Archived: Gensing Rest Home

Updated 24 December 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This was a targeted inspection due to concerns we had about people’s safety and care needs being met and the governance framework to support people and staff. These concerns included staff knowledge and reporting of safeguarding. Safe provision of medicines and management of errors. The governance of the service, management oversight of staff and auditing.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Gensing rest home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. Unfortunately due to unforeseen circumstances the registered manager was not able to attend the inspection and so the care manager took the lead.

Notice of inspection

We gave a short period of notice of the inspection. This was because of the COVID-19 pandemic. We wanted to be sure that appropriate infection prevention and control measures were in place before visiting the service.

What we did before the inspection

Before the inspection we reviewed the information we held about the service and the service provider. We sought feedback from the local authority and healthcare professionals that are involved in the service. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

Due to the COVID-19 pandemic we needed to limit the time we spent at the home. This was to reduce the risk of transmitting any infection. Therefore, we called the manager immediately before entering the service and discussed how we would safely manage the inspection. We also wanted to clarify the providers infection control procedures to make sure we worked in line with their guidance.

During the inspection

We spoke to four people who used the service. We spoke with seven members of staff including the care manager. We spent a short time in the service which allowed us to safely look at different areas of the home and to meet people and staff whilst observing social distancing guidelines. It also gave us an opportunity to observe staff interactions with people. We reviewed a range of records including safeguarding, accidents and incidents, complaints and support plans.

After the inspection

To minimise the time in the service, we asked the manager to send some records for us to review remotely. These included policies and procedures relating to the management of the service. We continued to seek clarification from the manager to validate evidence found.

Updated 24 December 2020

This inspection took place on the 18 and 22 January 2018 and was unannounced. At the previous inspection of this service in June 2016 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 12, 17, 18 and 19 of the Health and Social Care Act (HSCA) (Regulated Activities) Regulations 2014. This was because care plans and risk assessments, both health and environmental, had not protected people from potential risk. Staff had not received training in safeguarding people and the Mental Capacity Act 2005 (MCA) and had not received regular supervision and appraisals. Robust quality assurance systems had not effectively identified the service shortfalls to enable service improvements to be made.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met.

Gensing Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide support to a maximum of 17 people. Twelve people were using the service at the time of our inspection. People who used the service were younger and older adults with either physical or mental health needs and people with alcohol and substance misuse needs.

The service had a registered manager in place. 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 undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their Provider Information Return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Gensing has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding people and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Medicines were managed safely and in accordance with current regulations and guidance. There were systems to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and catheter care training. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. People were being supported to make decisions in their best interests. The registered manager and staff had received training in the MCA and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were on a one to one basis when people wanted the engagement. Activities were being discussed and the benefits to people evaluated. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.