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Gifford House Care Home Requires improvement

Reports


Inspection carried out on 17 February 2021

During an inspection looking at part of the service

Gifford House is a care home registered to provide accommodation and personal care for up to 102 older people some of whom maybe living with dementia. At the time of our inspection 47 people were using the service.

The registered manager was following the government's guidance on whole home testing for people and staff. This included using rapid testing and weekly testing for staff.

People were supported to isolate when required and the environment had been set up to encourage social distancing. The environment was easy to keep clean to minimise the risk of infection.

People were being supported to maintain contact with their families by video and telephone calls and when safe to do so visiting procedures were in place for people to see their relatives.

The service enabled people to have end of life visits from family ensuring everyone was kept safe.

Inspection carried out on 21 October 2019

During a routine inspection

About the service

Gifford House provides accommodation with personal and nursing care for up to 65 older adults, some of whom may be living with dementia. Gifford House is built to accommodate people across four separate units, however currently only three units are operational. The fourth unit is expected to open early in 2020 dependent upon on the number of new admissions to the service. On the day of inspection 64 people were living at the service.

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

People felt safe and well cared for and would recommend the service to others, though five out of seven people said they would like to see an improvement in the quality of the food.

The dining experience in one unit required improvement and the design and adaptations of the service were not being used to their full potential so did not always support inclusion, particularly for people with dementia.

We made recommendations about the environment.

The culture within the service was person-centred. People could spend their time the way they liked and had opportunities to engage in activities. The registered manager and staff involved people in decisions, listening and acting on people’s feedback on how the service should be run.

People who used the service, family members, and visitors were encouraged to make comments, complaints, or compliments about the service. However, we received mixed feedback about the receptiveness of management to concerns raised by people and staff.

We made a recommendation about communication and staff engagement.

Staff received an induction and training to equip them with the knowledge and skills to do their job. However, four out of five staff we spoke with about training felt this could be improved.

People told us staff were competent in their role and staff received daily support and guidance from the nursing staff. Staff listened to people and provided care and support the way people liked.

The service had been significantly extended which would increase capacity from 65 people to 102 people over time. Improved communication between staff and management was required to improve the admissions process

We made a recommendation about how new admissions were managed.

The quality of the service was monitored and assessed but auditing processes required strengthening as had not identified or taken action to address the failings we found during the inspection.

Staff were responsive to people’s needs and told us they enjoyed their work and worked well as a team. However, not all staff felt supported or listened to by the management team.

We made a recommendation about staff engagement.

People, relatives and visiting professionals told us about a nice staff team who were friendly and caring and we observed staff engaged well with people. Staff were polite and respectful and knocked on doors before entering and had a cheery welcome for people.

Relatives told us there was a positive atmosphere at the service and people were encouraged to take part in stimulating and meaningful activities. People told us that staff understood their needs and preferences well, and they received effective care and support from staff.

Staff knew how to recognise and report any suspicions of abuse. Risks to people were assessed and staff knew how to keep people safe. Call buzzers were answered promptly. The registered manager had a robust recruitment process in place which ensured staff were recruited safely.

On the day we inspected there were enough staff available to meet people’s assessed needs. Accidents and incidents were appropriately recorded and investigated. People’s medicines were managed safely.

People were supported to have as much choice and control over their lives and were supported in the least restrictive way possible. Policies and systems in the service support this practice.

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 (June 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.

Inspection carried out on 21 March 2017

During a routine inspection

Gifford House is a care home providing nursing and personal care for up to sixty-one elderly people. The service is divided into three units. Betts unit on the ground floor provides nursing care including palliative care. The Linford and Radcliffe units on the first floor provide care for people living with dementia. There were 58 people using the service at the time of our inspection.

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were safe at the service. Staff knew what to do to protect people from abuse. Risk was well assessed and managed so that risks to peoples’ safety were minimised. There were enough nursing and care staff to meet people’s needs. People were supported to take their medicines as prescribed

Staff had been safely recruited and had the necessary skills to meet a wide range of needs. We found however they did not consistently have the skills or guidance necessary to support people with dementia in line with best practice guidance. We have therefore made a recommendation about improved staff training and care planning in the area of dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff supported people to maintain good health and wellbeing and enabled them to access other health and social care professionals when required.

Staff knew people well and treated them with kindness and respect. People’s privacy and dignity was maintained.

The care provided was personalised and responsive to individual needs. People had access to variety of activities and pastimes. Detailed care plans were in place. The manager had put plans in place to improve the quality of the care plans. Complaints were responded to well and people felt enabled to share any concerns they had about the service.

There was a strong and effective manager in place who dealt pro-actively with concerns. They supported staff and promoted a positive culture and atmosphere which benefitted people who used the service. Whilst there was a need to improve the checking of care plans, we found all other checks on the quality at the service were robust and led to improvements. The provider and manager worked well together and had a joint vision for the service.

Further information is in the detailed findings below.

Inspection carried out on 16 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was unannounced which meant the provider and staff did not know we were coming. At the last inspection on 8 February 2014 the provider met all the requirements we looked at.

Gifford House Care Home is a purpose built care home that provides a service for up to 61 older people who may have care needs associated with dementia. Nursing care is provided. The home offers accommodation over two floors, and is divided into three units. Betts Unit on the ground floor provides palliative care. Linford and Radcliff Units on the first floor provide care for people living with dementia. All bedrooms are for single occupancy and have an en-suite facility. There were 58 people using the service at the time of our inspection.

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were happy with the service they were receiving and we received many positive comments about the service, the management and the staff team.

We saw that there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that the service was applying these safeguards appropriately. This was through assessing people’s capacity and making appropriate referrals to the supervisory body, (the local authority,) if people’s liberty was being restricted.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way. From the six people’s plans of care we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.

During our observations throughout the day we saw that staff clearly knew how to support people in a ways that they wished to be supported. On the day we inspected we found that sufficient numbers of staff were being provided to meet people’s needs.

Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs and work in a way that were safe and protected people.

We saw that staff respected people’s privacy and dignity and worked in ways that demonstrated this. Staff knocked on people’s doors and asked for permission before providing any personal care.

Records we looked at and people we spoke with showed us that the social and daily activities provided suited people and met their individual needs. People could make their own decisions about if they undertook activities or not. People’s preferences had been recorded and we saw that staff respected these.

Records viewed showed that people were able to complain or raise any concerns if they needed to. We saw that where people had raised issues that these were taken seriously and dealt with appropriately. People could therefore feel confident that any concerns they had would be listened to.

The provider used a variety of ways to assess the quality and safety of the service that it provided. People using the service and their families were consulted with. The organisation undertook a range of monitoring and areas such as health and safety and medication were regularly audited.

The management team at the service were well established and provided good and consistent leadership.

Inspection carried out on 8 February 2014

During a routine inspection

We spoke with seven people who were using the service and/or their relatives. The majority of comments we received were very positive about the care offered and facilities. One relative said that the care was "excellent" and that staff knew the people they cared for and their needs. They said their relative had recently has a heart attack and that staff had noticed that they were unwell and acted before the heart attack happened. Another person and their spouse said they would give the home "ten out of ten".

We spoke with two relatives who had some concerns. One person said they often came in to find their relative sat awkwardly in their bed or chair and that they had to make them comfortable. They said that staff were very good, but they felt there were not enough on duty. They were happy for us to raise this with the manager, which we did. The manager also said that they would speak with the relative to discuss their concerns in more detail.

Another relative said they were happy with the care but sometimes felt that staff could attend to their relative�s personal hygiene needs better. Again, we raised this with the manager who gave assurances that this would be investigated.

We found that Gifford House was meeting all of the essential standards we looked at. People's care was individualised and met their needs; medication was well managed; staff were properly recruited; the premises and facilities were well maintained and complaints were properly handled.

Inspection carried out on 11 October 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people living at Gifford house. We spoke to the relatives of eight people, who told us they were kept informed through written information, relatives meetings, news letters and discussions with staff regarding the care and treatment choices available to people who lived at Gifford house.

An anonymous concern had been raised recently with the Care Quality Commission (CQC) about support and care provision for people with dementia within the home. We spoke to eight staff, four people who use the service,nine relatives and a social worker, looked at care plans, observed care services in the home and found no significant concerns.

All the information we have indicates that safeguarding procedures were well understood by management and staff at the home. People and visitors we spoke with told us that they felt that the staff had the necessary skills and experience required to meet the needs of the people living there. People told us that they were well looked after by the staff. One person with whom we spoke said "The staff were lovely and willing to help you if you need it.�

The records we viewed showed that training and supervision processes were in place.The majority of people we spoke with were positive about the quality of service provided by Gifford house, the only concern remains the retention of staff which the provider is aware of.

Inspection carried out on 10 November 2011

During a routine inspection

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit on 10 November 2011 we were able to hold a conversation with three people and two relatives. Most of the information about people's experiences of Gifford House was gathered through our observations.

One person we spoke with told us �I am quite happy here.� I have a bath three times a week.� A relative we spoke with told us �The care staff are lovely, very motivated. The personal care is very good; I feel X is safe and that X is reassured by them.� One person told us �I can go away from here and know X is in good hands. If anything happens, you�ll always get a phone call.�

People living at Gifford House told us that they liked their rooms. One person said �I am quite happy here.� A relative told us that the cleaners are always in the home and there are no issues with the standard of cleaning. Another person told us �I requested the carpet to be cleaned and they did it.�

People we spoke with told us that there had been a high turnover of staff in recent months and agency staff had been employed. They told us that during that period there had been some issues with the attitude of some staff and the quality of care provided.

Reports under our old system of regulation (including those from before CQC was created)