We carried out a review of the data available to us about Gough House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Gough House, you can give feedback on this service.
Gough House is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 16 people.
Gough House is spread over three floors. The ground floor is made up of a lounge, dining room and bedrooms. The first and second floors are made up of bedrooms. There are communal bathing and toilet facilities on each floor. All floors can be accessed using a stairlift. The registered manager’s office is located on the first floor and there is a garden accessible to people. There is parking available to the front and rear of the building.
People’s experience of using this service and what we found
People told us they received support from staff who were kind and caring. Relatives confirmed this. People’s privacy and dignity was respected. People were involved with the care planning process and decisions about their care. People were provided with support in the home and this continued if they were away from the home. People’s choices and independence were respected and encouraged by staff.
People’s needs were assessed, and care plans reflected these. People told us they were involved with planning their care. People were supported to eat and drink in ways that suited their individual needs and people spoke positively about the food provided by the service. When required, people were supported to access healthcare services and the staff worked effectively with these services to ensure good outcomes for people. People were encouraged to personalise their rooms, equipment was available if and when people required it. People’s consent was sought before they were supported by staff. People were supported to access activities that were relevant and meaningful for them.
People’s needs were responded to and people confirmed this. People told us they felt comfortable to complain but people we spoke with told us they didn’t need to complain. No-one using the service was receiving end of life care during our inspection.
People, relatives and staff spoke positively about the registered manager, the registered manager was visible in the home and accessible to people. People and relatives felt listened to and said communication with the service was good. Staff told us they worked as a team to achieve good outcomes for people and that people received good care. The registered manager used a programme of quality audits and checks to maintain oversight of the service. The registered manager was proud to have been nominated for an award and updated us after the inspection that a further five nominations had made it through to the ‘semi-finals’
People felt safe and told us they received care and support from competent staff in a safe way, people said there were sufficient levels of staff to meet their needs. People were protected from the risk of potential harm and abuse because staff were confident about understanding what abuse was, what it looked like and actions they would take if abuse was suspected. Risks were assessed and managed to ensure people were not placed at risk of avoidable harm. Medicines and creams were managed safely, this included the use of body maps for creams. People were protected from the spread of infection because staff wore personal protective equipment, the environment was clean and free from malodours. The provider learned from mistakes when things went wrong.
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.
Rating at last inspection the last rating for this service was Good (Published January 2017)
Why we inspected
This was a planned inspection based on the previous rating.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
We carried out a previous inspection of this service on 15 and 16 October 2015 where we found improvements were required in relation to staff’s understanding and implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We also found the auditing systems in place had failed to identify the concerns we had found. At this inspection on 6 December 2016 we found action had been taken to respond to our concerns and improvements had been made.
This inspection took place on 6 December 2016 and was unannounced. At the time of our inspection there were 13 people living in Gough House. People had a range of needs, with some people living with dementia.
The service did not have a registered manager. The registered manager for this service had left but had not yet deregistered. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
A new manager had started at the service five weeks prior to our inspection but had not yet registered with the CQC. Since the manager had started at the service they had made a number of improvements in relation to the standard of care being provided, the activities offered to people and the management of records.
Staff had the competencies and information they required in order to meet people’s needs. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.
The manager was in the process of introducing new care plans for people which contained more detailed information about their histories, individual needs, preferences and interests. The manager was then using this information to develop more comprehensive and personalised activity plans for people to ensure they had stimulation and activities that met their desires, interests and needs.
Staff treated people with kindness and respect. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and provided people with affection and humour. Staff spent time with people individually and knew people’s needs, preferences, likes and dislikes. Staff understood people’s preferred communication methods and used these to involve people in their care and support them to make choices.
People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.
Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report any concerns. Safeguarding information and contact numbers for the relevant bodies were accessible to staff and people who lived in Gough House.
Recruitment procedures were in place to ensure people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable. Staffing numbers at Gough House were sufficient to meet people’s needs and provide them with individual support.
People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what they wanted to eat and food was presented in ways which met people’s individual needs. People spoke highly of the food. Where people had specific needs relating to their diet these were responded to.
There was open and effective management at Gough House. People spoke highly of the manager who led by example to ensure best practice was followed. People, relatives and staff were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.
We found that although the manager had taken steps to enhance the environment for people with dementia at the home, by putting up some signage and visual stimulation, some further improvements were required. We found that the living room and hallways had highly patterned carpets and signage around the home needed improving in order to better enable people to be as independent as possible.
We recommend the provider seek advice on how to best create an environment in the home which encourages and enables people’s independence.
This inspection was unannounced and took place on 15 and 16 October 2015. Gough House is a care home that provides accommodation for up to 16 older people. On the day of our inspection there were 14 people using the service. One person was in hospital during our inspection.
There is 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 found people’s rights were not fully protected as the registered manager had not followed correct procedures where people lacked capacity to make decisions for themselves. Deprivation of Liberty Safeguards (DoLS) applications had not been made to the local authority where people lacked capacity and were subject to continuous supervision and lacked the option to leave the home without staff supervision.
People told us that they felt safe living at Gough House and we saw that the premises were being maintained in a safe condition. We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage issues of a safeguarding nature. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.
Staff confirmed that they received induction training when they were new in post and told us that they were happy with the quality of training provided for them. One staff told us, “I am doing my NVQ and this will help me progress in my job with the skills I need.” The training matrix evidenced that staff had completed the majority of training that was considered to be essential by the home.
Staff had been employed following the home’s recruitment and selection policies. This ensured that only people considered suitable to work with older people had been employed. We saw that there were sufficient numbers of staff on duty to meet people’s individual needs.
Staff that had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.
People’s nutritional needs had been assessed and people told us that their special diets were catered for, and that they were happy with the meals provided at the home. We saw there was a choice available at each mealtime, and that people had been consulted about the choices available on the home’s menu.
People told us that staff were caring and this was supported by the relatives and health care professionals who we spoke with.
There were systems in place to seek feedback from people who lived at the home, relatives and staff. There had been no formal complaints made to the home during the previous twelve months but there were systems in place to manage complaints if they were received.
People who lived at the home, relatives and staff told us that the home was well managed. The registered manager and senior management had systems in place to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you would like to see the evidence supporting our summary please read the full report.
Is the service safe?
We found the service to be safe because people were treated with respect and dignity by the staff.
When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible, protect their welfare.
Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
The service understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards, and put them into practice to protect people. The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.
The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.
Is the service effective?
We found the service to be effective because there was an advocacy service available if people needed it. This meant when required people could access additional support to make decisions.
Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people's needs changed.
People we spoke with said, 'Staff are excellent, they really are' and 'Staff are brilliant.' A visiting health care professional person told us, 'Staff are excellent. I have no worries about the home, it's very good'
People's choices for end of life care were respected by staff. People had access to the specialist palliative care services they needed. People had the equipment they needed to meet their end of life needs.
Is the service caring?
We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.
People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.
Staff knew the people they were caring for and supporting. People were as independent as they wanted to be.
Is the service responsive?
We found the service responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.
People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.
People, and those that matter to them, were encouraged to make their views known about their care, treatment and support.
Emotional support was available to people, their families, friends and staff.
Is the service well-led?
There was a registered manager in post on the day of our visit and all other conditions of registration were met. The registered manager understood their responsibilities and was supported by senior management to deliver what was required.
The service worked well with other agencies and services to make sure people received their care in a joined up way.
The service had an effective quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.
People told us, 'I'm quite sure my opinions are listened to' and 'They listen to all of us, they're very good like that.' One relative told us, 'We can make suggestions. They keep you informed if there are any events going on.'
There were effective arrangements to continually review safeguarding concerns, accidents and incidents.
Emergency plans were in place and understood by all staff. Staff knew and understood what was expected of them.
We saw there was information for people in the reception area of the home so that people were aware of the activities available.
We observed that at lunchtime people were very social and interacted with each other during their meal. We saw that staff joined in the lunchtime meal creating a family atmosphere. People we spoke with told us that they enjoyed the food and could make choices about meals.
We saw there were sufficient staff on duty to support the people who used the service. The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw that people were treated with respect and dignity, ensuring that people were supported to maintain their independence as much as possible. One person told us "I do for myself but its nice to know the staff are there."
We saw that Gough House was well maintained with sufficient infection control measures in place to safeguard people against the risk of infection.
One visitor told us they had always been welcomed in the home and staff members were always polite and caring. They told us the 'the staff are very good, you couldn't wish for a better place.'
People we spoke with told us they were happy and safe at Gough House. One person told us, they had lived in the home for quite a while and felt very happy with the way the home was run. Another person commenting on the home told us, 'I cannot think of anywhere better than here.'
The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw people were treated with respect and dignity, for example, staff were observed to make good eye contact and used touch to reassure people.
Staff told us they were aware of the home's policies on recognising and reporting abuse and would not hesitate to report any concerns to the manager. Regular audits of the premises, care practices and documentation were carried out to maintain the health safety and wellbeing of people at the home.
We observed the atmosphere and general ambiance of the home to be friendly, calm and relaxed
Some of the people had been living at Gough House for many years and some had recently come to live there. A number of the people were in the early stages of dementia, but all of them were able to tell us about their care.
People told us that they were 'very happy' and 'wouldn't complain about anything'. People told us that staff treated them well and with respect. People said they felt safe at Gough House and that the home was warm and comfortable. People told us that the staff respected their privacy and dignity, and helped people to retain as much independence as possible.
Staff were observed working well together and providing care for people that was delivered with patience and kindness. Staff said they were well supported by the manager and each other. Staff appeared to work hard and enthusiastically.
We found that the home was clean and tidy in most areas. All communal areas, bedrooms and the kitchen were welcoming and well appointed. People told us they liked the lounge and the quiet area in the dining room. People said they also liked to sit in the garden in the warmer weather and 'watch the world go by'. Some people told us that they found the dining room chairs hard to move due to them being on a thick carpet, but that staff would help them if they were struggling.
We observed a lunchtime meal and the food served appeared hot, nutritious and wholesome. The lunch was enjoyed by most people. We are concerned that one person who did not eat her lunchtime meal was not attended by staff quickly enough, although staff eventually tried to provide this person with a number of different options.
We are concerned also that the home had not provided specific training to staff who cook for people. This can lead to people not receiving adequate nutrition or hydration, but there was no evidence at the time that the home was not meeting nutritional needs for people living there. The provider also told us during the visit that training for the staff who cook the meals had been arranged.
Pharmacy medicines were stored properly and administered in accordance with records and charts. We are concerned with the recording and audit of controlled drugs and staff not being able to demonstrate therefore that medicines are stored, handled and disposed of safely. There was no evidence that anyone had been given a controlled drug in error.
We found that care plans for people who live at Gough House appear to not be in active use and have not been updated or reviewed recently. There is no evidence to demonstrate that the person using the service or their family/carers are involved in the review of the care plans. This can lead to staff not providing the care and support to people that has been agreed and does not promote the rights and choices of individuals.