Archived: Ghyll Grove Care Home

A registered manager was 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 carried out an unannounced comprehensive inspection of this service on 14 October 2014 and 15 October 2015. A breach of legal requirements was found. This was because the provider did not have suitable arrangements in place on Medway House to ensure there were sufficient staff available to support people’s needs. In addition, the dining experience for people was not positive and we had concerns that people’s nutritional and hydration needs were not being consistently met.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 14 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the improvements they told us they would make had been made.

At this inspection we found that while further development and improvements were needed in some areas, sufficient improvements had been made and sustained, particularly in relation to Medway House. This related specifically to ensuring there were enough staff on duty to make sure that staffs practice was safe and staff were able to respond to people’s needs. Additionally, the dining experience for people on Medway House was observed to be positive and this showed that improvements had been sustained and maintained. Furthermore we found that three out of four houses were generally meeting legal requirements, however where further development and improvements were needed in some areas, this primarily related to Kennett House.

Quality assurance checks and audits carried out by the provider and registered manager were in place however, the systems had not been fully effective in identifying the issues we identified during our inspection and had not identified where people were potentially put at risk of harm or where their health and wellbeing was compromised. Suitable control measures were not put in place to mitigate risks or potential risk of harm for all people using the service as steps to ensure people and others health and safety were not always considered. Specifically, improvements were needed on Kennett House in relation to medicines management so as to ensure that people received their prescribed medication. In addition, manual handling

The dining experience for people three out of four houses was positive. However, on Kennett House this was not always positive and as person focussed as it should be. Consideration by staff was not always well-thought-out to ensure that eating and drinking was an important part of people’s daily life or treated as a social occasion and improvements were required. Where instructions recorded that people should be weighed at specific regular intervals, this had not always been followed.

Not all of a person’s care and support needs had been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. The needs of people approaching the end of their life and associated records relating to their end of life care needs contained minimal information and required reviewing. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia and who resided on Kennett House.

People’s comments about the care and support they received were positive. Whilst some staff’s interactions with people were positive and staff had a good rapport with the people they supported, improvements were required on Kennett House. These showed that while staff was kind and caring, some staffs practice when supporting people living with dementia required further improvement and development as it was mainly task and routine focused.

Although staff stated that they were supported, improvements across the service were required to ensure that staff received regular formal supervision so as to provide them with a formal opportunity to discuss their practice and development. Assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected however these required improvement as some of the information was contradictory. Nonetheless, the registered manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the Local Authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Although people did not always think that there were sufficient numbers of staff available to meet their needs or their relative’s needs, our observations showed that staffing levels and the deployment of staff were suitable at the time of this inspection. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity and where appropriate people were enabled and supported to be as independent as possible.

You can see what actions we told the provider to take at the back of the full version of the report.

We looked at 19 people's care records. We also looked at the provider's arrangements for obtaining, and acting in accordance with, the consent to care and treatment for people who used the service. In addition, we looked at medication practices and procedures, the provider's arrangements for cleanliness and infection control within the home environment, staffing levels, complaints management and the provider's arrangements to monitor the quality of the service provided.

Observation of staff practices was undertaken to ensure that people who used the service had their care and welfare maintained to an acceptable level.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us they felt safe living in the service. They told us that they would feel able to speak up if they had concerns or worries.

CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which apply to care homes. No DoLS applications had been submitted at the time of this inspection. We saw that staff were provided with training in the Mental Capacity Act [MCA] 2005 and DoLS.

Where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements. We found that not everyone had had their capacity to make day-to-day decisions assessed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consent to care and treatment.

Effective arrangements were not in place to reduce the risk and spread of infection. Not all areas of the home environment were seen to be clean and odour free. This related specifically to Medway House and Kennett House. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control.

We found that people who used the service were not protected against the risks associated with the unsafe use and management of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines management.

The provider was not able to demonstrate that there were sufficient numbers of staff available for the needs of the people living at Ghyll Grove Residential and Nursing Home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

We found that an accurate record in respect of each person who used the service in relation to their care and treatment was not maintained and improvements were required. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to records.

Is the service effective?

Our observations and discussions with staff demonstrated that people who used the service received regular support from, and access to, a variety of health and social care services and professionals as their conditions and circumstances required.

Is the service caring?

People told us that they were happy with the care and support they received.

People who used the service had a care plan in place. Improvements were required to ensure that people's needs were clearly recorded detailing their specific care needs and the support to be provided by staff. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

An effective system was in place to deal with comments and complaints received from people who used the service, those acting on their behalf and other third parties.

Is the service well-led?

The provider was not able to demonstrate that there were suitable systems in place to assess and monitor the quality of the service provided. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

As part of this inspection we visited Kennett House, Thames House, Roding and Cromer House. We spoke with the registered manager, deputy manager, interim head of care, 18 members of staff and people who used the service.

We found that some improvements had been made by the provider, particularly in Kennett House, since our last inspection in November 2013. However, further improvements are required in order for the provider to achieve full compliance. This refers specifically to the further development of people's care plans and ensuring that care provided by staff is in line with this. Medication practices were not as robust as they should be so as to ensure people's health and wellbeing. In addition, further improvements are required to ensure that staffing levels are maintained and that deployment arrangements are managed effectively.

People told us that they liked living at Ghyll Grove Residential and Nursing Home. Comments included, "I think it's very good living here. The girls are very nice, they treat everybody the same. I'm glad they don't have favourites," and, "Nobody's ever unkind to me, I think they're all very nice."

People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

As part of this inspection process we visited Kennett House. We spoke with the interim manager, area manager, two qualified members of staff, three members of staff, four people who used the service and two visitors.

At the time of the inspection 30 people were living on Kennett House. We found that the majority of people who used the service told us they were happy with the care and support provided. However we found that significant improvements were required to ensure that care plans and risk assessments were completed for all areas. Improvements were needed to ensure that the dining experience for people who used the service was positive and that people's nutritional needs were met. We found that staffing levels were not always maintained in line with what they should be. Staff training was seen to be satisfactory and there was evidence to show that staff received regular supervision.

We spoke to people who used the service but their feedback did not relate to these outcomes. We found that although significant improvements had been made with medicines management, further improvements were still required. We also found that improvements had been made to ensure that staff now received updated training in core subject areas, regular supervision and appraisal. Further improvements were required but these related to the recording of information and ensuring that issues highlighted were addressed and followed up.

The atmosphere within each unit was calm and relaxed and staff interactions with people who lived there were noted to be positive. Staff were able to demonstrate a good understanding of people's care and support needs.

Records showed that the provider had an effective recruitment and selection process in place and this involved all relevant checks being carried out prior to the member of staff commencing employment at Ghyll Grove Residential and Nursing Home. Staff confirmed that staffing levels within each unit were appropriate for the numbers and needs of people living there. The deployment of staff was seen to be appropriate throughout the day of our inspection.

Improvements were required in relation to the management of medicines. This means that people were not protected against the risks associated with medicines as the provider did not have appropriate arrangements in place to manage medicines. We also found that improvements were required in relation to staff training, supervision and appraisal.

During our visit in February 2013 we looked at all the areas that had required improvement. We found that many improvements had been made. There were now monitoring systems in place for skin integrity, weight and nutritional intake. There were clear records about staff training and supervision and regular team meetings had taken place.

People spoken with said that they were happy with the service and its staff. Comments included, 'Its better now, I don't seem to have to wait so long,' 'This is my fourth care home and it is good here, I am happy with everything,' 'It is all fine here; the food and the staff are good,' and, 'Things are better now; the new manager is very good.'

We found discrepancies and conflicting information in some of the care files. This sometimes made it difficult to establish which information was correct or current. The service was in the process of introducing a new care planning system. When we viewed an example of the new format we found that information was more streamlined. The new format made it easier to understand people's needs and follow through a chain of events.

At this visit we found wheelchairs to be clean and all were fitted properly with foot plates to ensure people's safety. The environment had improved and repairs had been carried out.

We observed practice and spoke with many of the people using the service on both units. They had mixed views about living at Ghyll Grove. Some people said, 'The food is OK' others said, 'The food is not great.' Most people were positive about the care they received from staff but some were not.

We found that some of the records were poorly written, had not been fully completed and information about individual's health and welfare was incorrect. Other records had been stored in cupboards that had been left unlocked.

Staff spoken with both in Chelmer and Medway units told us that they had not received the training that had been identified as a need at our last inspection. They said that they were often moved to work in different units due to staff shortages.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.