Archived: Gadlas Hall Nursing Home

We inspected Gadlas Hall on 18 September because our inspection of 15 May 2013 raised concerns about the poor recording, administration and monitoring of medicines, which might have resulted in people not being fully protected against the risks associated with medicines. The provider had taken steps to improve the systems however; the provider had further work to do to ensure compliance. We judged this had reduced from a moderate to a minor impact on people's welfare.

We inspected Gadlas Hall on 25 October 2013 because we received serious concerns about the care being provided by the service. These concerns had been reported into the local multi-agency adult protection process, and were subject to a police-lead investigation. At that inspection we looked at the care being provided, and being recorded, for those people identified by the service as being most at risk of developing pressure ulcers. We found that those systems remained in place but were not being used to best effect. Although assessments of people's needs, care plans and records were in place, the staff team were not always identifying when people needed additional support and/or medical help to alleviate their conditions. We judged this had a moderate impact on people's welfare.

During this inspection we conducted observations throughout the home whilst people were supported to get up during the morning. This was because not all people were able to tell us their views.

We observed that people received caring support from staff on duty. We observed that care was not rushed and the staff knew the people and their individual personal needs. A number of people in the main lounge area were not always supervised as staff helped other people to get up during the morning. However, those in their bedrooms were well supervised by staff. We asked the provider to review the deployment of staff throughout the home to ensure that people's care and welfare would not be compromised.

We considered that people who lacked the ability to manage their own care received caring support that was responsive to their changing mood and need. Care records were in place that provided staff with instructions on how people should be cared for and why. Staff had significantly improved the entries they made in the care records.

The way the staff managed their responsibility for dealing with people's medicines had improved. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had improved the systems in place to continually assess and monitor the quality of the service provided. People and their relatives knew how to complain. No complaints had been received by the provider. This meant that the way the service was led had improved.

When we inspected in May 2013 we found that systems and processes were in place to support good skin care. At this inspection we looked at the care being provided, and being recorded, for those people identified by the service as being most at risk of developing pressure ulcers. At this inspection we found that those systems remained in place but were not being used to best effect. Although assessments of people's needs, care plans and records were in place, the staff team were not always identifying when people needed additional support and/or medical help to alleviate their conditions.

We observed that people received caring support from staff on duty. We observed care that was unrushed and the staff knew the people and their individual nutritional needs.

We considered that people who lacked the ability to manage their own care received caring support that was responsive to their changing mood and need. Care records were in place that provided staff with instructions on how people should be cared for and why.

Staff understood the importance of keeping people safe from harm.

Overall, we considered that the provider had taken steps to improve their medication systems in partnership with specialist advice to achieve better outcomes for people. This meant the impact of harm to people from non-compliance with medication management had been reduced from moderate to minor.

The home was generally clean. Cleaning schedules were in place but needed review to ensure the housekeeping of premises was constantly maintained.

The provider had more robust systems in place to assess and monitor the quality of the service provided. A regular overview of the supervision of staff was in place. This meant that the service was more professionally led.

People's views were sought in a variety of ways to make sure that they consented to the care and treatment they received.

Detailed care plans were in place and were updated whenever necessary.

Some systems were in place to keep people safe but these did not always work and the service could not evidence any learning or changed practice from such incidents.

Systems were not in place to make sure people were safely supported with medication.

Staff were provided with training opportunities. A formal process of staff supervision was being developed.

The service had some systems in place to monitor the quality of the service but not all of these were effective in improving practice.

There were 28 people living at the home on the day of the inspection. We spoke with four people who lived at Gadlas Hall. Several people were unable to tell us their views so we observed their care. We also spoke with the manager and four members of staff.

All of the people spoken with told us that they were happy and well looked after by staff. People told us that they had enjoyed Christmas. One person told us, "We had a lovely time".

We observed people to be relaxed and comfortable with staff.

The home was adequately maintained and people were able to personalise their own rooms.

Systems had been set up to start auditing the quality of the service provided.