Archived: Gosberton House Care Home

Gosberton House Care Home is registered to provide accommodation and support for up to 46 people, including older people and people with a physical disability. There were 44 people living in the home on the first day of our inspection.

The registered provider also provides day care in the same building as the care home. This type of service is not regulated by the Care Quality Commission (CQC).

People’s experience of using this service:

The provider was failing to provide people with consistently safe, effective, caring, responsive or well-led care.

The provider had failed to organise staffing resources safely and effectively to meet people’s needs and preferences. The management of people’s medicines was not consistently safe.

Some people’s care plans and individual risk assessments were out of date. Records indicated that staff sometimes failed to meet the requirements of people’s care plans, in areas including nutrition and skin care. Staff did not always follow current best practice guidance in their delivery of care. The provider’s approach to quality monitoring was not consistently effective.

Some staff used institutional, impersonal language to refer to people living in the home. The provider had failed to maintain confidentiality in respect of people’s personal information. There was limited evidence to indicate people who stayed in bed or in their room were provided with sufficient stimulation.

In other areas, the provider was meeting people’s needs.

Staff worked collaboratively with local health and social care services to ensure people had support when required. Systems were in place to ensure effective infection prevention and control. Staff were provided with regular training and supervision. Staff recruitment practice was safe.

Staff worked in a non-discriminatory way and promoted people’s independence. Staff worked in a generally person-centred way, responding to people’s individual needs and preferences. People felt safe living in the home. Staff knew how to recognise and report any concerns to keep people safe from harm.

Staff were aware of people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The registered manager and acting manager provided strong, supportive leadership. The owners of the home visited regularly and were well-known to people, their relatives and staff. The provider notified CQC and other organisations of issues as required. There was learning from significant incidents and any complaints were managed in line with the provider’s policy. The provider was committed to the continuous improvement of the service in the future.

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 (published 1 June 2017). At this inspection we found a deterioration in the quality of the service. The rating is now Requires Improvement and the provider is in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified two breaches of regulations reflecting the provider's failure to monitor service quality effectively and failure to organise staffing resources safely and effectively.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We have requested an action plan from the provider to address the breaches of regulations identified at this inspection. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We inspected the home on 16 March 2017. The inspection was unannounced. There were 44 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for two people living in the home and had submitted a further three applications for consideration by the local authority. Staff had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

Working together to put people at the heart of the service, staff in every department understood what was important to each person and went out of their way to do everything possible to ensure their personal happiness and promote their well-being. Staff were happy in their work and proud of the service they provided.

Staff knew and respected people as individuals and provided extremely responsive, person-centred care. People were provided with food and drink of high quality that met their individual needs and preferences. A varied programme range of activities and events was organised to provide people with mental and physical stimulation.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home. The provider had failed to notify us of two incidents involving people living in the home but this was an isolated shortfall and in all other respects the home was well-led, with sound administrative systems in all areas.

People’s medicines were managed safely and staff worked alongside local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. A wide range of auditing systems was in place to monitor the quality and safety of service provision.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider organised a varied programme of training and encouraged staff to study for advanced qualifications. Staff were provided with close supervision and shift handover meetings and other systems were used effectively to ensure staff were aware of any changes in people's needs. The registered manager was respected and admired by her staff and provided strong, supportive leadership to her team.

Below is a summary of what we found when we inspected Gosberton House Nursing Home on 28 April 2014. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. During our inspection we spoke with five people who used the service, two relatives who were visiting, the registered manager and four members of staff. We looked at four people's care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five questions:

Is the service caring ?

Is the service responsive ?

Is the service safe ?

Is the service effective ?

Is the service well led ?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Is the service effective?

People's health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We looked at people's records which showed that care plans set out people's individual care needs. They were current and the records showed they had been reviewed on a regular basis and adjustments made when a person's care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. People we spoke with told us: 'Staff are very friendly and on the whole it's good here.' Another person told us: 'I wouldn't live anywhere else. I've made friends here and have nothing bad to say about the place.'

People who used the service, their relatives and friends completed an annual satisfaction survey. Where concerns or comments were raised these were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

During our inspection on 11 July 2013, we found there was no effective system in place to ensure verbal complaints were used to improve the quality of the service provided. The provider sent us an action plan which set out how they planned to address those concerns.

During our inspection on 28 April 2014, we found the provider had devised an easy to read complaints/concerns form for all staff to use. This documented any verbal complaints/concerns raised by people who lived in the home or by their friends and family.

We looked at the collated forms and saw that the registered manager and general manager had undertaken audits to identify trends which highlighted a need for improvement. These forms were readily available and staff we spoke with were aware of the form and had documented comments.

People knew how to make a complaint if they were unhappy. One relative we spoke with told us: 'If I ever have to raise a concern there is always someone to speak with and I would be confident that it would be sorted out.'

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role and were able to tell us how they would escalate any concerns raised.

Is the service well led?

During our inspection on 11 July 2013, we found the provider had not ensured that their statement of purpose contained all the information listed in schedule 3 of the Care Quality Commission (Registration) Regulations 2009. We found the maximum number of people allowed to live at Gosberton House Nursing Home did not match the maximum number of 51 people the provider was registered for with the Care Quality Commission. We also noted that the statement of purpose did not contain the name of the service provider or the registered manager as required by the regulations.

The provider sent us an action plan which set out how they planned to address these concerns.

During our inspection on 28 April 2014, we looked at the provider's statement of purpose, We saw they had taken action and this document had been reviewed. We confirmed with the registered manager that the maximum number of people allowed to live at Gosberton House Nursing Home matched our records of 46. We also observed that the statement of purpose now contained the name of the service provider and the registered manager.

During our inspection on 11 July 2013, we found the provider did not have suitable supervision and appraisal arrangements in place to ensure staff were supported to deliver care and treatment safely and to an appropriate standard. We found that there was not a central list of who had received and who needed supervision. We looked at records which showed a deadline of 31 August 2012 had been set for all appraisals and supervisions to be up to date. We saw this deadline had not been achieved.

The provider sent us an action plan which set out how they planned to address those concerns.

During our inspection on 28 April 2014, we looked at records and spoke with staff which confirmed that appraisals and supervision now took place. We saw there were now central lists for tracking when appraisals and supervisions had been completed and also set out dates for staff for 2014.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

People told us they liked living at the home. One person said, 'You don't want for anything you should have.' Another person told us, 'It's all right. I haven't got any complaints.'

There were group activities available to people from Monday to Friday, morning and afternoon. However, we saw where people did not want to join in group activities individual activities were provided. One person told us, 'We have activities. We have keep fit on a Monday, that's good fun.' Another person said, 'I like being on my own. I have books to read and the paper every day.'

There were appropriate systems in place to manage medication. People who were able to self-medicate were supported to do so.

Staff received training in appropriate subjects to ensure they delivered safe care and treatment to people. However, staff were not supported through a robust system of supervision and appraisal.

The provider surveyed people to get their views on the service they received, but responses to issues were not always sufficient to eliminate the risk of a reoccurrence of the problem.

The care staff told us nutrition was a standard agenda item at the residents' meetings. The residents we spoke with supported this. The chef said menus were developed to suit the needs of people who lived in the home.

One staff member said, 'The attitude to food has improved. It's very good.' Another said, 'I brought up how we could improve pureed food at the last meeting with the owner, it has improved a lot, the chef listens to us.'

One person told us, 'We have quite a bit of choice. Another person said, 'There are lots of choices of sweets. They always ask me what I would like.'

We spoke with the relative of one person who told us, 'The food is very good and even though it's pureed it's always well presented. The chef is very good, he asked her about her likes and dislikes and sometimes she doesn't feel like a big meal and has a baked potato.'