us, “Of course I’m happy here.” We reviewed the compliments the service had received, and we saw peoples’ records were stored confidentially to promote their privacy.

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 (published 4 October 2017).

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.

The inspection was prompted in part due to a low number of statutory notifications received from the provider. A statutory notification contains information about certain incidents and events the provider is required to notify us about by law. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, good governance, fit and proper persons employed and failure to send statutory notifications to the CQC as required. We have also made a recommendation around the current systems in place for managing Deprivation of Liberty Safeguard applications.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rating at last inspection

At the last inspection completed in April 2015, the service was rated Good.

At this inspection completed on 19 July 2017, we found the service remained Good.

Why the service is rated Good.

People said they felt safe and well cared for and safe. Comments included “It’s very good here, staff are all very kind to me” One relative said “I feel my relative is safe and well cared for. The staff are all very good.”

People benefitted from an environment which was clean, homely and had the right equipment to keep them safe and well.

Staff knew people’s needs and wishes and were available in sufficient numbers to enable them to provide personalised care and support. People benefitted from a staff team who were well trained and supported to do their job safely and effectively.

Risks had been considered to ensure people were supported to maintain good physical and emotional well-being. Menus were planned around people’s likes and dislikes. People were supported to maintain a balanced and nutritious diet. People were highly complementary about the food being service. One person said “The food is very good, I have no complaints. I eat everything.”

People befitted from a responsive service which ensured there were regular activities and outings for them to enjoy. One person said “We had some lovely singers in yesterday, they were excellent.”

People are supported to have maximum choice and control of their lives. Staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People knew how to make any concerns known and were confident their views would be listened to and actioned. Visitors and family were made welcome and believed their views and suggestions were valued.

The service was well run and the caring ethos promoted by the registered manager and provider was shared by staff who had developed close bonds and relationships with people who lived at the service. Care and support was delivered in a way which promoted people’s dignity, privacy and respect.

Further information is in the detailed findings below

During this inspection we spoke with eight people living at the home. They were all very positive about their experiences of being cared for. Comments included ''I couldn't have picked a better place to be, the staff are all marvellous.'' Another person said ''They have been so very kind to me, I have nothing but praise for the girls here. They are so kind.''

We found care and support was well planned and staff were experienced and knowledgeable about the needs and wishes of the people they cared for. Care and support was provided in a person centred way.

We saw there were robust processes in place to ensure only people who were suitable to work with vulnerable adults were employed. The service had systems in place to ensure the quality of care and support was reviewed and monitored, taking into consideration the views of people living there and those of staff.