The Garden House

The Garden House is a residential care home providing personal care and nursing care to up to 102 people. At the time of our inspection there were 94 people using the service.

The Garden house is made up of 3 nursing units called; Cedars, Maples and Oaks. The residential unit called Sundials specialises in providing care to people living with dementia.

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

People’s care plans contained important information relating to their mobility and support.

People were supported by enough staff. Staff felt supported and said it was a nice place to work. Staff received training and supervisions. The registered manager undertook daily walk arounds, held resident and relative meetings and open coffee mornings. These were an opportunity to discuss and feedback any areas which might need to be improved on.

People were supported to access health care professionals when required. The GP visited weekly and other referrals were made to professionals when required. Incidents and accidents were reported and monitored for any trends and themes. However, we found 1 incident which needed to be reported to the local safeguarding team. The registered manager took action to report this concern to the local safeguarding team and they confirmed following our inspection this concern was closed.

People were supported by staff who had received training in mental capacity and safeguarding adults. People felt safe and staff supported people to make choices about their care and support.

The service worked in partnership with health and social care professionals and also with a local school. Used equipment such as walking frames were sent to countries where others could benefit from them.

Rating at last inspection and update

The last rating for this service was Good (published 03 May 2018).

Why we inspected

This inspection was prompted by the outcome of monitoring activity where we identified the service needed an 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 inspection was also prompted in part due to concerns received about the management of medicines, staffing and people not receiving adequate care and support.

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 from Good.

Follow up

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

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

The Garden House provides accommodation with nursing and personal care for up to 102 people. At the time of our inspection 98 people were living in the home. The care home has four separate areas. The Oaks, Maples and Cedars provide general nursing and personal care. Sundials provides nursing and personal care for people living with dementia.

At the last inspection on 21 February 2017 the service was rated Requires Improvement. We found breaches in two regulations relating to consent to care and Deprivation of Liberty Safeguards (DoLS). Following this inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 27 and 28 March 2018. At this inspection, we found improvements had been made and the legal requirements had been met.

The service has improved to Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Medicines were safely managed. Risk assessments and risk management plans were in place. Incidents and accidents were recorded and the records showed that actions were taken to minimise future occurrences.

Staff demonstrated a good understanding of safeguarding and whistleblowing and knew how to report concerns.

Appropriate health and safety checks were undertaken to reduce risks to people. The home was clean and staff followed the homes infection control policy and procedures.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Improvements had been made and people were helped to exercise choice and control over their lives wherever possible. Where people lacked capacity to consent to care and make decisions, the principles of the Mental Capacity Act (MCA) 2005 had been followed. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

People received a service that was based on their personal needs and wishes. Changes in people's needs were identified and care was reviewed to meet their needs. People who used the service felt able to make requests and express their opinions and views. People were helped to exercise choices and control.

A range of activities were offered and provided people with entertainment both in and out of the home.

People benefitted from a service that was well-led. Systems were in place for monitoring quality and safety. Improvements were made when shortfalls were identified.

The Garden House provides personal and nursing care for a maximum of 102 people. At the time of the inspection there were 96 people living in the service. The service has four separate areas. The Oaks, Maples and Cedars accommodation provides general nursing and personal care for people. The Sundials accommodation specialises in providing care to people living with dementia.

A registered manager was in post at the time of our inspection. 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 and associated Regulations about how the service is run. The current registered manager was new in post and had been formally registered with the Care Quality Commission as the registered manager since 23 January 2017.

The service had not fully complied with the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. The service had not consistently ensured legal conditions attached to people’s DoLS had been completed. In addition, we found that best interest decision meetings for when people did not have the capacity to consent to a specific decision around their care or treatment had not been consistently undertaken in accordance with the Mental Capacity Act 2005.

People at the service told us they felt safe in their environment and with the staff that supported them. People were protected as staff understood their responsibilities in relation to safeguarding. There were sufficient staff on duty to support people and the recruitment of new staff was safe. People were supported with their medicines, however we found some recording discrepancies in relation to topical creams that had not been identified by the service management. People’s risks were assessed and risk management guidance produced where required. Accidents and incidents were reviewed.

People felt staff were well trained, competent and delivering effective care. There were trained ‘Champions’ in specialised areas such as nutrition and hydration and dementia to support staff in providing effective care. The provider had a recognition scheme to acknowledge good practice and staff received support through appraisal and supervision. New staff received an induction and also worked towards achieving national accreditation in health and social care. Staff were supported to develop through nationally piloted schemes.

People had access to healthcare professionals as required and people’s needs for eating and drinking were met.

People said that staff were caring and relatives we spoke with gave similar feedback. The service had received numerous compliments both at the service and via an online platform. Our inspection team made observations throughout our time at The Garden House that were mainly positive. People told us their privacy and dignity was respected and we saw the service had ways to achieve this. Social isolation risks were reduced as people’s visitors were welcomed at any time and people’s end of life care wishes and preferences were respected.

People said the service was responsive to their needs. Care records we reviewed were personalised showing people’s care, communication and social needs. There was a system to raise a complaint or concern and people said they would feel confident in addressing any matters. There were activities for people to partake in if they wished and there were links with the local community and the registered manager planned to further develop this. We were given examples of when the service had gone the ‘extra mile’ to meet people’s needs and make a positive impact on their lives.

People at the service and staff gave mixed feedback about the management and leadership. The provider had systems to demonstrate that employee welfare was a priority and there were systems to communicate with staff through meetings. However, we did find there was no uniformity throughout the service as to the frequency of meetings in different accommodation areas of the service. There were systems to communicate key messages to people and their relatives. Governance systems were in operation to monitor the health, safety and welfare of people at the service, however not all had been recently completed in accordance with the provider’s required frequency. The registered manager told us they felt well supported by the provider since taking post.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People we spoke with and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management in their role.

We reviewed the nutritional needs of people and found they had a choice of meals. People we spoke with said that they couldn't "wish for better." We looked at the quality of the service and found the provider had adequate systems in place and people were given the opportunity to provide feedback on the quality of the service.